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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I tcrcby .mrm lndcr pcnrlty of frjury rhar I m cictrl,l fmn rh. Conticro6' Licnr L,w for l1lc folloeirE Easn (S.c,7011.5 <br />Btrsioess ad Prolc$hn Cdc): Any Cfty or Cou.ry wihn rcqdB a Fmir ro mNlrucr. .lls. inprclc. d.mlirh or Epdir aoy <br />slrucrw. prior ro ns ilsumcc, .lso Equircs rhc lpplt0nr for such pcrmit ro filc a signc{ (rlcft.l rhar h. or she is lic.nscd pu6urnl <br />ro rhc FD"irions of rlE Conr@roas Li.c.sd t w (Chaprcr 9. ConmEioS wnn Sccrion 7000 of Division I of rhc DGires od <br />Pmfc$ions Codc) or lhar he or sh. is cr.mpr lh.r.nonmd rh. b.rn for rh. llhBcd.rchflion. Any vhldion olSelbn ?oll.5 by any <br />aprlicoir for 0 pcmir subjsts rhc rypli.! to ! civil lcmlry of nor mrc rhM live hu.drcd dollds ($500). <br />L s ownr of rhe prcp.ny. or my .mplorrcs wilh w!B€3 &s rhcir $lc onrpc,sarion. will do rlr wo* .!d rlE nrutE i ml <br />inrcnded or otrcred for sle (Sa.?Ol4. Aosircss and Pmfcssions Codc: Thc Conmdois Lkm* l rw des ml rpply lo m owr o, <br />rhc poiEn, who blilti or ir{,mws dx@n. r,rl *tr der ssh M* hinccll r lErelf or lhmuSh his or hcr oen ctrOloyccl. <br />[ovidcd lhot such imlovwnls e nor inl.nd.d or oltcrcd for sBh. l( ho*w, ltrc blildins or nr{'mEftnr i. std whhin om Fd <br />oao,r{,h'ion, lh. O*'mr Buius qill hlE dE bu,$n ollrcvinS ihd lE or slE dll mt briE or invrerc tlE lxotsly 6r rlr pnps or <br />-1. <br />ss ow.cr of rh. pmpcnr- um cxclusivcly conkrd irs wirt liansc{ conrractoa ro .onntucr rl* Eojcc! (Scc. 7044. Au$ness <br />did Pofi.sibn C6d.: Thc Contaclor's Li.cnsc Law docs nol applyro moqns of nrorc.ty who builds or impnlcs O(6n, <br />lnd {ho contn€ls for Mh rroirrs qnh ! Codd.to(s) licc.sd tusunr ro rhc Con{6.roa3 Lrc.n* l!e). <br />-l <br />@ crcrpr und.r S&lion- B. & P.c. for Ihis @on <br />uoxrE8s:roMfjtsarllt! <br />DECI/BAIION <br />I herchy al6rn utrdE pe lly of p.rury om oa lhc follo*inB d(lml ions: <br />-l <br />halc m, will'Mitrrdio r Ccnifrarc.aCors.or lo Scltlnsue r sorl.rr'c.nDrnrdion.artmvid.d|or6ySelionl7n0orrhc <br />Lntff Codc, tu rh. t sfonuncc of lhc work |or $hich lhc ,crmir is ksucd <br />_l hrlc 0nd e ill noinr0in workcs .o.rr.ns!lio. imraNq ,r r.qun d by Sel ion lr0o of lhc L5tsr Codc. for lhc perlomec or <br />rhi\ pcrnir is i*udl ntyso .n cofipt nrarn,n in\uaftc cdfticr 8nd <br />7(/fl0 <br />_l ccnitr rhdr in rhc pcraormn.. orrlE No.k lor which rhir rfimil is ksuln. I shall nol cmploy any Fsoo i. ao, ftrnfi <br />s .r ro tB{nE subrc.r ro rhc wortcn' comlcnsarion laws of Coliforniu. and lse rh ifl lhould b.coB subj.{ lo lhe <br />workdl mmpcnsol ion ,,mynions of Scdion 1700 of lnc L,tnr Code I sltnll. rodhwnh conll)ly wnh $os prcvisions <br />w nNlNC: tailurc h {curc sork.^ .otrrpci$rnrn .orcrrlc is u shdl suhicr an em0nDc. b dninal lctulris dnd <br />civil finc\ rI i. orc hlndrdJ rhou\r l dolllrs lSllD.IXX)), nr cosr of cotrr,Etrs ion. &tu8es ar !rcrklcd lo, !h. <br />Sccltun.ll,76 oflhc ltrb! Codc, imcrcs nfrl arlornct\ iccs <br />IIECLASA:IION <br />I hcEl,y rtiirm ! lcr p.mh,olpcrjurylhlr I !m liensn undcr Fornion ol Chnfl& 9 (.omm*ing silhSc.ri.n7Om)ofDivisionl <br />oi rhc ausildss rnd Porc$idrsCodc. url nryliccnsc is h iullius trRI clisr. <br />$ 7 C2o, lJ6 <br />1,//t / /f7 '/7 <br />CaINIAllcIlalt"LlNl]INgrlCDNCI <br />I hcrchy uttd undcr pjinlryorpcrury rhd hcic is r cotreru.tiotr Lnding.Bcrcr ln lhc pcrform!rcc oarh. wotk ftr whi.h rln\ Fimn is <br />hsucd lscc. ll(x)'7. (:iv (.). <br />-l <br />ocnify rhir I hrvc rcod this lorlic.rion ad slarc rh{trturioi h..trc.I.I agr( rocornply{irh lllCiryund Counry <br />authoia rcrE$.krivcs ol rhi\ Ciry and Counly lo lnrs urbn ro.dinrnc.i rnd Sr.lc ti*s 6hlin8 ro buildinS on <br />ftow @nriomd pmpcny f <br />Appli.a or A8cfl Si8tuue:'""' d/4/s <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test <br />rl <br />FINAL atLs\\v,,< 4(, <br />Notes, Remarks, Etc. <br />Meter Release <br />port yuunl,,,@.ow": <br />7al4/ L/ <br />Idrhf 3 Ad.!.s'- <br />8-E[LI(:ANLDI(I BIUlaN <br />I h.r!$, rllinn u ndcr pcnxlry olI.rjury onc.irhc n,lk,wiit &chrrrnnN <br />Dcri'liri(nr Pcnnirs \hcdo\ Norinclrion l..dcnlR.EulIio\ (1irl. ao. r'a.r6r <br />_koquncd l.rrrrol Norill.nriri <br />-l <br />enify rhat rhc lcdcdt rcghrionr EgaxtinS .sbaros cmvd @ nor rrplicoblc lo lnis pmhcl, <br />lz <br />tt <br />II <br />tt <br />I