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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OIII\EB EUILDER DELCANATION <br />I h.Eby .litrm urds petully of F.iury Ual I m ercnlpl tDm lhc ConlrutoE Lictr{ ttw lot ll* folhwinB Een lsft.7ol l 5 <br />Blsin€ss aln Prcfc.sion Cod.): Ary Cily or Counly *hth rcqunc! ! pcmh t! ensltucl, allcr. itrorolc. &mlr\h o. EP&r sy <br />srrururc. Fior lo irs nsuo.c. rl$ rcquirc. rlE applicd lor such pcmi to nh a siSncd rlalcmfl rM h or shc i\ lianscd pur$unt <br />r. rhc pmvisio.s of ttE Conrrocrtr\ Liccns.d L$ (Chal,rd 9. CommminS whh Scction ?000 of Divhion 3 of th. Busin.ss lnd <br />Pof.ssioN Codc) or rhnr lrc tr slE i cx.ftfl rlErclrcm and rlE hcrir aor thc dlcScn cxctrplion. Ao, violarion of S.tlbn ?03!.5lry lny <br />arpliclnr for ! Fmir slbjdlr rhc qrli.anr 16..ivilp.nlltyofml me lh!. five hun&.d doll&s (5500). <br />-1, <br />.s ovncr of rhc !,!Fnr. or ny cmplor.es wirh wdgca rs rrrn $t smpcn*lion, *itt do rh. wo* and $c nrEt@ i\ Nl <br />inrc(H or oficdn for $h (Se.7oa4, Busimss and Profcsions Codc Ih. Co,t.adols Ltcn* L.w &Es ml arrly ro d owrcr of <br />irE lop.ny wln tlitls or nrpDt6 fice( tud *h6 dB sh slt hirelf or hcr$la ot lhru8h his or hcr o*n en'ploya.. <br />provucd rhlr such iolrnwmnt e ml inlddcd oro,Ic.rt for sak, li hoswi lt tDiHinEoritrOowtr i, $U witnin onc Jqr <br />ofodpLlion. tlE O*rcr Blitd sill h.rc tu hrd.f, of pDving thd lE or dt dii mt hrld o ir9ret 0E pmFrty for tlE ruI.$ ot <br />-1. <br />as owrcr of the Dron ny. ao .i.lNirly conreling *nh lic.nsd conraclon ro oniM ltE r.mi{l (Scc 7Ot4 auriftsl <br />nnd Prnfdsir Codc: Thc Conrrslol s Lice.t Lrw d@r hl lptly to u owncr of tftp.ny who huildsor imrmvcs rhc,eon. <br />rnd who ontocB lor such pElels wnh a ConlEdo(9 licctrsd I,!F@or ro ih. Conlroclols Lia.s lj{). <br />-l <br />dn.xc6pr urdd S€tion- B. & P.C lor lhir ltM. <br />Drle: <br />-_ <br />Om <br />lr]atrE8l-goMtlNsAro! <br />DEq,ABAIII}N <br />I hcrcby afiirm undcr pcMltyofpcrjuryon. otlhc following d*ld.rions: <br />lhr\.n' rlllnridniruCcniltrrlcolG'n\cnrbScllln\trrctrqolkcr{conDct\rri{n,.r\In!lnhdnthySccri{nr.l7(x).lrhr <br />lrt$(irfu.,nrrhcFrlt' rnic. oirhc von( klr whi.h rh. lcnnit i\ i\\ucd <br />t hav. lnd *ill nuinrrin *orkc^ .orqrnetiot insursmc. .s rcquirn by S*r ion :!70o ot lh. tihor Cod., for $e pt,folitl!re of <br />rlE work for whkh lhis l,cmil i3 iisEn My work6 compcnsdion iNuratue.ei.r ari Plb, nunbcr e: <br />-l <br />ccnily rhal in rhc p..forerc oftlE *ork tor which rhis p.,nil k tsucd. I shsll ml cnPloy.ny P.@n in lny mnmr <br />s I to b.rom subiccr ro tlE el}oi con{E.srion lows.f Califoni!, ! a€te rhar ifI *hould 6ccom suhtct to rhc <br />worksl orrp.nsarion prcll\ion! of Sdtion 370() of lhe tibor Cdq I shrll. aonhwith @mply wirh thos l,mvisioni. <br />WARNINC: Ftrilurc ro sN *ork *' @nr.n$iion owdE is unL*tul, snd shall subiil o coFloFr lo qimind !.Mlrica..d <br />civil nn.r up ro om hudnd lhoo$nd dollm (CIOO.OOO). in.ddilioD lo llE Nsl ol con{4nslion, d.m8.s ss prova.d fo,lhc <br />Sarion 3076 of lhc kbor Codc. inlcrcsl dd lltomy\ l*( <br />Dale: - Apruenl: <br />Llsltr5ErlcaM&lcrca <br />uist ASAM!i <br />I h.rchy alirm uMcr ll..ollyofpcrjury rhdr I m li{trtd undd r$lision (lChrprg I (tnnrcncin8 wirh Ssrio. T(xx)) orDivi\ion I <br />of rhc B!\irc*6d Polissiors Codc.0rrl nryli.cr{ n ii llllfttr.c utdclfNr <br />Licnsc Class:-Licns. Nunhcr <br />CANEIBI]CI:IONIENDIIGAGENCI <br />I h.eby amm undcr rnrlty ol pcrjury rhlr $@ is a ondrucr ion lcdins uscncy rdr rh. pdfonmncc ol the Mrl lor which lhis Fflril i3 <br />isiucd (s*, J0r7. civ. c,). <br />APTLIIANI.D&CTASAIII.IN <br />I riftby dnmundcr pcn.lly of pcljury om ofrhr folhwnrg d.cL$riotrs <br />Dcnxnnion PeirnnsAshcsros Nori,l.arion Fcdual R.Eul,ri.ns (Tirlca0,l'!n6) <br />-Rcq!ircd <br />l,cn.r o, N.ri,l.ili.n <br />-lc.nilirh <br />rhc firlnllregularions rcsudi.s 6lt no\Etuvdldc nor.Pplic lelolhnPtu.tr <br />-l <br />cerlify rhar I haw rcld rhk sDplicilion !d slalc ltll lt lhot i.fomurion is coffil. l a€@ lo onply tirh trll Cily lnd Counlv <br />odimm.s ed Srllc L.*s Ehring ro buiuine @nit@rio.. aid h.r.by auttsri4 eft*.ralitcs of lhis Cny and Coufl, ro .nlf trPon llE <br />abor ftiliorcd popeny for insp.rlio. plrposs. <br />Pcrmile nlnE (prinl):_ <br />Appliances <br />Ivletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <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 />Rouqh Mech. <br />Final Test <br />Meter Release <br />FINAL 9/6he ,(,(,/il1'/ <br />Notes, Remarks, Etc <br />ID/SIG. <br />Smoke Detectors lnstalled <br />Other <br />, ('onlr.dor <br />Applicdr or A!!ot Si8mrurc:- <br />- <br />Drl.:- <br />-T <br />----r--