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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS O\I'NER BUILDER I'ET,CAIIATION <br />I hscby sfid uid6 pdaly of Fjory thrl I @ sopl nln rh. comdcr@' Licc.s. ke fot lt bllowitg r6$n (sd.7031.5 <br />BciiB a.d Prcfdio. Cod.): any City or county which r.qund a Fmir lo oDsrucl, ,lc. hprovc dirDolish or ra6ir roy <br />sr .lue Fior ro irs i3s!4.c, .ls. Equic rn sppli@r for suct pdnit ro 6L a si8o.d slllffil lhal hc or sh. b liccn*d PEU&I <br />ro lh. FwiiioB oa [E ConE&toa! Lienscd tiw (Chapl6 9. Conmocing wnh S..lion 7000 oa Divilion I of lh. BBiN ed <br />Prol*iotu Codc) or $ar h. or sh. b .i@pt theton dd lh. b6!k aor thc dtcs.d d@priotr A., viotalion of Sdrio. ?01 t 5 by ey <br />agplic6t lor a ,.mir ilbjcct th. rpplicrrr ro 6 civil p.ety ofnor nor. tte nv. hun&cd dolld ($500). <br />-1. <br />as oMd of rh. propcry, or hy dployc {ii o!a6 s th.n ek 6dpcGa!io!. ei! do th. tro &n dE slr8l@ I ml <br />idad.d or ottu fo. elc (Sc.7044, BqilrB ud Profdsiotu code Tlic co.trrcld i Lk.* L.* do6 nol apply io D oMd of <br />lh.popqry who tuil& or iEFovB (@r. dld eho dod sh wd( tnNdf or nddf or lhoug! hi! d IIa oM.trtPloyc.s' <br />provid.d rhlr such iiprelola$ & @r id(d.d oroiE d br 3.le ll how.E. th. b'rildill8 or hrFovd@t h$ld widtii o.. ra <br />ofompldiolllE O*fu Buildi siu h.r rlE bud6 ofFoliie *r,i n or stE drd @l hild or irproE dE FoFq tu 0E Pnp6.of <br />-1. <br />s oM6 oflhc Flpqly. d.xclBivcly co iacling {ih li.os.d coilrrdoB lo con$tucl lhc ptDj{l (se. 7044, Busind <br />and PDftsih Cod.: 'rh. conr6.rol3 Lic@ rrw doc nor .pply ro u ownd ofpropqly wto buildr or iiPro!6 tt6@n, <br />sd who @m'&r5 fo' iu.t pDjers wirh. conEa.lo(,lk s.d p6@r & tnc cod'adoa! Lk@. Lrw)- <br />I dn.xmDl ud6 S(nor .A &PC forlhal$on <br />Drtcr_ Om6 <br />.$IaE,KEELCOIIIENSAIIS! <br />D[q!.a8aua! <br />I hscby lmm und6 pdally ot!.rj!ry o.. oalh. aollo*'ing d..lmrlioN: <br />I hav. &d will mint.in a Cali6cdc ofcoMr lo S.lf-l!B@ fu wdkdt @np..!alion. s prolid.d for ty S.dion 3700 o[ih. <br />t bor Cod., aor rh. p6[ollr@. of $c lort fo. *hich th. p6oir i' i$!.d, <br />-l hav. and sill maiirai! workeB comp.Mlion insuuc., s rcqlircd by selion 3700 ofln ubor codc fot th. paaomec. of <br />the worr for *hicl rhis pdmn i5 tisucd. My wortm ompaslion iNurdc. @id md Policy Nnbq ac: <br />Policy Ndb.r: FIPiB, <br />-I <br />cdiry thar i, th. pdaortruc. oalhc wort for whict lhis pmi is i$ual l stail not dPloy any pds. io an, Emna <br />s s ro bcome subjer to rhc voi(6 ompoNaon bws orcdifomia. dsBdth,liflslbuldb6on tubjei rorh€ <br />\rc*6'mmptetionpovniosolsdionlT00oflh.LlborCod.,lshdl.fonhwnhcohplywihOo$ptolisio$. <br />WARNINC: loilw ro sue work6 onpmarion ovdae. i! uhstul, nd shdl subjal & anploya ro simi,al FEti6 ed <br />civil fins up ro orc hundrcd rious.rd dolld (ll0O.OO0). 6 .ddiiion to thc cosr ol conrpc@lion, ddagd 6 PmviLd lor lh. <br />Sction 3076 oilh. L,bor Code inls6l ad ltorn y r f6. <br />lJclNllD-lol{rnl(:ru4 <br />DECI.AAAIIO! <br />I h.ebt amiinondn Frhy of p.rjury that I d liceis4d unds n'ovGion oich.prs 9 (coonrencins snh s..tion 7l'00) oll)ivision l <br />of rhd Businst and Pnlssioff Cod.. &d nry Iiccnse is in lull forc. &d cihr. <br />t-ic.e Chs:-Li..6. NrEb.i <br />colgr8xclloN.LErDllcScElq <br />I h@hy rle6 udd p6,lly of paju.y thd llG. ! a @.fiu.rbi ladins .gacy for th. Ffoll@cc olthc erk tu whkh lhi! panh b <br />isucd (56. 3097. Civ. C.). <br />AIIIJCATI.IIECIAAAITO! <br />I ha*y aIftE u.d6 pdlty olpajury oE ofrhc follosilg deldalions: <br />Dmolition PmisAlbd6 Notifiqlion F.ddal RBulalioE (Tille 40. Pan6) <br />-R.qun.d <br />kllr of NotifEliion <br />-l <br />cslify lnar 6. fcdcral rq.ular6s rcearding sbdor .moval s. not applicabL lo this poj..t <br />I .oriay rhnr I h.v€ r.ad lnis application dd srate rhar rhc rborc inloruri.n i5 cor.d. I agre lo .onply wlh tll Cily and Counly <br />ordinmc6 dd slal. Lr*s ElrtinB ro buildins coBlrucrion, aId hd.by aulho@c rcrr6oraliv6 of lhis cny ed count, lo 6la upo" lhc <br />aborc ndtion d popeny for tupoxion purlos*. <br />Appli.er or AB.nt Sign.turq- Dal. <br />Appliances <br />Evaporative Cooler I7/nh// t 'r|.nqa'/E- <br />Compressor a <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh 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 />Above T-Bar <br />Rough Mech.,,lnlftl ('/llo7l''ff2- <br />Final Test <br />Meter Release <br />FINAL "4"4llq 'i4lXk-R>- <br />Notes, Remarks, Etc <br />ID/SIG. <br />Metal Fire Place <br />Furnace <br />Con(nclor: <br />P6nir( nmc rprinr) <br />I