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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OvNER AUILDER DELCARATTON <br />I hd.by allhn undd pquhy of psjury lhlr I o .rcnpl fiDm lh. ConlEcloB' Lic.nE Ls{ aor th. fouoving r@D (Sd.?oll.J <br />ausin6r dd PolBion Cod.): Ant Ciry or Counry qhich EqunB 6 Fn ro corslru.r. alr6. improve. dsnolbh or *r.t ey <br />sEucru.. Fio' to irs is@c., abo 'cquic rh. @rlic&l for !u.h Fmi ro fiL a sisicd.ramr rhd hc or slE 6 licoEn puMr <br />to thc povisioc otlhc Conlracba! Lic.ns.d Llw (Chaprd 9. Colm.ncing wirh Selior ?000 oaDivirion I of thr BBinN ud <br />Prct*ios Cod.) orth.l h. m sn i! ddtrp ineton.trd rh. hala tor dE rll.g.d q@ptioo. Any violalioD ofsdtion 7011.5 b, a.y <br />applic&t hr a pdnl lubj*l3 $c applicdl lo a .ivil pcmhy o t rci mor€ rhan fiv. hundrcd dollds ($500). <br />-1. <br />a o\@ oflhc pmp6ly, or nry mployc€ wnh wa8c a lh.ir FL cor.p.Nario( will do ttE sok ard tlE 3ln[1w is @tidatu or offecd lor slc (Sc.?044. B6be &d Profsiom Cods Th. Co Bcroas Licoe t w do6 el apply lo d 0\66 of <br />lh€ proFq wto hiilds or imrm!6 rh@n. md who do6 s(h wo* himclf or hcelf or rlftusfi hii or hd osn .oploy.d. <br />provid.d lt l such imF!!6mln5 m d hlod.d or ofr6.d tu sL I[ howa, rn hiklnB or in'F$qml ir eld pithin on. ,r <br />of@oplaioi. $. 0l^16 Bujldn *ill haE t. hlda ofprovi'r8 tfid h. or sh. did nor t{ilt o. i,npovc 6. Fnpoty for $c purFE ol <br />-1. <br />B oMd of rh. Fop6tr, m .xclusi!.ly coMdins *tt licG.d contrcloG <br />'o <br />@ntnd rh. !rcjd (Se. 7044, B6ins <br />ed Pls6sb, Cod. 'I'h. Conlracrol3 Lic.nle llw do6 nor apply to e owocr of propory who buil<ls or inprcvcs rhd{.. <br />dd sho ftdrEk for such Foj..rs wirh a Codrdo(, lics.d poBMr ro th. Conl.rcrd r LicN Llw} <br />-l <br />crcmpl unds Ssrion . a. & P C aorrhis rcaon <br />.waar!8r.coM[Extau0! <br />Dgct4Sarlg! <br />I hftby sftm undq paaltyofpgjuryoncoftn followinB .t .lmlioGl <br />I h,v. ed will nli.rain a Cdificalc ofconst lo S.lf-losurc for $oddd onrpm.rion, 6 provid.d lor by Scrion .1700 of rh. <br />Llbor Cod.. for fic p6[omec. o I $c \w* tor $ hich lhc lanir is isu.d. <br />)/*. * *,, *,* *on6 conp.6nio! icueq s rcqut d by S<rio. l7o0 of lhc trbor C.dq b, lhe <br />thc sort for $Iichrhis.mi n ieer.ti Mv <br />frq etFle-"!.ksr conl{nsrn'n insuEn.c c&nc md Flicy nunb,jr d.: <br />?Lufrtvo6ozrry <br />_l cdli&0'ar ii fi€ rsfol]@c. of thc vo* for qhich thh p6nit is issu.d,I sh.ll nol mp any p.Bon in lny mann6s 4 ro b..om. sbjel ro fi. &d6'.onp@!rtio! las of califonir. &d aec rhll ill .hould b..on subjdr lo tlEsi(6' conp.nslion proeisiom orsc.1io. 3?00 oflh. rrbor Code. I 3ndl fonnwiln onply tr ilh rhor pmvilioN.. <br />WARNINC: Failur€ lo *cur. sork€6' compcnsation cowsc is unlawlul. md shall subjd e oploF lo sinitu! psuhiB and <br />.i(l 6n6 up lo ore huodr.n lhoMd dolls (t100.000). in lddilion lo lhc osl olcompcMrion. da&s.s 6 prorid.d lor lhc <br />Cod€. inr€rd md anomy 3 as <br />Lrcf,Nsm co rxaclroR <br />Dpct 6Salrau <br />I bs.5y a,r@ utrdE p.laly of pqjury ll'n I u tos.d ud6 Fovisio. of Ch3pt6 9 (oDll@cios sith Sclio! ?000) or Divbion J <br />of th. BBi!B ed PFfe3ioB Cod.. dld oy lic@ i! h tul tore &n.lTc! <br />c 2a c='rF.__ <br />co!iB-lt!:ll0t-u Dtlcllilil(r <br />I hcr.h), aillrm undcr Fnal(yolpcrruD'rhar rhsc t a.onslruclior lendLng qcncy lor rhc IEfom,Mcc oflhc\o't ftx \hi.h rhis lqnil is <br />nsucd(SN 11097. Civ C ) <br />A9PI.ICANT NECI AR]AI'IOII <br />I @y ar:m @dd p.naty of pnju.y onc ol $. following d,*la&ions: <br />Dcnolhioo PmnrAstcrG Norificaron F.dhl R.gulrtioN (Till. 40. Pdr6) <br />-Rcqlncd <br />kil6 of Nolifclrio, <br />-l <br />cdiry tn tbc a.dE l E8rhlioB Erading abdos roo{d e nor appli..bL lo tht ,rojd. <br />-l <br />.Eliry rhlr I havc rad fiir applicalion dd srdrc rh.l thc aborc irtomolion is cotrdr. I asre ro conply wnh all Cny and Cou.ty <br />ordina.c6 and Srarc Laws Elatins lo hildins connddio4 fld hocby arhori2..eF* div6oalnisCitymdCo <br />ahorc ndrion d propdry for iapdion <br />Applicet or Asol Sisnature: <br />Appliances <br />Metal Fire Place <br />Eva porative Cooler <br />Furnace <br />Compressor <br />It4isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rou gh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Iype 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 />Above T-Bar <br />Bqugh Mech. <br />Final Test <br />Meter Release /n\ <br />FINAL -24*1 vytLlt)l <br />Notes, Remarks, Etc.\/ <br />Drtc:_ <br />'<_