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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER EUILDER DELCANATION <br />t h@by amrn lda paulty oapdjury Od I e ddpt tom lhc Contr&lou Lic@ t w fo.llE aolowing lg$n (5€.7031.5 <br />BNir6s rrd Profgion Codc): Any Ciry or Courny vhtuh rcqun6 a Fmn 10 cotrslNd, all6. inprcv.. (brctish or r.p6ir e, <br />3truct@, Fio. ro ils isu@q also r.qui6 lh. .pplic6l for such Fmil b nl. 6 sisn d 3uldot lhal h. o. sh. b lictr d Pursuam <br />ro rh. FovirioB of tk Contrscbis Li.m€d Lsw (Chapld 9. Comdcing win Setion 7000 ot Divilio. 3 of lh. Bsinds Dd <br />Pof*ions Codc) or rhlt lE or shc C qdpt fio.Aom ed rh. bdlis fo, $. dlcg.d qoplion. Any violatioo ofS..riod 7011.5 by any <br />appti.d! for a pdoh subj<l'rh. rppli.mi to acivilp@kyor.or norc tbo fNc hundr.d dolls ($100). <br />l. s osn6 olthc FoFnn or my @plot€ wnh wag6 3 rh.i el. ompats,ior win & $c wcl !d tlE st'.!c n ml <br />iildldcd or ofio.d for !sl. (Sc.7044. Bqi,B @d PrDfsioG cod.: Th. codra.tols Lic.E t w do6 not lpply to e oM6 of <br />ri. Flpdy who hrl6 or i6,ro6 rhd@[ dld rho do6 $ch qoll hi@lf or h.elf or lhmugh hn or h6 oq dn]loyG <br />prcvid.d lnrt ft.i' imFoEn r s e ml inldld.d or of6Ed for elc lf. iowdd. rhc buildiq or nnFo!.nEr ie sld whnin on. yd <br />ofo"tplaioi, $. Osd B{il&r eil h,v. tn hmLn ofFovina lhd h.o! slE did tul toild o. iniFoE U. Fopdty tut lhc porpok ol <br />I, solrc oath. P,lFty, @sclqiv.ly co ra.ling Mlh licscd.offlcloR lo @dtuc1 UE Fojc.1 (Se. 7044. BahB <br />and hofBni Cod.: Tt. Conrra.ioas Lic@c Law doB aol oprly ro s osn6 oaFoFly who build! or idpm!6 On@.. <br />ed eho @eas! h. sh FoiEr. ent ! Co.lEdo(, lic@cd pljMr ro Ihc conradoa! Lic.m ke), <br />I m crdDl uda s<Do . B. & P.C, fo.UE llen <br />D .: Oi!.r: <br />lllaaE&i:(allflNsAr.Iar <br />DECLAAAIIO! <br />I h6.!y sflid !.dd paalry otpdjuly oG ofrhe following ddl66rioN: <br />I havc ard will nai.r6in ! Ccniar.al. otcoMt !o Sclf.lEur. for *ortd compcEalion, s Fovidcd lor by SGrion l70o o f th. <br />t b.r Code aor th. pdfomucc ollh. wo* for $tich lhe pmil b isusl. <br />.- I hale and wil! ftain[in worl6 .omFnsarion iNurdce, s r.qut.d by S€tio. ]700 oflh. Lrbo, Coda for tn. p6fom ceof <br />My wort6 compcsrrio. iNuroc. crid dd policy .umba s.l <br />",,.*{lwEA loq54(, <br />, ccniay rhal in rbc pdaomN. of lheqork for which lhis pdmit is i$@d. I shau not @rlo, a.y p.sn ir an, mDfl6 <br />s 6 ro beom. subj*t ro rhc sod(6' corp.dlrion l6ws olcalifomia. od alre lhal if I should b..oo. subjdl to Ih. <br />work6'compe@rionprcvisioNofs€tionl?00ofth.L€borCdelsltll hnhslt @mply viln lhos P,Drisio6.. <br />WARNINC: Failur.lo sur. wort6 compqNlion cows. is unhNlul. ed shall subjel mplols lo ojni.al FaIi6 aid <br />civil fitr6 up to on. hundr.d rho@nd <lollm (S100.000).addtion ro rn cosl of .omFMlion. drnEgs a providcd for rh. <br />Sdrion 1076 ollhc Llbor Coda ifl.rd ed <br />t(!:rsED3)rt!Aql8a <br />DECIJAAI!!]I <br />I hdlby allm udd pa8lry ol pqjry thd I @ li@6.d lndE FovilioD of Chlpld 9 (@@ci.e *ith Salion ?000) of DivGioo 3 <br />of th. B6in.s dd PrefeioG C!dc, ed ay li.@ i! i! tuU ao(qpd.frel. <br />)L,rS t <br />CONSTRUCTION LENNING ACENCY <br />I he.by .mm undd Flrlty of pcjury Od llr@ i! . corstudb! kldire rs@y ror thc Ffoll'mc of thc <br />isu.d (Se. 309?, Civ. C.). <br />_l .dit rhal $. f<16.1 r.SulrtioN rBarding sberos movd dc nor arplicabL lo lft projel <br />rhis .pplicdion od nal. rlEl l'. abor inlomirior is .otrd. I asre lo conply wirh aU City ed county <br />lo h0ildirs coisrucio'! dd iE o trhie Chy dd Coul, ro dl. xpon llF <br />dborc nalion.d popaly ror ktLs <br />Appliances <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <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. Drop Test <br />Above Hard Lid <br />Rough Mech. <br />Final Test I <br />Meter Release I <br />FINAL K/nlr* .-M'141 ) <br />Notes, Remarks E <br />*Ert O,,,,r;y'1 .o,, rfgl/L,;r;,r*r <br />Metal Fire Place <br />Above T-Bar <br />kn * u.w <br />o:.H.,, <br />.",,,",2L[n <br />Lddd 3 Addr6:r lrpucmr iitdiari:riron- <br />I b.!ryatrmund( pa!!y orp6jur) on ofrh. tollo* irs ddlrarhns: <br />Desolnio, Pmih-Ashcros Nori6c!'io. Fcddal R.gxlaiioN ('rnk40, Pan6) <br />-R.qu@d <br />tlitd of Nori6..tion <br />I <br />I