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MECHANICAL.INSPECTOF HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.rchy rftu$ undcr p.nolly of Frjury rhd I m ci.'rfl film rhc Co lacroN Lirr* tjw for lh. folo*ing Et$n (Scc.tJll.5
<br />Busincss !,n Pofcssion Code): Any Cny or Cou,tty shach rcqdcs ! Fnil lo oNlrucl. alts. itr{,rovc. &mli.h or E?ot my.
<br />srEturc. rir ro irs isruffi. abo re{uics ltE lppltd for 3ucn Fmil lo file a siSn d slarcE lhrt lE or rh. ir lkcr*d ,rlsul
<br />lo rhe F.vbioN of tlE Coitmiols Lkcn*d Liw (Chqn* 9. Conmming wih Scction ?qJo of Divisiof, 3 of lh. Burincss and
<br />Polcsions Codc) or th,l lE or sh€ is stunpr rlErcfrom Md rhc becb for ttE llhg.n crcqrlior. Ary violadon of S$ion ?01l 5 by loy
<br />apDlicanr aor r lcmn ru6jers ihc appli.rnl lo a civil
<br />'cnshy
<br />of not mE Inm rivc hundrcd doll@ (S500).
<br />-1.
<br />N owncr of rhc popcrry, or my cmtloyccs wirh wagca a rheir slc compensalion, will do dE wok {d lhc srere i! 6l
<br />inrcndcd or o,Icrcd lor slc (Se.7044. BNtEar d Pmf.$bns Codq Tn C! rrdn s Lkcnic kw do* .or aPply lo an owner of
<br />ri. pmFny wtb biks or ir+mr rhs&l! ad who d.cs seh ffi& himcf or n s.laor lhrcu8h his or hr ow. cmn,.ycci.
<br />pmvidcd thor ru.h improjmnrsctur i.r.!'ded orotr tld for eh,It tbwm. dE hlildin8 or infmEtr i{ $Llsidinom Fe
<br />of@rftjrion. rlE O*F BuiB.. will h.k tE bud.n of Imving thar hc or slE dA hl b{ild o, ing,oE dE !6Fny lor tlE I,urFF of
<br />-1.
<br />ar .wnq ol rhc lr6Fny, m erctusiy.ly.onrEclin8 wiih liccnrn conlturoN r. co.hd rlE poitrct (Scc. ?044. Busim$
<br />srn Eoa*sirn Codc: Thc Contrelor's Liccn$ L!* des mr apply lo & ovrcr of prop.ny who bu ilds or iq,mlcs lneen.
<br />lnd who coddcrs tor slch |,birlr wirh . Conhdo(3) lkcnscd pu6uml Io thc Conrebr's Lien{ b*).
<br />-l
<br />am crcmpl undr S*tion- B. & P.c. for this een
<br />uaBtrE&LcollllNsarloN
<br />DICI.ABAIION
<br />I hcreby amrm undcr pcnalry of pc.jury onc orrhc trbwirc ducl{,iioos:
<br />-l
<br />tavc ud will minrain ! C.niararc of Consnr io scl osxrc for $o*Lii .onuEnel ion- as 0oviid i'or by S.crion.lTur ofrhc
<br />bbor Code. lor rhc pcrlbrmne oflh. Bork ai, which rhc P.mn ir nrucd.
<br />-l havc and sill nlinlain wo*.^ .ofrpensarion i.suEn.c. as rcqutcd by Ssln'n 3?00 of lhc Llb6, C.dc. lo'
<br />'h. Pcrionmncc o{
<br />rhc *orl in*hich rhisFrn'ir is igru.d ion.D\umn.c cunc, nnd rnliry numbcr dc
<br />€-r.-l
<br />o>IE )
<br />I ccnify riar in ihc p.rformcc oIlh. wor* for shi.h this nermir is issued. I sh3ll nor cn0hy tny persn in M, ftonrcr
<br />$ as h tEcom obj.d n, lhc {or*ds omp.nsrion lows or C.lifortria. ord lsN firr if I ihould b.rom sub]yi ro rlE
<br />workd( ..nD.trqtion lovnions of Scclion 3700 or lhe Lllnr Code. I shnll. tonhwirh .omply *nh rhos Prcvisions
<br />WARNINC hilurc lo surc
<br />ciil 6ncs up lo otrc hlndr€d
<br />*orkcd otrip.ns3|ion oBagc is uobwtul. &d shal! subrcl 3n mplottr lo diniBl FBxbs and
<br />rhou\rnd dollr^ ( S lrr).lll X) I in addirion h rhc d,( of codncnerion, drtuEcs $ previdcd for rh.
<br />i'l.rci rid r(onry s lc.s
<br />O9 t
<br />UCEXTILCANIXAIIOS
<br />Dlict aSAuQN
<br />I hcr.h, umrnrudcr p.lalry dfF-rjury rh.r I am licnsl und.r Povisio.oiChillcr') (co,ntunciig *irh Sdri)n 70fi1) ofDivi\ion 3
<br />of thc Bolinc$rnd Prolcsions Codc. a,xl nry ltcn\. is inlullLr.d drl cffcd.
<br />0
<br />cl)NsrtlJcuaNtllDlxc-d{irNtr
<br />I hcE$y rfinn ufricr Fnalty o f pciju,y rhlr rhc,c i\ x co.{d.ri.n hMing dBctrcy for lh. Frtonunce of thc rork fn ehi.h rhir |Imtn L1
<br />nsucd (Scc.:ltlrT. aiv C.).
<br />A"PTI.ICANIIIECI.AAAION
<br />l,Ercby B,[m undcr llcnllr, ofF.ju,, ont ofrhc rolhwing d(lrarions:
<br />Dcmolirio. PcinrirsAshc{os Norifior ion ,'cdcnl ltc3uhlions (Titlc 14, Pln6)
<br />-Rcquncd
<br />hllcr ol' Ndifi ctrri,n
<br />-l
<br />c.n ity rhd rhe f.dcnl esrrl,lioos Egiding {sh.sos rcrmval orc nol 0t'/i.!hl. lo lhis pmJccl.
<br />-l
<br />enif, th.r I n w rcad rhis spplicarion &d srarc rhlr rhc dtsw infomrion h .orr..l. , alre lo snply vilh !U Cily and Counly
<br />ordinrrf,c\a d srdr tjwsEhrin8 roburldinS n. ud hcrcby nuthoriu c rcprc*.r'lirca oi rhn Cny .nd Counry to cntcr ll)on ltr
<br />abnr. mnriomd pDFrt, ror iNF.rion
<br />Amlic! or AScnt S iB nallrcl mln(n
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Tvpe I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar lt4tt l 71,qD"/s 7
<br />Bouqh Mech.
<br />Meter Release
<br />FINAL I 4/n-.,1A &/?r?O'/ o-t
<br />Notes, Remarks, Etc.
<br />Final Test
<br />u"", 01
<br />I
<br />I
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