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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI.CARATION <br />I hecby allrE ud6 p@ally of psjury thd I m a.opl nDo lhc Conltt.lom' Lic.ns. t w for fi. lollowiig llen (Sc.?0ll.t <br />Bcines Dd Prof*ion Co&): Any Cily or Coudy which !.qun6 o pnd lo oillro.! alo. ioprovc doolitn or EPait dy <br />3rru.ru.. Fior ro ils issleq .I!o requiB llE applicel for $ch p6nil lo fih a siln.d stardot tar lx or !n. ir lica*d P!e.!r <br />ro rh. Foririo6 ot tlE ConE dols Lien*d Lsw (Ch.pG 9. Coom.nd.S pnh S.dion 7000 ol Divisio. I of llE BEin6 &d <br />PofrsioB Codc) or thar h. or ii. i! q@pl tlraEtDm 4d tlE b.sis for lh. allcgcd q@Fio.. Any violltioo ofs6lion 701 I 5 by 6y <br />applior for a Fmir urbjels rhc spplicd ro a civil pcn ly olnor norc Ud 6r. huftlr.d douds ($500), <br />-1. <br />s oMa ofrh. prcpdln o. ny @plorG wi6 wag6 s lh.ir sl€ conpc@tion. wiU do dEwrk d rhc $ruci@ h mt <br />iirod.d o. off(.d f6 3aL (se.7044, BNiIB dd Prof*ioB Codq TIE coilrBdois Lictuc LM do6.or 4Plv lo e o{c ot <br />lhcpop€ny who buil& or inp.ov6 $dan, sd who doc such turt hins.lao. h.Ml lor llmusn hB or hr oM .mploF€. <br />provid.d rhar such inpmruE se@r i ad.d or olIs.d ao. sL. U, horrcE. |h. hlildi.e or itnplwnE l is $6 eithi! on ra <br />oI@Rpldiob. lh. Os!6 Buii&r win h!re thc buln olptoviie lhtl h. or dE drd lol hild or ittptoE rhc FoP6t, ht ln. p'trpoF of <br />-L <br />c own6 of$. pmp6ly. m dclusiv.ly coolt&ring wio lic.n5.d conlnclos lo coa$ruct 0E pmjd (S(. ?044. Bci.e <br />atd EofisionCod.: Tll. Contacrols Lictr. kw dG nol alplrlo oma ofproPcdywho buildsot ieprov6 thn@r <br />&d wno conrBcts fo' su.h pibjdls with a co r.cto(, licas4n ps$t to rh. conr.dors Lc.@ Las). <br />I ffi d.6pr und.r Sdriori _, B. & P,C. lor ltis ra$n. <br />!48&!88C4!,lElSArq!DEgdAATq! <br />I h6.by .IIm uidn pd.lly ofpsjury on. ofth. followitrS ddLralioc: <br />-l <br />barc ed will Mi aln . C.niftal. of Congl !o Sclf-l4ur. ior Mt6 @mr.nFlio4 s Fovid.d tor by Sdtion 1700 of th. <br />l,bor tu , ror th. Ft rtucc of lhc slt fo( *hich th. Foil b b.u.d <br />-l <br />hav. a.d will mai.hi. wo*.c comp.nsarioD iNumcc, 6 rcquilcd by Sftlion l70O of th. Lsbor Cod.. fo. tie pafotlMc. oa <br />rh. $oir hr which this Fnil ir irscd. My wort6 codFaarion iBumc. cdi6 ad lolicy numbd e: <br />PoticyNubar Erptls <br />-l <br />cdiay fi.t in lfi. pdtomdc€ of llt wo* fot which lhis pmir is isslcd,I shall lol dploy any p.uo, in any mdnn <br />s 6 ro b€cone subjd lo rh. m*d' omposalion t.s of Califomiq dd +E lhd if I sholld b..on subjdl ro ln <br />wort6 .o(pdurion piolisioB orscrlion l?00 ofrhc l,sbor Codc. Lull, fonntrilh co,4ly wilh thos pmvisios.. <br />WARNING: Failu. lo Ge wort6' omFE Iion ovdsc i3 ulswtul, ed shdl subjel & dploF lo onind FEni6 ed <br />.i!il 616 {p to o& hur&.d thouard doll6 (5100.000). in.ddilio. ro rt cosl of comp.@tio[ d@!€ a Ptovid.d tor lh€ <br />sefio, 10?6 offi. tahor Codc inr6d dd anonay ! fd. <br />Abblicmi: <br />ll(ullrllcaNl&1(]oB <br />IICIAATUAT <br />I h.y.b) afilm trnds pcnaliyolpqiuD- lhsl I d li&nsrd unde,,.\ ision oiChaflEI (co'nhocin! {nh Sdion 7000)orl)ntion l <br />oa rI[ Busi,6md ProtNionsCodc. ard toy lic€.sc is in rulllor.. md.llc.l. <br />CONIAIJCIION.LIIIIN iEN(I <br />I ncr.by amm undcr p6alr, ofpcdury rhd rh6. isa consruclioa lmdins asdcy loi rh.lEaommcc ofrh€ \ark tu wh'ch rhls pnnn is <br />isstr.d (S(. 097. (iv (.). <br />ATIU(AILDICLAAAITA! <br />I h.r+ry aJIm unds pcnalry of Frjury onr of lh. tollo$ in8 d€le.lionsl <br />Demollion Pcnn ils- A sb€sros Nor ilicst io n Fed€ral R.rul.rio.s(lnt40. Pan6) <br />-Requt <br />d Lerro otNolificarN. <br />-l <br />cdiry $d rtc Ld.ral EsulllioG r.sdding ebGtos ,ffiwl e. mr spplhdbl. lo rhis poj.d. <br />-l <br />cdiry rhd I te. r@d this ,p?li.{io. ud $tt. thal rtE atov. infomdion i! .ond. I agrc lo omply wtn aI Cily aod Courly <br />ordbrc and Sr.tc Las clrltrrg ro bqilding .oGhcrior\ .rd hdcby @rlbri& ..F.ordiB ofttis Cny dd codly lo di6 lpon ti. <br />ator ndiorcd prcp.ny lor ilspGlion pEFs. <br />Applicul or Asol Sisnllur. <br />PmirdlW. (prinrr -_ <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough 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 />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL 5-6"r Ylt <br />Notes, Remarks, Etc. <br />Furnace <br />t/.tu