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APPROVALS DATE ID/SIG.COMMENTS OIVNER BUILDER DETABAIION <br />I hs.by 6trm unda pen lty of pdjury lhar I m d.nfl lion lh. ConlncloB Lic.i!. ke lor dc fonowing ltei (Sc.7031.5 <br />Bui!< ad Proleion Cod.)r Any cily o, couiry whth r.qniE a Fni to @nno.t .nc. iiprovc &6oli!h or Epoi sv <br />srflcru.. prior lo irs issue... also rcqunB tb! opplicdt for such pdni lo filc t si8r.d slatdMl lhal hc o. ,h. s licats d pauul <br />ro lh. prwisio.r of lhc Contdcld s L@rsd tlw (Ch.$6 9. ComadDs wih Sdlio. 7000 of Division 3 of ltc Buit6 od <br />Pof$ioN Co.lc) or lhlt h. oi lhc i! q.nfl tnu.froE Dd tbc b6is for lh. alk8.d ddplion. Ary violaio. ofsetiotr 7O3l .5 bv av <br />apllie for a pdot subjd! r!. .pplicer ro a.ivil Pdahy of nor norc lhM fiv. hundt d dourB (1500). <br />-1. <br />s om6 otth. FoFrin or ny .6plo,6 wilh vaAd 6 lh.n eL .onPo!dio.. will do th. PorI 3d liE lrnrctld h 6r <br />if,tdd.d d ofra.d for slc (Sd70d4, B@in@ lnd Aof.srioB Cod.: Tt. ConlEcloas Lic6e Le &6 aor ePly Io e o*G ot <br />lh! Flpoty wfio bo dr or ilrFoBthdol! ad who doa *t wlt himclf ot h@laor llmush his d hr oM.mrlot€e. <br />prcvidcd lh.l luch iir,rlEn deE@l i ordcdorotuld 6tsL.l[ hov!6.dEhilditgoriDF!@s iJ$ldwihhorcra <br />of mmpldioq lh. OM( B{itl6 win firt th. b'!da ofPloi.s $d h. or 5h. dn tul bild or tmporc ln. FlFly 6r fic F poeof <br />lgL). <br />-1. <br />s oMo oath. Fopqry. M *ctuiv.ly @ii.eiog wnh Ucd.d coffisloa lo cocltud $. Pmi..l (56 7044. Brina <br />,'d Profi*shdCo&: Th. Co d.lor't Lic@c L.w do6 nor.pplylo Downsofprcpdy-ho brildsor imPrevBfioad. <br />dd who @nta.ls ror 3uch projds enh ! Co mro(s) licos.d pus@ln lo tt. co Ectoi3Lic.etlw) <br />l.m.rmnr trndss..ri.n .B &PC aorlhs Bon <br />]8985!EEIOM[E!SA1IAN <br />D&CIAAAIIAts <br />I hneby amnn undd Fflahy olpojury o.. ofth. aollowing d(hBtio6: <br />I havc udwiu nEi aio ! Cdiificar. of Cocmt lo Sclllcu,c fo. trrtkdt conf.nsaron, s p.o!id.d for bv Sedion ]?00 ollh. <br />lrb.r ('odc for th. p<aor@c. oIlheqo lor whict rn. pmil b isue!. <br />I halc and willnai.rain work.rs compcNalioa i6ur.ncc. s rc!!t.d bt Sation 3700 oalh. Labo. Co.lc. for th. Pofof,n.nc. of <br />rhe wott lor shich rhis ponir is ie.d My ,0rl.6' cooposaion i6uft. csis d policy numb.r a.: <br />I csliay thar in lh. pdfoll@c. oalh. work lor which lhis pcm is i$u.d. I shall not dplo, any ldso. in ev mdM <br />e s lo h6om. suqd to lh. sork6 compqsllion las of Ctlifomh, d.gc thar ill should bdomc subj.cl lo$c <br />wort6 coop@rionpNviliomof S.dion ]TOOollhc Labor Codc I dEll. fonb$nh codply wirh lhos.Povisio6 <br />WARNING: Fel@ lo wuE worL6' @sp.Natioo @v@8. i! unlawftl. sd slul subj4t 4 dplolq lo oinin.l FEltie dd <br />.ivi! fir6!plooEhbdr.dlhous.ddo[!B($|0O,0OO),haddhiotloln.oilofconpcBarion.daEg6apovid.dlorlt <br />scaon 1076 ofrhc trbor Co& int6.n ed lnqEy's f6. <br />ApplMlr- <br />LlgillEllcoauaflaB <br />Dliclal4llox <br />I hftby omrnr undd p.aalry of pdjut, rld l o licds.d undd prcEion ofchagd 9 (commocins \it Sdlion 7000)ofDirision l <br />ol rhc Busi.sidd PmfsioNCode, ad ny li.tuc i in au,l for.. od cffcct. <br />cols[8lJclloN.lrENDlxcicllcr <br />t n66y,Iftm unda pastry orpajuy thd O@ i!. @trrncrbr lodin8 !8@y fot l[. Fromlltc otut wrt 6r *tich rhi p6nit !t <br />i$!cd {56. 1097, cil. C.). <br />A.[IIICANLD&CI.68A:I]ON <br />I My itr n @&r pasny of Fjury oe of rt follovi!8 d.cllitioc: <br />D.nolitioa Pddt!-Asb6loi Nodfr.dio! F.dcd R.rubtioN (Titl.40. Pa6) <br />-Rcquircd <br />t dr6 ortloti6.do. <br />-l <br />cdiry rhd lh. Ltldal rcsularios cardins sbGtos r@oval s. hol a licsblc lo lhis prcj.d <br />-l <br />cElily tfi.l I harc rdd $is lDplicarion md stttc lhd lne sbovc in fo@rion is coEEl I asre l. cooply wnh aI Cil, and Connrv <br />ordi.an.G dd Sr.r. L.ws r€lalins ro buildin! consloction. md hqeby a hooe r.r.eslalif6 oalhis C'r, dd Counly lo ors uFn de <br />abov. motion d propsry Io. iBpdiion purFs <br />Applicror o, 496r Si!.alur.: <br />Appliances <br />Metal 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 .ht'ltl r -*a\orA-/a-- <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 />I <br />Rough Mech.?.bflM aw{k tY <br />Final Test <br />Meter Release <br />FINAL il'*lr4 6yttra-lA-- <br />Notes, Remarks, Etc <br />MECHANICAL-INSPECTOR RECORD <br />Policy Nunba:-Erpitcr <br />- <br />I ctrJcr'' Ndr'c <br />- <br />: <br />=