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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I b@by .rm udd panlry of Fj$y thd I d .r6pt Eor llt Co.rf,cloB' Lic.is. L5w for lhc follosing @r {Sd.roll.s <br />Buin$ sld P.obrio. Cod.): Any Cny or Couily ,tich r.qliB s F,nn lo conntuct. tllc inProrc. darolbh or E ar dv <br />sttuc{u., Fror ro ils isud.€. sle rcqui 6 th. applicul for such Fnnn b filc . siSncd $armd lhd hc ot shc i! licc.s.d psudl <br />lo fi. p.ovi.ios of dE Conti&t6! Li@i$d Lr* (ch!9ld 9, Co@4in8 Mlh sction ?000 of Divtion 3 of lh. Brsin* 6d <br />PofdoB Cod.) or dDt lE or sh. b ddpl lho.&on ald lh. h.si! for lhc dkecd d@diof,. Any viol,lion olsEtion 7011., bv uv <br />applicmt for a pmh subjets rhc appli@l lo s cilil p€Mlty of nol hoa lhu liv. huf,dred dollm {1t00) <br />-1, <br />s l)$M ollhc FlFny, or my cnplo,6 wi$ w!86 6 tlE el. conFsaliol! will do lh. *o,t !d rh. *rd@ b rct <br />ina&d o. olIdqd fo. elc (sE 7014. Bcins od Proi6sioB Cod.: Th. contoctols Li.@ L{w dod nol appl, lo e oms of <br />ln.Dllpdry who boildsor irtp.ov6ln6o( 0d who do€$chs hi"E.llor h#lfor lhough hb or ho oM.d9lott6 <br />provid.d rhrt s!.t imgtrr€Gll3 6 ml Lnod.d dorad aor sh. l[ hoB6, dE hildtits or imFDrqftll it dd wnhin oE ]@ <br />ofconpldio4 $. Otr!6 Boiltc will isE th. tritdd of prctog $tl lE o. slE did nol bui6 or imprew ln. FtPdtv for thc ptrFe of <br />-1. <br />6 os!6 oalh. prop6ly. e dcluiv.ly co r&ting wilh lic..&d colrEcloBlo coGdcl th. Foj.d {Sc 7et4 &BhB <br />ud PrDfissbn Cod.: Th. Conlractof s Lic$c Law do6 nor apply lo o*f,r ofproFny who buildsor inptuv6 lhdofl. <br />and who entEcrs ror 3u.h sojcG win s co Bcto(,licsB.d p6u! rorh. cont6ctoa! Lic@ tis) <br />I dn.xempt undr Scclioo-. tl. &P.C aorlnisi.6on <br />Dot€ orn.r <br />!48K!8$IOMTEN!AIION <br />DEC| ASAUA! <br />t tftby alfm und6 p.ri]ly ofFjury orc offt. lolloviis d..llr.tiocl <br />-l <br />h.E dd wiu ui ai. 6 Cdific.ic of CoNdl to S.tf-Ireurc fot wkss o p..!aioq s poqd.d fo. bv Sdlio. l70O otoE <br />Labor Cod., for thc Ffotu.. of thc @rt for whi.h $c pgftil b isru.d. <br />I h!v. and will mainrai! woik63 mmp.@liof, idud.c. s rcquir.d by Sdion 3?00 olfi. kbo. Co.L, for th. Faom@. of <br />thc Bork for which fiis pqnil is isr.d. My worlGt @nFEalion icl@cc csid ed poli.y nlnb.r d.: <br />Poli.y Numb.r-ExPiB: <br />-l <br />cdriry lh in rlE pdaormc. ollh€ vork ror whkh rhis p.a.il is issu.d. I sh8ll nol @plo, ov Pd&n in &v n@d <br />$ s 10 b..o,nc subjdr ro ric @116' cohp.realion laws ot Cslifomia. ard asG thal if I slBuld b€.on $bjel lollE <br />solt6 codp.Mrion pbvi,iom of S.clior ]TOO ollh. t bor Codc l sltrll. lonhrYilh conply wilh lhos Provirio6 <br />WARNltlCr raifur€ to su. w.l.u' comp.salion <br />.ivil fn6 up lo onc hundrcd lho@d dollm ($100 <br />S..rion 10?6 ofth. tibor Codc. iild6l &d !(rmy r <br />i! u.lawf!|, ed shall subjd m 6ploF to ainiel po'dtt ed <br />addnion to rn. cosl ol cortrp.Nlion. ddna8e s provid.d lor thc <br />I hody amm u.d6 paalry oapdjury ttul I @ lien*d ion ofChaplq 9 (commmcin! wilh S..1irn 7000)ofDivision l <br />of lh. Buins dd PDt*ioB Cod.. sd fty lic.e G in tull torc d .lId <br />\ DL\r6 ( <br />Ihcrcbyanlnnundnp.nahyofpedtrryrharihd.isa.oBrtudionlmdinsasm.ynrrhepgfonnanccofrhe*oi(lnrwhichllispmnitt <br />isslenlS( 3097, Civ C ) <br />I..nify lhai I haL c r€ad lh6 appl icsrion and star€ rlml rhc aborc iolonraion is.oftdl. lasr€lo conplywiri.ll Cnyand Cou.ty <br />o'dinan.6 md Sr,r. h$s r.lot (.F6cdrliv6 oflhis Cny dd Counly lo nls upon {a <br />a!ov. nodon.d p@p<ly for <br />Appltur or As6t Signar@: <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 tl'/? -/g'€n loz BY J,Url"ar?) <br />Residential Ranqe <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 lr <br />FINAL zHb ti1 5) <br />Notes, Remarks, Etc.(tt )t <br />Furnace <br />D.L:_ <br />LendersAd&s:-a". rt:aNT prar RArroN - _ <br />I hddy afm undr Fnalty ofp€.jury ooe oa rhe aollowing d.cldal ions: <br />D.orolirion Pmirs-Asb6kx Notificarior [.dml Rcsulslions (Tillc 40, Pd6) <br />-Reqrn <br />d Lclld oa Notification <br />-l <br />cdiry lhar rh. acddal eeulatioN rcsedi.g sb6los roold d. nol @plicable lo rhi. pmjdr <br />_______r= <br />I <br />I <br />=