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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUILDER DELO{RATION
<br />I hcrcb, a,I]rn udc. p.Ety of pcrjury lhd I d cr.qtl rmn d. Co Bd6 lsM L3w for llE folbwing tab" (Sd 70ll.5
<br />Bucin.s ad Profession Codc): Ary Cny 6 Cou,uy whhh Equi4s . Ffltril lo oisel ih6. imlrcE &mlish or EFt my
<br />srnde, prior ro ni irw.. sl$ EquiB ti. spplhsl for such pcrnil lo fih a si8..n rdcml lhd lt or slE is lie.sed p!]s@r
<br />ro lne p'.visioN of dE Cortmlols Liencd lrw (Chlprcr 9. Conmrcile wilh Scclio. 70m of Dilhion I ol ltr Ausircst ud
<br />Prcfcsions Codc) or lnar lE or slE Lr €xcn{'t $.rEfrom .,i lh. ba3is for thc lllcg€n crcrPlkr., Ary vblarion ol S..lbn 7031.5 by .ny
<br />{mlk!fl nr " lEmi subjcls llE ryplic! lo ! .ivil p.tuhy of ml mE b. five hudt d dollrs ($5m).
<br />-1.
<br />as oencr of rlE Imltny, 6r my cmployccs wilh wae.s os fi.t slc oqEnel ion, will do ltE ffik &n E srtrrw h nol
<br />inrcndcn or olTeEd lor eh (Se.?()4]l, Burimsr ! Pmlcssions Codc: Tnc Cnnnrdors LtcnE tiw dms nol apdy ro u 6*ner of
<br />th. tmtEny qho hoilds or irvml$ rlE@n. ,rd sho tkEs skh hir himscli or hcrslt o. thmush hi. or hcr own.mplott.s.
<br />flovidcd rhlr such impmmEnls m ml inlc lcd d ofrcrcd ior sL. lt hoftB, ilE building or itrg,mE tnl is su wnhi. om Fo
<br />ol.odDLridn. rhe O*n r Build6 will hsrc lh. bufllcn of nmvins rhd h. or sh. dit mr bdld ot in{,mw lhc Imp.ny tor llE PnTsr or
<br />L as ownf.r rhc pmpcny, oin crclusilct, confocr ing tnh liens.d conta.bm to con{ruct Inc lDjctl (Sa ,1x4. aulinc$
<br />ufti Prlts\in C6dc: Th. conr.dors Liccns. L!* docs trol lplly ro an olnr.rprop.at who buildsor imtmlcr rh.rcon.
<br />and who conrracG for su.h poj6r\ wirh 3 Co.rrcron, liNn$d pursuad lo the Conllmld\ Liccn* uw)
<br />-l
<br />m cxcmpl undcr Sdio.- B. & P.C. for tnG rca$n.
<br />Drl.' ()m.r
<br />la8f,rr5:couflNlalaN
<br />DECI.Af,AIION
<br />I hcrcby.fiinunds lenalry of ricrjury otu ofrh. nrbqntg dl.laru'ions
<br />-l
<br />hulc and sill roinrain a Ccnifi. cofconscnrk'sclf-lnsurcnnwo,kc6.onlP..{n,n.,r F)vid.{ frtr by Sccrnr!.1700oarhc
<br />ljl{r ('dc. hr rhcNa'orrun.c I rh. $oA l,i \l'tr'h rlr F 'n hr$ucd
<br />I
<br />tt l^. ,", ,,1, ,,,'no. o.*c^' comncnqrnn insunurc. !s rcquircd by sc.r ion l7u) or rhc hbor code. lor rh. p.ffortukr or
<br />rhc *ork ftrwhi.hlhis pcnnit is hsEd Myworkcn $nrrnerion in\rrrN cafticr dld Bnic, nun$crac:
<br />tNS"C-o" oQ*he cue5t
<br />d?L qo.l63gL{OO z-t?- zaLa
<br />-l
<br />enifr rl in rhc ltrfomB of 0f, wort for whichlhk pcmil is hsd,I rhall nor cnPloy lny p.rsn inlnytuoN.
<br />$ &! & tE6m shjccr ro thc wortcN orycBaribn UBi otc,lifomia. lnd lgrcc th0t if I snouu b.<.m subjer b llr
<br />wrksl onpcnsalior prcvisions ol S.dion lTOo ot rhc Llbor Gnc. I shdl. f.nhwhh.onply wiln Oo€ pmvi.iof,s..
<br />WARNING: Failotc ro ccm wortm mmpcnsliotr cov.n8c is lnla*ful. ,nd rhrll subJcd sn cqtl'Jlr lo onin.l FMllics and
<br />.ivil linc. oD ro om hundEn rhousdnd dollds (SlO.uJo). in addilion ro rhc c.{ ofconFnsrrion. dln3cs ri provid.d fot lh.
<br />Ssr ion ]076 of rlE Libor Cdh. imcEe and atomy\ fccsl-8-zozo ,tri ILO
<br />LICI'NSXILCANIAACfOf,
<br />DEILIXTD!]N
<br />I hcrcbyrr'lirnu cr lrnolly olNrjurr rhd l,m li..trk{ uMm provhion oiChup!$ 9 (c.nntu..in! silh Sc.lnn ?m0) oiDili\nh l
<br />of rhc Bosircs Md Pmt$iorrCodc. oi 'nyli..n{ i\ i', tull r,trcu,kl cnc.l
<br />/ oL1 672
<br />ozA A
<br />CONSTNUCTIOII I FNDIN(: AGENCY
<br />I h.rety aIftrm $d.r Fnally of p.4ury lhal lhcrc h a oi\rrudion bndi.g .gcncy for lhc l,.rfomncc of rlr sor* fot Nhi:h lnis pc.ni is
<br />isslcd (s*. 1097. civ. c.).
<br />AIIUIAtrLD!;ILdN{IION
<br />Il*Nhyrlltnru crncn![rolEriuryon.ol rhelnlkNi',srlc.]rrdiots
<br />I).trr,liii{n, Pcrtrik A$.nus N.ifi.drirr l;.Llcrrl Rcgtrlnri(nrs rl irt.ll).1)nn6)
<br />Rcrtutrcd l.rrcr oi Norilicrrio,
<br />I ccnllyrhrr rhc fcJ crr I rcguhr n,n\ tu!t(dnrg Ahc{.\ rcnxiulrrc nolutpliflhlc t, rhi\ tn,j..r
<br />Fl9.cniryrru r rra*c rcaartn appliurrn'n !ft1 nrrc rnrr rturh,v. i'itunnarotr i\ c.rccr I rara ro.r,nlnly *irh all ciry rnd cou.ry
<br />ordinarces lnd Surc Liwr Ehring ro buik itrB consldcrion. lrrl hcrc$y uurhdri2c rcF.enr,'ivcs of lhis Cily snd Corn'y io .nrd ulo. tlE
<br />Elc 'knrintud lmpcnr aor inrllelion puiF*s.
<br />()Ytf lrtn c i3 C)lt^
<br />t-8-2ezc)
<br />Appliances
<br />lvletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />It/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Bough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release I tl A
<br />FINAL 112y2d7 {ba/a /J2.d)
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />trndd i A(!dt$a
<br />-
<br />III
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