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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DELCAR TION
<br />I ncrc6y affEn und.r Fulty of Frjury rh.r I d cxcryr rmm rhe Conlructon Licnsc kw for rlt lollowing Eas, (Scc.7ol l .5 '
<br />Ausin.s ard Prclcssion Codc): Atry Cny or Colnry wtth Eiuircs ! Frmn lo @n$ru.r. rlro, intmr. &ml6n or E an an,
<br />snldlG nrbr ro irs issucr.. lls rcquircs rhc applica for such Iimir r. lile a siSn d sl.l.mnl lhll lE or rlE i\ lien*d !!i!.m
<br />ro rhc povhiotrs of ltE Corrrlcror's Li..nscd ti* (Chuprcr 9. Codftn ing wnh S.ction 7(x[ ot Dirision ] ofllE Blsinc$ ud
<br />Profesrion. Codc) 6r $ar tE or rh. is cr.nq $.Efroo Md lh. ba3is for thc rlhScd .rcmnlio.. Any liolario, ot S.dion 7o3l .5 by a.y ,
<br />E,rpli.anr for ! prmir subjers rhc atplic! to ! civil p.nllly of ml mE th8. nvc hunrlred dolh.r ($500).
<br />_1. &i owrcr olthc pN|*ny, o, Dy cmplotrcs vilh pt8ca rs ihct sL olnpensalio.. *ill do lL wrt ald dE nndE i, mi
<br />inlcnd.d orofrdcd for elc (Se.7044, Business d Prof.siom Codg The Connmlo! s Li..n* Llw docsnol,pplylo Momr of
<br />rlt rnpcrty slb hrlds or iqioB 0ENn. ,nd w,F dB *h h* hin*lt or h4elf or lhouSn his or h.r ovn cnplorc.s.
<br />[ovidcd rhal s!.h nill,mvcmf,k @ ml inlcnd.d or ofiscd for sh. lf. hosw. ltE trildiry d itrprrEmnl is $U wirhh onc ]Ea
<br />of Enplcri.n. dE Oemr Buithr will haw tlE bodcn ollmvir8 thd rE or rlE dil rcl Ldild or nqmt lh. I,orEry for rlE plFe or
<br />-1,
<br />osowrcrolrhc lmpcny. an.iclusivclyco ncrirs *irh lic..$d conitudo t, snnruci ilE pmjccl lS(. 7044. Blsin$s
<br />dd Frlcs$6 codc: Thc contd.tx s Liccnsc Ljw do.s no( apply ro 0n owner ofplopcn, wto brilds.r inprovcs rhcrcon.
<br />and *ho co Bcts tor tuch pEjccl3 wirh , Coomc(.(l) lierscd lurrlelo rr* Conirulors aiccns Law).
<br />-,
<br />mcxcmpl undcr Sdl B & P,C. i(trhi\ rcasotr.
<br />IOBf,E8S:COMIENIAIIAN
<br />DECLARATION
<br />I hceb, lllirnoidq Fndry 6l pdjury on. ofrh. rollowane dccharaons:
<br />-l
<br />hae atn will minllin . Ccnirf,dc otcrncfl ro Sclf-lniurc lor wt6 .omFnsalion. rs pmvidcd for b, Sdlio. l7m of llE
<br />L.bor Cod., fM llE F folrrwc of llE qdt for whkh llE psnn B issucd.
<br />A hrlc,nd siU tuiorain sorkcc .onp.nsarhn iNurrn.., ns rcqunM hyScfliotr37(Doflhc til,nr Codc, nnr
<br />rht *ork lnr*hichthis p.rnir i\ i\su.{ My (or kcN onlcncdion iN!tra cricr srd,Flicy nlmhcr e:ail+z_-
<br />(a @
<br />-l
<br />e.rity rhar in lhc p.rtorm@ of rhc work lor shkh lhis pdnir h issucn. I shlll ml cmploy lny pcMn in lny Mer
<br />s s to b€om subF.l ro lhc wolicrl smpcnstiotr h*s ot Califomi!, and lcE thd il I sh.trld b€sr subj.cl to ltr
<br />mrk 6 onrFnsolion prcvisions of Scclion 3?00 orlhe L{lnr Code.l rhall. fonheirh o,q,ly *iln tho* pmvisions..
<br />WARNINC: Failun Io surd {orlr.rJ.onrFo\rn,n c.vcnCc i\ unlnwlal. lnd shrll suhjsl an cmpbrr r. dinin.l Futics 0nd
<br />.i!il finc\ !p ro oN hunded rhousud dollds ($lu).fin1. in ddirn,n b rhc cost o{ conl.nsslion. duroscs ds provid.d ror th.
<br />int.rc.i d dromyt rk.
<br />ZO
<br />LEIINIIID-I!'NIBACI9A
<br />EILAAAII9Ii
<br />I hcahy drri,,n undcr n tralry or p",j,,y r t ur t 0,, tl."n*a ffiiii.i.-Jchal,s e (conmEn.ins wnh scd ion 7tx[r or D\isid .]
<br />or rh. Bu{ksr dnd Pn,rcssiorN Cod., ,'i nry licensc is in tull ntre ud cll(r.
<br />CZA .,,,,*,7??/7A
<br />Z)Z,Codncror l-
<br />caN$:Iaucu0llllBDlNc-acrr!.Y
<br />I hcrcby llrlnnr udcr t^-.nalr, orFrjrry rhnr rhcr. i\..on{fldi,n lcndire igctrc, irtr Ihc p{rforronc ofrhc }ork tu $hth th,{ Irnrir il
<br />i$ucd (Scc.:l(}97.Civ. C )
<br />_l c.nitrhr r)tr t.dcrrl rcrularidrs E8:din8 r\h.(o\ ttrx)v.l nrc tror.pt'lic,blc x' rhtl,r)jccr
<br />-l
<br />c& iiy rlnr I hnvc Eld rhn &ppliur i{r rdl {rrc rhrr rlr rh'ec ilronnnr nr t con(r I rsre ro comnl} wnh lll Ciry and CoMr,
<br />ordinaRcs lnd Srsrc tlws rcl,rinr ro building .onslru.rioc lxl hcrcby aurlbri& rcprcenlllvc! oa rhis Cily
<br />.n)E mnr ioned pmpcny for in
<br />Apdic{nr or Ascu si8narurr z7\
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lVlisc. 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 Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />Installation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release l^.
<br />FINAL 7/L/.ID zt tA-?il /
<br />Notes, Remarks, Etc.-)t lr'
<br />L.n<h. ! N!m:
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<br />t nds\ Addr6+
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<br />APIUCANTDI'SJAAIION
<br />llErhylmmhncr p.n3lly oipcrjtrr, one otrhc rolbsiis dccldrrnrn\:
<br />Dcmolirn,n PcirnirrA\b.nos Norilir.ri rtdcr.l Rc8ul[ioos (Iillc 40. PlnO
<br />-Rcqutcd
<br />Lllreiol Nolintuii,)n
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