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MECHANICAL-INSPECTOR RECORD <br />DATE tD/stG.COMMENTS OWNER BUTLDER DEL(}NATION <br />I hcrcby lrtrm undlr lcrulty of pcrjury rt r I m cxcn 'r frcn rhc Contracror' Ltcn* trq fo, rh. followi.g Be$n (Se.?031.5 <br />Blsircsi o,n Pioacsrion Code): Any Cny or Counry shich rcqla6 r F mit to consod, !1t6. inprorc. dcmtish or rcp6i, My <br />Blrucrurc. Irior ro its icruue. alm rcqunca tho arplic&t fo, !u.h Fmir lo lilc z si8ncd sr.rcmnl rhrr lE or shc i\ li.cn$d l,u,$ur <br />ro rlE rIDvi\ions of tlE Conrkrof s Li.cnsd L.w (Ch.prr 9, Conmfting wirh Sdion 7m0 of Oivision 3 of lh€ Busincrs lDd <br />Prcfesions Cod€) or rhil nc or sh€ t cxcn r rhc..fb,r sd rlE bssh tor rhc alhScd cx.q,rhn. Any violrtion of Stlion ?0.1 Lt bt .iy <br />optli.! ll,r a l.ml subjcch rhc appli.an( io !.i!il Dc.llry oi.ot mrc rhdn nv. hundrcd douss ($50o). <br />-1. <br />s owtrtr of rh. pmpcnt. or ny chployes *irh vegcs &s rhcir Flccoml.nsrion, *iU &, tlE stt,ti t nid@ is ml <br />inieod.d or o,Icrcd for slc (Sn.7044. Busine$ ed Prcf*sions Corlc: TIE Co.r@roas Liaok l,v docs .ol lpply lo ai oe@ or <br />rhc pDrEny who boilds or nrll'm6l}rmn. ud who dG Mh m* hinsclf or lEMlf or rhmu*h his or hcr o{n empl6y..s. <br />p.ovid€d th,r trh iqft\tenri m sr hrcnded oronbd for sL. lf.ln$ls.0r t{iEhs 6r in{eEmni k 5ld v nin orc rE <br />of@r{ikrio'l rhe O*tur Buius qill hlr rhc tldd of rmving thar hc or sh. did mr h{ild or nrqow dE potcny for d. purFc of <br />-1. <br />!s owncr of rhc FoFrlx am crclucilcly conr@rine wirh liccnsd .ont,eron h onnncr rL nrolxl (Sec. 704.1, Busims <br />dd Pbr!:rion Cod.: Thc C6nrh.ror's Licc.i. tiw doci mr {rplr ro unown.r oftmFny sho builds or ihprovca lh6@n. <br />rnd who contBcrs for slch prcJcls *irh a Conhdo(t li.cnsd pu6u.nt ro rnc ConE&ror'r Li.enc Lrv). <br />I rm.rcn,pr unJ.r Sccr <br />l)r'lr ()rrnf <br />u0af,E8l.(oltfrNsArla! <br />DNCLARATTON <br />I hereby rmrn undcr Fnahy ol lcrury onc of th. followine d.cls.liors: <br />-l <br />haw ard eill tui.kin. C.nifrrr. of Co.sc lo S.lf-lnor. for wdt6' @mFm|li.n, &s Fovi.Ld fm b, Sdtior.1700 of tlE <br />Llbd tuc, for rh. Frfommc of rnc wort fo, *hich rhc ldnir Lr i$uct. <br />_I h.ve and sill nainlain eo*.6 .ompcnsarhn i. lme.ds EqniEd bySerion l?00oflhe t bor Codc. for lhc P6fotlllm of <br />rhc work lor whth thh pcml L{ is$rd. My work6 .on{FMrion irsumm.ntr lid polky numbcr el <br />-l <br />ccnifythor in lhc t'crformrcc of rhc wort for whth this pcrmir is issud.l rhDU odr cnploy.ny FB.n in lny nfuncr <br />F at ro lrsm slbjccr ro rhc wo.l6 or?.nsri{,n kws ol Calilofria lnd 4@ rnnl if I stx,lld tEronE subject lo th. <br />w6rkc^ Nn4cnsrion polisions oasccrion 3?0o otrhc tjhor Cdlc.l sholl. fonn*ithcomply with lhos povisidns. <br />I{ARNINC: Failurc h s@ {ort 6 conFosdio. @rcBgc is uihstuL $d sholl subj(rr e.nploF Io cinin l leM[ies ud <br />civil fincs u! to ore hundrcd rhousnd dollqs ($100.0001. in addnion lo lh. co.l ofcomp.ndion, damgcB as polucd for thc <br />Serion :1076 of lhc Libor C.d.. im.rcar Dd anomy's fes. <br />Dole: Applionl <br />LI!:ENIIIIS)NISACIAB <br />Itl:CLAf,AI](}! <br />IhctobyrlftnundcrNnilry.fFrjuryrh,r!anrli.cn*lunddrprovnionolChrtrcr9lconrnrncinsqilhsccri TmO)olDivisn l <br />oi lhc Bu\inc$ ond Profcst'ns Codc. mJ mv liccn\c i\ in lu1lturc. ddcfltcr. <br />Licccc Ckss:-Licensc NlntE( <br />Doler Conl <br />CONSIAUCIIONIENDIMijIiENST <br />Ihcrchyaffirn)undcrlcnxlryorFrjuryiln rhcEis,strsr crio. Lndi.8 o8cncy for lhc llcrihrrorcc ofrhcso* ror which dn Frmi' n <br />hsucd (Scc.309?. Civ C ). <br />AIILICANLDECT.ASAIION <br />I ffir,JIm u.dcr l.tulry ol r.rjury ok of rhc tullowin8 d(ldrdbnr <br />DcnoliliM P$nili^\tr{os Nolilicaln,n lrcdcrl Rcruhnxrs fl itlc &- Pan6) <br />-Rcquncd <br />Lcrlcr olNolifi olnn <br />l.cdiry rh,t rhc Ld.ral rcgultrliotrs rsudnr8 astr,stos rcnFvdaE nol opnlicot !c ro lhi\ pniccr. <br />_l errily th,r I hrrc rcad rhn applt.rio. !d s|atc rhd $c !h,w info rErion is corer. Lgr€ ro 6npD wath .ll Cily and Counly <br />ordinstucs a.d Srdrc b*s rchling to buildi.g .on(rucliol\ 6rn hcEhy surtsrizc rcF.$nlalivcs oflhis Cilyaid Courry ro c.r6 ulpn {x <br />abolc ftnlioftd pmtcny for isl'<raon puqDs.. <br />AndrM , <br />^8cnr <br />s13trJruE: <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room i Clothes Dryer <br />Residential RangeOther ,ltt -#r,*,al 7,zz-rlz f/,-^.-u b"lL <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />r7.zz'6 z 'Cq.urz &z-/ <br />Notes, Remarks, Etc. <br />APPROVALS <br />Meter Release <br />FINAL <br />--------T----------f-------f----- <br />-------r----- <br />- <br />= <br />=