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MECHANICAL-INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS OWNER BUILDXR DELCARATION <br />I hGby lrom und.r nendry of pcijury rh l &n cxcnpr frcm rk ClnrddoR Lic.nre Llw to1rhe followinS reasn tss 701t.5 <br />Busimss 0nd Profcssion Cod.)r Any Ciry or Counry which cq!tui a Frn[ ro connru.L slrn iorrew. .Lmlhh or q;n dy <br />rm€turc. riot !o its nsulna, ale EiuiEs rhc onpli.anr for such lrrnrir lo fiL ! si8md sllrcmnr rhar lE or shc ir lk.nEd puRan <br />lo lhe prcvisions ofltE ConlEcloas Liccnsd tlw (Chapro 9, Contufting wirh SFlioo ?000 of Divlsion 3 of l,E ausir.rs a.d <br />Polessioas Codc) or rnlt lf, M shc n crcmpl llEEaron dd li. badr aor fi. alkScd .rcnpliotr. Atry viohtion of Sction 701 L5 by liy <br />,palic{nt lor a Frnir slhFrrs rhc applica 16 a cilil pcnslry ot nor mE rhan fivc hundEJ douus (5500). <br />-1. <br />as owrc. of rh. !'ml.ny. o. mt cmllorcs with w.Bcs rc lhc,r sl. comp.nsurion, will do ix *ort and ltE slMrw h nol <br />inl.n tcrt or o,t*d fttr slc (56.7044. Autincsi and ftnfcssions Codc: Thc Connsro* Liccnsc Law do6 noI al)Pl, ro an owrcr of <br />lhr pmpeny wlD builds or dpfl,vcs dENn. and *ho dms sch eorl hid*lf o. h.mll or lhrcugh hi or hcr own.mplot.d, <br />lr.vidcd rh8r su.h i!ryrolctunc @ ml inte.'dd m ofiLrd atr $h. ll how(i r toildnB or in!$wmnl is sld wilhh om y@ <br />ofot{ilcthtr, llE Oarcr Blil&r will haE lhc hlr{lcn of Imving rhd ts or sh. dil mt hrB or inprsrc tF pDIEly rtr tlE puqDs of <br />-1. <br />asoqncroflhc rm,rcny. rnexcllsnrlyconlrnclin8 wilh li.co*{ conlmcloB lo.onsltucl llr prcid (SN.7044, Blsincs <br />0d Ablissid Cod.: Th. C.nr6.rois Li.cn* Llw docs mr aptly ro !nowncr 6lpropcn, wto blilds or inprcrcs fic..on. <br />8id qho.!flrBdsrorsuchpmirlsqirtaConrmto(s)lk..scdpursumrolh.C.nturolsLicnsLae) <br />_l dcrc'hfl lndr Sccr <br />SOAf,EIS:COMIENSAIIO! <br />DECI.ABA.IIIIN <br />I hcreby .ftrrn hdcr ncmhy ot pcrFry onc ol rhc folloqing dcclE.rio.s: <br />-l <br />haw and will Minrain . c.ftifror of co.sc.r ro sclf lnr!rc fd sorl6 @rlrBorhn. a Fovidcd for by srcrion 1700 of tic <br />tlho Cod., fd rh. Frtolffi of lh€ erl fd *nah rhc lcnir is k$.d. <br />I hrvc !6d willFai.rain woikmJ .onpc.satnrn insuEncc, rs rcqltcd by Sccrion l7O0.frh. hbor Codc, for lhc pcrlonwc of <br />-l..nify <br />lh.l in lhc tdaorronc. of thc work lor whth thk Frnil is irsucd. I shlu ml cmploy rny peMd in lny numr <br />$ !s ro b(oft subJc.r ro rhc e*6 mmFnsdion kwr of Califomi!. atd asn lhll if I sholld tErom subjd to rlE <br />m,ta' onpcn$rio. pevisao ofs€rioo lToootrlE Libor Codc.l shlll. fonhsirtomply*ith rhoenovi!i.rs.. <br />wARNINC: Flilurc to surc wrtcrs' cor{rnslion ov.Egc ir unhw6il. ad sh8ll subj.cl an cmplo}€r h dmiMl pcdhis ud <br />civil fincr uI ro or hlnrird rhou$nd dolld (S100.000). itr lddnion ro rhc cosr of.orpcnsdion. damscs ss novidcd for tlE <br />Scclion :1076 of rhe kbor Codc, inrcrc ed lorrysfes. <br />Dale: Apdis <br />ug[Ntgll;lJNrSagra& <br />!&CI.AIAIION <br />I h.d, 'rfird undcr Fnahyolpcrjrry rhd I a6liensl undcr pmvhio. olChaprcr q (com'Eftins wilh Sdri,.70(x)) olDirision l <br />of lhc Bu\incss ann Pmlissions Codc.ond <br />'nyliccnsc <br />n in tullt{trcc trlxlcfi€r <br />caN BucuoNLENDlNc-ac$q <br />I hcrby !fit undcr Fnrny ol Frjury rhur thcE n ! conitu <br />'i,n <br />LndinB 38cnc, i{, rhc lcrfornEncr ol lhc work lbr *hi.h rhn lrmil i\ <br />issucd(SN :1097.Civ C ). <br />AIIIJIiNfDDCL -8./l.t]l)I <br />I l{Nhtrlltmund.r l{nalr, ol p{tury orc ofrlrc lnlbu iDE dc.l{flridN <br />IrrR,lili{r Prnni( A\bc{o\ Norificarnn,I:rdrrrl ltrstrhrlon\ l lirle.l0. Pln6) <br />Rcquncd krrcrol Mnilhnron <br />-l <br />ccdify rh.r rlE f.ndll Egulllions rc$ding asbcsrol Emvll orc rut slpli.abk to lnis pmjccr <br />I cdiry rhnl I hnvc r.!d rhh +pli.arn,n anl {ut rhdr rh. abvc inl(rulion is.omr.I !tr.!tr.onplysnhr0CnrlndCounty <br />ordinan.cs trid Sr0rc Llws ruluiing b huildi.g c.n{tucriofl. und lErcby lurhrize rcFc{nrarivcs 6lrhir Ciry{nd Cor l to cnt.r upon lh <br />rh,vc tuflnnrd pmpcny in ii\!r.r <br />Appliances <br />Ivletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />\rlisc. Equipment <br />Duct Work <br />lnsulation <br />Smoke Detectors lnstalled <br />Rou gh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Rough Mech.I 7fr10//1fr) <br />Final Test <br />Meter Release <br />FINAL 7/L/t$,\ ax <br />Notes, Remarks, Etc. <br />DATE <br />Pre-lnsulation <br />Above T-Bar <br />.nl*nA <br />^, alzolaty <br />I <br />----r------ <br />I <br />----l--- <br />= <br />I <br />I