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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNEft EUILDER DELCARATION <br />I h@by aflm oda pollty of pcjury lhrt I m qchpl Ituh th. colnac|oa li.oe lrw for tbe fouowing lu$n (Sc.70] 1., <br />scins and P.oasion Codc): Any Cily or Cou.ly whicl Equt6 a Fot lo ontrucl. ,116. impro!., donolirii or r+ti dy <br />siru.l@ Fim to ils is@c. al$ r.!uir6 Oc applc$l tor srch Fnit lo 6k a sisntd qarEMt lha hc or 3h. i5 ticosil puEudl <br />lo Oc prDtcios of 0E ConlEclois Lic.ns.d bw (Chlpld 9. Cor@r! wilh S.(ion ?000 of Divisio! I of th. BEiid Indftlfsios Codc) or ri.r h. or 3hc n .rdfl thacnom ud rhe b8ir for ln. 6ll.8cd ddflion. Aly vioLti@ oas€tion ?01 L5 by tny <br />applicar ror s p.mir subj.ft rlE agplic.or ro t ciril p.i.lry or not moE rhd fiv. huad.d doll6 (t500). <br />-1. <br />s osd ofltc FoFrty, .r my .mgloyc whh wsg6 s rh.t $lc cohpoBaion, sil do tlE *or* ed $G nillG h ml <br />inlqd.d or or.r.d for !al. (Sc.7044. Buin* ed PDf6io6 Cod.: Th. Co.,lr!.lols Lic@ kw (,16 ml arpty lo d orhd ol <br />thcpIlFty *do hil& o. ihpr.!6 tlE@r n'd who .lG rkh w* tirelf or nddf ot lhrclgh hi. or ha oM mplo,6. <br />prcvided rhal such ihFror&ml! c mt inlod.d o. o,lan &. eL. l[ hou46. lh. boildhe or inpovdol i. $ld snnin on. ,Br <br />ofcompl€rioo, rh. ol"nd Buildd *illh.vc fi. hrds ofproliru t h. or sh. did ml boitd or improvc dE propdy for lh. purpoFof <br />l. s ownd ofrh. Fop6ry, m qcluiv.ly .o raclins wnh Icas.d .oiEacroB ro codtud lbc F.jdl (Sr. 7044, BEi.6 <br />dd Pbkion Codq TIc Co 6.lofs Lic.cc tnw doB nol.pplyto uoma of propdly who boilds o. inProv6 lh6@n, <br />&d wl$ coftods lor sucfi Fojers wnh a Conrmcro($ Iic63cd pu6!a( lo rh. Cortrdols LkG L3\r. <br />_l @ 6@d uldq s.dion , B. & P.C 6r tbb lE$.. <br />OrtrE:___., <br />rYoatrE8{-q0lfilltart0! <br />Dl:cldaauq! <br />I hftby arm und6 paally ofpGjury orc ohhc followiB dclMlio6: <br />I h.\. sd \y ill ,nrinr.in . Cenificalc ol ( oMnt lo Selflnsur€ fir \{ntds' .o rr.Nr ion, as ror id€d lor b, sdn,n 1700 o l'rlr <br />Lnhor Cod€. for rhe triomrd.c olrfu No lor shi.hthcpdnril is issucn. <br />--l halc a.d will nairllii worl6 cohp.sation tuu@c.. s rquncd by Sdtion 3?00 ollhe tjbor Codc. for th. Fforr@cc ol <br />lhe so* for which $i! pcmil is i!i!.d. My eort6 omposalion iEurmc. cdid dd policy nunbr d.: <br />_l cdiay lt6t E tn pctoiruc. olthc wort ao sfiich lhis p.rnil is isucd. I chlll Nl mdoy rny FRon in ay m&od <br />e s ro bcom. subjel lo rh. erl6 .omFMrio. L* ot Caliaomi., Md rgr lhsl if I shoutd h<on. subjd lo {E <br />mri6' coDFMrion Fovisioc of Sdion ST00 olrhc Lrbor Codc, l ddl, fonh* t 6mdy wnh lhoe rrc\isioB.. <br />WARNING: Falu. lo sE work6' .onp.Ntion b unlawtuL ad snal rlbjal d @ploF lo dini.ll pdElrt od <br />oddiion lo rh. co3l of comp.E lion, danEs6 s p.o!id.d fot rh.civil 6o6 up ro on. nundr.d lhoBand doll6 ($l <br />Serion 1076 ofrhc Lator Co&. intd6i dd <br />DEC!,!AAIO! <br />I h@by ar"r undd p6.lty of Fjuy $ar I m lies.d odd Fori5ion orc'ltrprd 9 Gomftins elh s..rio! 7000) orDivnion 3 <br />ol llE B6hB and PrcfeioB Code ed my lic.c i! i, full foc &d dl.d. <br />//<r tr <br />I h$b, alm und6 p.nrlty oa psjury lh.l th6e n a comlrud ion lcnding alocy for rh. pdlommc€ otlhc rvort for whicn rhn pdmn i! <br />issued(Sec. 1097. Civ, C,). <br />AIE!,ICAITU&QABAIIA! <br />I h4ry afhn undr pcoahy ol Frjury onc of rh. fouowing d.rkrarionr: <br />Dcmohion Pmits- sh6ro! Nolilicarion F.do.l ReSulariom (Tillc 40, Pan6) <br />Rcquned kllo ol Norincarion <br />-l <br />cstit lhd th. t darl cgulaliotu Egddir8 ab6td ltfuy&l &. rct applicablc lo lhj! pror.rr <br />I c6ri& rhd I hav. rdd rhi aoDtication ed stai. thd the at{v. i.aorsarion is .oE6l. I lsre lo omply *i'h all Cily od Counly <br />o.di@c6 ed Slar. l-e! Ehling lo building codrucrioo ad hcrcby autborizc tcr@llliv6 oalhj! Cily dd Codty lo old uPon $. <br />,bovc narion d prcpd, tor iBpc{ion pxrpos.Opr/g <br />Appliances <br />Melal Fire Place <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 l'14-t0 I TlbVtt f <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. <br />Final Test <br />FINAL tl-q-B ))r(*@ D <br />Meter Release <br />!p!e9.89rncl!9.E!s-_ <br />".", z, ,1/4 /R