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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUIIDER DELCARATION
<br />I h€Eby amrm lndcr Fnalry of pcrjory thlr I m.rcmpr from rhc ConrEcroR Licn€ Lrw for rh. follo,ire casn (Se.7031.5
<br />Busincss ad Proacsion Cod.): Any City or Counry ehich rqliEs a |-nt lo @n$e[ !16. imprcw. &mlsh o. GFt Dy
<br />suuctuE, prior ro ns isuoE. al$ rcquircs llE ippltd ror sucn p.on b 6k . sigmd slolcmnl lhal tr or shc n li.cnsd puNal
<br />ro rhc Fovisk B of dE Conr@toir Lialsn t,w (Ch.ptcr 9. Con@Eing snh Sftlion 7000 of Divirion 3 of lh. Busimss . ,
<br />Pmfcssions Codc) or rhlr hc or sh. is cx.npr thcrcfiom rnd rhc barh for lhc lllc8sd cr.tr$ion. Anr eioLfion ofs*thn 7031,5 by u,
<br />antlicanr lor ! p.mit iubre.ri rhc lpnlkot ro ! civil n Mltl of ior mB lhu titc hundrd dolbs (1500).
<br />-1,
<br />as ovmr of lh. pmFny. or my cmployccs wilh pl8cs as lhcn et comF€nsllion. wil do llE krk dd lhc slrw'tw ir mr
<br />i .nded or o,tcEd for slc (56 ?044. Busiturs Md Profcssions Codq TIE Co o.roar Lken* llw .lo.s er ,rpl, lo an owNr of
<br />rh. ropcny sho huilds or impmlcs ttEmn,0nd who dB s..h wlk himr.lfor h.Mlf or rhmu8fi tk or hcr own cmfloyccs.
<br />pnrvtd.d dui su.h imFnrftnt m m! ini.nd.d d ofM for elc li ,E$trr. tlE hiilli.g n in+rcftrnr ir sld *iihin oE rar
<br />.l.orplcrion. tlE Own( Auid.r sill hih rhc hnrdcn of tmling (tun hc or *hc dit nnr huild or nnpmvc thc p6Fny for llE lItrpos of
<br />-1.
<br />as owrcr of rhc l(Dcny. am cxcl8iwly conmdi.s wnh li..nsd .o ridor ro on$rud rh. pmjd (SN.7{)44. Busmas
<br />a.d iloissi,rCodciThcConrr.clols Liccns. Law do.s nor rtplylo 0n owncr of rmlcrty who hlildsor im!rcvcs rhcrNn.ind who o.tncis fo, skh tDiirs *nh ! Co dd6(O ltcensd ponud ro rhc C6otra.roa. Liccnsc t w),
<br />-l
<br />am cxcmpt undcr Sclbn- A. & P.C. for l,rG Euson.
<br />IIoIIKI'IS' CoMPENSATTON
<br />I'ICLAAAIIIJN
<br />I hcrcby lffirn und$ ,.Mlty or,'njury om ol rhc lolh*ing dcchorions
<br />I htr$ nkl uillnrinr naccdio.ar.ofcon\cmtus.lrlnsurc,rsorkN.onD.\.tiotr.r(povidcdlorhyS<ion37OOoirh.
<br />blhr Cud..lnr rlte Fnntumc uf rh. so* frn whi.hrh. Ptrnrir k i\srd
<br />Z6vc lnd will m!i.rtrin $()ik16 $nlEDsal i{nr nNurrtrcc. rs rcqutcd by Sccr io :l?U) ol rhc lih.r cinlc, ror rhc p. anmncc ol
<br />- rhc work iorwhi.hlhn pcrmir h issw, Myworksl co.U.nsoli(,n insuroncc odcr drnicynun'bcr c.
<br />G>w,e U,r* t-
<br />,ttcur90234Ll 9ltr" / z--
<br />-l
<br />ccnilrrhar inrhcpcrfonmnccofrhc worl for whichrhixpc.mir is tsucd,I rhrlr oor.nl,loy,ny lcrsn in&y munmr
<br />s sro bdonE subrc.l to lh. wolkdc snqFnslhn bws of Catifomia. ond s8E lhal if I should tE{om $brc{r to llt
<br />wollsl conD.nsllion pmvhions of Scclion 1700 of lh. titrr Codc. I slBll. aonhsirh comlly wilh rho$ |)nrvnions.
<br />WARNINC Failurc to $orc rorkcrj
<br />.ivil lincs uI lo om hlndred thouend
<br />Sr.rio. 1016.artu litr.C.'d. inrcE(
<br />coq,cn$l6n covemg! k unla*tu|. und sh.ll sbrccr .n cmplorq ro dnirl Fuhi6.rdr jpir h rhc (( nr srlpcn\u,ion. lton[rc. r\ Fovi{
<br />7o",, tlulzo
<br />ut[tistDloNlna(.roa
<br />DIrCLISIIION
<br />or ,h. rlu{ncs\ 3 Prdclsi,)ns (i)dc- ud n,rll.cfsc i\ i'r nnlr,,.. nlcll.cr
<br />to 37G8'
<br />TAIIIf,IJCIIAtr.LENDINC.ACENI:T
<br />I hcrcby nafinn und.r Dcn,lrt dr r.rju.y rhur rhcE is d..n{tucri.n lcrding,g.n.y Lr l}rc r.rfonMn.c olrhc work nr which rhis ps'nir ir
<br />hsucd (Ss 1097, Civ. C.)
<br />AIILTCANI,!&CI/BA.IION
<br />I tlrby dfiinn xnd$ Nnrhy.fp.riury ok ofrhc Llbwi.B d(ldnrknrs:
<br />D.mlirion PcrmnlAsbcsros Norlication lc{tcral Rc8ukrio.s (l irlc 40. Pd6)
<br />Rcqui'ql L!(c, ol Notifrrrhn
<br />l..nilirhd thr L{cnl nguhrotrs oS0rdiig r$.{o( rc )vrlrrc nor mliclhlc rorhn pnjccr
<br />lEl.rn'l) rh. rhr\rru,lrh^Jnnl'!,trtr,:url{ r rhJ h. rh)rr i'nnn dnr n..nNl I rsra lo conDly sirrr nll Ciry inn Counry
<br />ordiNncs an.l srarc lj*a rclariiE ro huildin8 .onnMrion- and hcrct'y rlD'izc rcprcEnrdi!.s {)rrhi\ Ciry d coun'y b cnrd upotr rhe
<br />Ctet,r .'r. -/"",.,-tlztlru
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Pre-lnsulation
<br />lnsulation
<br />smoke Detectors lnstalled
<br />Rouqh 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 />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release / /F|NAL // K/&- 4 ';ron"/
<br />Notes, Remar(s, E{c.
<br />)
<br />Duct Work
<br />Dale: Orrcr:
<br />{
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