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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.OWNER BUILDER DELCARAIION <br />I hd€by .nm undd p.nrlry of pdjury thar I m ddpt lrcd rhc cootac,roR Lic@ llo for lh. IollowiD8 r.e. (sdro3l .5 <br />Bcinas atd Profsion codc)r Any cil, or comy {hkh r.quir6 a p6,ril ro co6rocl. dts, i-provc tldnolbh or c?an ey <br />shct@, priorio ire isumca !te. r.qliG fi. rppli.el for !!.h Fmn lo fil. s si8...t $dffir lhd h. or rnc is licN.d pEudl' <br />lo rh. Fovisio6 ol tlE Co.r6croas Lics*d Lr* (Chaprc 9. ComminS wnt S*tion 7000 of Divllion 3 of lh. Buincls .nd <br />ProfdioB Cod.) orlhd lE or shc is d.opl rh@iioh dd rhc b€sir [or lhc.lLscd d.ortion. Aly liol io. of Sdion 7031.5 by any <br />appli.al lor a pqoir subj<k rh. applican to a civil p.ulty olnor 60r. thM fiv. hun&cd dou@ (1500). <br />-1. <br />a omd otuhc prop6ty. o. my dployB wirt wagB s rh.ir el. @np@!nion, wil do tk vort !d $. 3rtui@ b ml <br />intad.d or oE Ed for !.1. (Se 7044, Buuirc &d Aofdioru Co&: Th. Coorreloi3 Lic6e Llw 1106 oor eply lo e olG of <br />thc propdty slD hil& or in!o6 dE@r, dd *,ho d.c sh wd( hiNclf or h*lf o. lhrcugh hi5 or hE oM dploy€6. <br />prcvidcd th.t sucn n FDrqEr& c @r inrald.d oro&td h. sL. lt ho$€6. tltc blildj4 or irqro!.@lis sld whhin on ,s <br />of@npldioo. tlE o\*na Bdld.i si! har thc b!d.n ofprovins lhl( tr or sh. did @t build or 6For LlG F!Fr, 6. $. pqF* of <br />-.1, <br />a oM6 ofrh. popoty, o .icluivcl, .o racriis wnh liGE d .oirr.crou ro @Blrud llE FljrEl (S*. ?044, Bcin6 <br />dd PD&sir. Cod.r Th. Co,lrslor'i Lic.@ kw dc not 6pply ro d o{nE o f prop.ny who buil{Ls or impovd lh6eon, <br />ed who 6tna.1s for seh Fojds wih a cotur.to(s) licsed rNU&r h rh. conradofs Licmc La{). <br />_l m cr.mo ddd sdion_, a. & P,c. lor rhi! !.en. <br />D.t.: orn€: <br />lottrEafltoMrEltarlo! <br />DECIAMIIA! <br />I hdeby dlfm undd p.tulry ofr{jury onc olthc followins dels.tioE: <br />-l <br />hsv. Erd will Minr.i. d CsrifE.r. of CoN.nl b S.lf-lNuE aor mrt6 cohp.nsarioo. a Fovid.d lor by S6taon 1700 of rh. <br />L,bor Codq for lnc psfo,rmc. of th. m* for which th. pmir ir icau.d. <br />I h.v. .nd will n.i!t!i! eort6 conpqMtion i.sura.c, a r.qun d t Sclioi 1700 of rb. L.bor Cod.. for lh. Flotrucc of <br />lh. e{ for wlicn rti. Fnn i. i$u..l My er[6 @nposarion iBU4. @n6 ard ,olicy nunbs E l <br />PolicyNuhbq: Erpncal <br />-l <br />.ariry rhd in rh. Frfomoc. ol rhc vorl for which rhis psDit is assue( I rlull nor @ploy any pas6n in dy ben6 <br />$ a io b..omc aobj{t to lh. eork6' omp@lion la$s of Calilomia d sBE that if I snould beoft subJ<t lo thc <br />work6' conposrtion poisioB olsetion I700 ofthe Lat r Cod., I shall. aonhwilh comply Nith lfioF pmvisioN.. <br />WA|ININGT F ilu.lo su. mrt6' comF@lion covdg. is unla*tuI. dnd shall subj..l m dploF lo oiniml p6trld6 dd <br />civil fr6 !p ro on. hlndrcd tho$d.d dollm ($100,000). in addirio. ro rh€ cosl olcomp.Mlion, dlhs8d a provid.d lor lh. <br />Sc.rn{ 1076 olrh.l-ahJr( odc, idcrd i d ornc) <br />Dolc: Appliont <br />"F)unn- <br />fffr- <br />LIcTNSED coNrRAcroR <br />DECldf,AIIotr <br />I heb, amm undd F.rlry of psjury thsl I m liccrBd undr Fovisior of Chspl6 9 (smMciis virh Sdrio! 7000) of Dili5ion l <br />ol th. B6ioB atd Pof6ioB codc, ed Ey l(.@ i. io 6,ll lo.c. ad ctf<r. <br />t_ <br />colgrf,lJcrIa!_lllrtlc_ac&rcr <br />I hdcby alfid und6 Fnahy dapoj!,r_rhd rhdcis a NtrrlNclio.lodi.e a!o.t fo, th.pglonn ceoflhcworkforwhichlhisp6hil i <br />issu.d (Sa. 1097, Ci!. C.) <br />A.EETICAIfDEC!.AA{II()I <br />I hftt'_v rflinn undo p.n.hy olpsjuryone ofihc iollo*i.! d€lealions <br />Demolirtun P@nirs Ashtsn,i Nolific on F.&ral Reruh iols ( f,rlc 40. Ptu16) <br />Rcqrndl Lllrd ol'N.rindnnr <br />I cdiry that rhe fcdqal rcrulatioB EgEdin8 eb€ros Enolal e. nor appltahl. to $is prcj4l. <br />I cdliry rh!| I halc Md fi! ,ppltdion ad llar€ Od rh. abov. inhmaio. i. con .1. I a8E lo conpl, wilh all cily and counly <br />ordituc6 .nd Sbr. LaB E&iins ro trildins conntucliotr &d hdcby ruthoria rcp@!a1iv6 oflhi. City dd Counly lo ot6 upon rlE <br />abov. dotioncd p,Dpdy for <br />Applicnl or Ag@| Sigu(@:X,\rvrrN"'- <br />\ 'V t't'ttr <br />Appliances <br />lVletal Fire Place <br />Eva porative Cooler <br />Furnace <br />Com pressor <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 G-7-lE <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Dam per <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL 7-a-tg )fa4( <br />Notes, Remarks, Etc. <br />COMMENTS <br />)l <br />PmileMc(Fiir): <br />- ---T_-----