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MECHANICAL.INSPECTOB RECOHD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes D ryet <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. Dro p Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />^.\FINAL -7-7t-tv YJU'11 <br />Notes, Remarks, Etc. <br />OWNEN BUII"DER DELCAAT{NON <br />I hnc6y amrm undcr pcorlly of Frjury lhal I m .x.m nDm lh. Conlrs.IoB Liccns tis for lhc following Elmn (Se.?031.5 <br />Bu.hcss aid Prof.ssion Cod.): An, Cir, or Couty *nich Eguirs a Fcdir ro onsltucr. alrci idrrcr. &mlnh or Etlor dy <br />ddclE, Fnr ro irs Lr.!rre. !l$ mquiEs rhc.polkanr tor sn h r.mi 16 lik r ri8n.d stai.ft.r rhrr lE o. rh. is lien$d pu*uMr <br />to rhc previsionr of rhc Con,eror.s Lie.s.d Llw (Chlpr€r 9. Commftins snh Scction 7000 of Divirion I ol th. 8uii.c.s ,nd <br />Prof.ssions Cod.)or thlr hcor sh. k.r.q,l ihcEfmn.rd rhe b6sis for lhc,lbecd€x.rprion. Any violslhn ofSclion ?031.5 by y <br />arnlkanr for opemir slbjels rhc otDli.rnr to a civil Ftulryof mt mrc rh!, fivc nlndrcd dollds ($500). <br />-1. <br />6 oqmr oalnc pmllny, or my rmplot!€s wiln w!8cs as lher ek @mF,salio.. will do tlr sst lid dt nrul@ ic ml <br />inicnded or ofiercn fd sh (5(.1044. Busircss and PDft$iotrs Codcr The Conrro.rols Lian$ lj* dod nor lpply ro M 6ve of <br />lhc prDpcny who hlilds or niprlB lhds( .nd who .kE* sh e* ninsclt o. h.Glf o, rhreu8n ll.s o. hir oetr coploym3. <br />provaddl lnd su.h irymtrcnts m ml hrcndol or ofr.rd for slc. l( howE. llt hitinS or irg,oEmnt ii sld antin orc y.a <br />ofotrphlion. tlE Owrcr BuiLld wil tlw E h{d.n oapr$vine UEr lE o shc did d hrikl or iipoE 0E FoFry for lrE plrposof <br />-1. <br />os oNEr of rhc r,ot cny, aE crchsivcly omrcrinS wirh licosd .onrtulm ro enirucr th. pllj.rr (SE. 7Or4. Bulifts <br />a.d EDi..sk'n Cod.r Thc Conkacio." Licc.rc Law docs Mr arpl, |o on osncr of nrolcny who hlilds o, imnrov.i lncrcon,und *no contncrslbr such pmj.lrs wilh a Conh.lo(s) lic.nsd t'trnulnr ro rhlc,ntretols Ltcn* tt{). <br />I dn.rc'nd x .r S..ri <br />rQatrE8t-coldfjNsanoN <br />DISJAAUON <br />I heeby!flnm undcr,,cnohrof l}crjlryoncof thc folbwin8 dcclnrrlions: <br />-l <br />hivc ukl will nri ninrCunificd.olCotrsctrrroSclfINURturworkss.n r|fnw i()n.rr Imvid.dforhrSccrnr3TlDoirhc <br />Ltrh.r (j)dc,l{tr rh. r.nnnMncc ol rr work fd which rhc Frnrir i\ i\\ucd <br />_l hrle and sill rointain workers oorcnsarion insurcmc. .s rqlncd by Sdion l?m of ltc La6or Codc. fo, thc pflbrtunc. of <br />rh. srk lor which tht rrmit is hed. My sorlss ompcnel bn insurucc clEkr and t)olicy nlmbcr sc: <br />-l <br />.enity rhlt in rhc l,crforencc of rhc sork ior etkn $h Frmir h nslcd. I shlll mr cdploy any !.Mn in rny Mm, <br />s a.lo bc&m subirr ro <br />'he <br />wol*dc conF.sdrion laws ofcalifornia. und aSr. rhai ifl ithuld b..oft subjcl to llE <br />eo*cR @n Etr{ion pbvirioB of Serion lTm of ir tibo. Cdde. l stulL tonh*nh mnlly *it ihos lovhiom.. <br />Wl\RNING: Failxm ro $urc trorkns'.onD.ns,rion ihall suhjct an c'nploFr lo aiminrlpcEhics lnd <br />civil lincs u! ro on. hundicd lhousnd doll&s .o{ ofcoq,.nsarion. dam8cs os rrovidcd for rhc <br />I hcrchy afi,m undc. n nah y ol ncriury r,ur I am lic!.$n undcr o ol Ch.plcr 9 (.Ioftti.s wnh Sdio. 7uD) ol Divhio. l <br />of lhc Busincss ud Pmrcssions Code. o,n nry liccnsc h i. tull lorN !n cffsl <br />t6 CLR r go 673V <br />I hcrcby lifi rmundcr lcnallyof perjurylhll <br />tsucd (S.c lo97.Civ. C ). <br />IcndinB r8cEy nnthc pcrformuicc oarhcwork fin whi.hrhh Fron i\ <br />BSordin8 asbei* rcm,vrl ,rc no' srflkabk b rhis pmj(rr. <br />utnrc irlonuri,n i\.omcr I ArL{ u 6nDly wnh allCnyotrd Counly <br />his Ciry and Colnry lo cma qnn tlEhcrcht rulhori^ rcprcs nrivcsoft <br />o ^, "E /otl( <br />Polcy Nu $.i_Erftrcs <br />- <br />o(0 <br />LtndcisAndr$r-rppr.r<riiiliiffi <br />I nd$y ,frm undc. p.nalry ol F.jury om of rnc rollowing delior ioosl <br />Dcmlition Pcrnits'Asb.slos Nolificrlion Ftderol Rcsulaltuns (Tnt ro, P!n6) <br />R.quicd t kiof Norii.arhn <br />--T------ <br />=