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APPROVALS DATE ID/SIG. <br />Appliances <br />Ir/etal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation l./,'{,lY)/cJo4,O <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouoh Ductwork <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Ducl <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar P'4.-tb ))eS*z ,@ <br />Rouqh Mech. <br />Final Test <br />Meter Release <br />FINAL a-tf-19,Jd.S31:o .$1. <br />Notes, Remarks, Etc. <br />- owNER BUILDER DELcaRArtoN <br />t lhrcby sffirm !nd6 pcnrlry of pqJltry lhar I @.xcn n!ft lh. Crrrtulos Li.cns ljw for $. follo*in! @sn (56.?031.5 <br />Businc$ ad Profc$irn Codc)r Any Ciiy o, Counly which rcqlits u Pcrmit ro consrcl. dl6. imltow, d.mlhh ot EP!i! uy <br />srrucr@.Irhrrons hsu c. s r.guircs th€ rypli.d for ikh lr nn iofiles si8tudslllcm lhal lEor.hc is liccn$d poFldl <br />ro tlE porisioni of dE Cootmror's Liensd L!* (Chorld 9. Conmmi.E *ilh S4fi,n ?0(x) of Divirbn I of th. Busiflcis and <br />PDfcsion. Cod.) or lhd lEor shc iscx.nw llttfiono.d E bsis for llE clb8cd .rcmplio!. Any violdion of Stcliotr 7011 5 by any <br />0pplicanl for r Fmir subjEts thc applaool lo s civil p.Mlty of mt turc lld litc hundrcd dollus ($50O). <br />-1,a\oworrolrhcptup.ay.ortrrycn]ploycNqithsr8c\!sll'cir$lc..nrpcDsrlion.willdorhcsqk <br />rllhcitrlmn'Fr <br />inrrMcd .r oftrcrl rd salc (SE.- ?Ol,l, Busircss dd l')ror.\\n rs C.d. rhc Conkd.i\ l.iccn{c uw docs not {Ily lo o o$nrr ri <br />rhcrropcny sl( t{ild\ or i'qrn*6 rh.mn. drl who dGs nrch ql'{ himsclf.r hcr*lfor rhNuAh his or hcr .wtr .mlloyccs. <br />piovidd rhrr nRh i'npmvcnEnB m nol hrcnkn or oni:tri n, {lc ll, h,wcvc.. rtE huitlins or inqrtu\$rnr is stl rirhin mc )tr <br />.f.omphtbn.lh. O*ncr Buihr willtu\t E tnr&n ol I'ro .s lttrl hc or \hc did mr t k] ot inqmrc rhc tDFny ror rNqrEor <br />L ar osnd ot rhc pm|r.ny, Mr ciclusikly conrtu.ri'r( wirh li.c.\cd conrr.crou n, coontucr rlt ,rojccr (SLr 70'14- Brinr$ <br />Jrl PNrLs\in Cod.: 'l hc conr6(ktr s Li.cnsc l-!s dm! not aplly ro uo*ici orr)Pcny who builds or ihfn)vcs rher.on. <br />utr'l $ho co kr.k r.i JUch,'n+cl\ *irhr Conrrlcl,,lr) lid,rcd pursud h rh. Conrrclu r l-kcn{ hw) <br />-l <br />ncxchpl undcr SNrion-. B. & P.C. for$is eson. <br />WORI(FRS''OMPT'NSATI(IN <br />DECIASAIIAN <br />I l*rcby roim under p.Mlry of 0.iju y om of rlE followir8 dcchEtiotur <br />l.rIxtr C(xlL. :,tr rfu IfrlnrnriNr ulrh. work lirshich lhc t^-nrir n n\!ctl <br />-l hrvc nnd witl nsinrain wolke6 coq).marhn insurano, as n4!n.n by Ssrion l7m ol lh. L3tDr Gd.. tor rtE p.rrorromc of <br />rh vort for shich lhis pcmn ir kscd. My work 6 conqE.stion inslmne @ir did Flhy numh.r e: <br />RnicrNumhc, <br />---E.nir.t <br />-l <br />ccnily rhll in rhc FrfonMrc ofrhc worl for which lllk rEron i4 ils!.d.1shallnol c'Dhyan, pciso. i.3., ro.ncr <br />$ as ro trNm subj.rt lo lhc wo*s oEpcBlrio. hes ofcdifomia. md lsc rhd ir I qtnuld h$om rubrccl ro rhc <br />*0*6 sDp.nslion ImvGions of S<fion l7lx) of t tit Codc.I shall. fonhwnh.onply *ith lhost,mvisio.s.. <br />WARNINCT lriluB k, *-ud w.rkcr compcNrt covcrhsc is unhwlul, and +!ll suhjcd an cnphrcr $ diflin Fmllics.nd <br />.ivil fincs uI lo onc hlrdrcd I ,0oO), in lddnion lo $c .o{ .f conlEnstion. datug.s as providcd for lhc <br />Sc.rnrn 1076 oithc Lahor clric, inr.rci <br />,.n 6-aJ../y' <br />I hcrchy rrinnrllrdcr ltnllryurFrjuly rhd I in liccnsn undcr Pnrvi\b. ofchrfrcr 9 ( nuErcins wir h sc.! hn Timo) ol Divii.n .l <br />., rhc Busirc$rnd Proacsir'.s cl .. xnd 'hyli.c { is ir full li,re ud.th.i <br />4 7fz-r/?/2 <br />I hcreby allli udcrlrhlryorncrjxtyrhdrhcrci\rcon(rucrio.lcndir!ieuNyrotrh.Frli'rn mc urrh.sork for trhichrhn Frnrir is <br />kqEl is.c l(})7 ('iv (' ) <br />A.EILICANLDruJBAIIOS <br />I lrr$y.llirn xn,lcr ltnrlry oinLrJtrry on..fihc t,,ll.*in8 dcclrrrrior: <br />Dcmolirion l,cmirs A\tiio\ NorIi.0lion lcdcr.lRcsulari.ns('lirlc 40.1)da6) <br />R.quncd Lrrtcr olNorili$rion <br />-l <br />enaf, rhar rh. t dcral ru8uhln'nc rgardin! !$linor rcditel aE mr q,llica$lc lo rhir pFirr. <br />COMMENTS <br />MECHANICAL-INSPECTOR RECORD <br />Vents <br />/. <br />t!td.r\ N.m.: <br />- <br />T <br />fT--