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MECHANICAL.INSPECTOR RECORD OwncrBuildd L).ch.ntion I hd.6y o,Ilrm undg p.Mhy of perjlry lni I !md.mpt form lh. ContoctoG Lic.N. L.w fo.lh. followi,s raon (*c 70t.5 B6in..s s.l Prof6sion Codc): Any Cny or Couly wnich rcquiG ! p.rmil ro 6slDcl. rlrE. inprovc. ddolith or r.plir my nrucrEc. For ro iB irluncc, als r.qun6 $. lpDlica.l for loct pmi lo fl. . sigNd !hl.m.nl lhar lrc or ih. i! liccNd puRul lo lh. poviiioB of th. . Conthcror'e Lic.B.d hw (Ch!fls 9. Cohmencins witn Scoron ToOo olDivirion I of$. BBinsslid Prof€3ionr CoDrl rkt hc or lhc i! ci.mp rhccfion a.d rh. b;n lor lhc rllcgcd .imflion .Ary liolllio! of Scsio! 701 I 5 by Ey lrplicanr t r . p.mh;!j .d! 'hclppti.r.t to ! civil p. nyoa.or nor.thm fiv. nudrcd do0d(l5OO). _1. e o*nd.f th. pop.ny. or my .mploy6 a hh ura6 .r th.t rol. comp.ns iotrwilldolhcso*6drh.3hclu.b no' i 6d.d 6r olr.r.d for s.l. ( 56 7044. Aam.!! !6d Prof.sbn! Cod. Th. Conlrlcror'3 Lic.B. L.* do6 nor lpply ro .n oM.r ol lh. ptupdly wno builds or inprov.r lhd6.. ed *ho do6 3kh work ninklf or h6.laor lhrou8h hii or n r own .Dploy€, provid.d lhll ruch ioprov.ndls &. lor int.nd.d or off.(d ao. !.1.. lt howcvd. lh. blildas or inpbvcd.ot ir 3old suio on. y.a oa.oopLrio'1. lt OxtucBuild.r will h!v.lt bfd.n ofprcviog thlr hc or3h..or build or inprov. fo, th. purpos of!.L). _l. orown.roalh. prop.ny, @ cx.luriv.ly co.lddirs uirh lic.6.d conr&lo6 to coNmcr rhc prcj(l ( 54,70.14, Buin6! ind Proa.$En Cod.: Th.Conrocbr's Li.cB. t e do6 ,or rpply ro e o*"n oa p.op.ny who builds or if,prov6 thd.on , md who @nl,!crs lor suct proJars * h ! conr,lclo(r lic....d puBu to rh€ conracloir Liccnse bv ) I mcxdpl undn Sdion .a. & P.C. ror rhi, r.en. D.lc: 0*!61 worl for *nbh lhi p.mn n i$u.d My wo .R' ceid: rr V a rra^ All rbn i.su.rnce Gtrier lnd po[cynudbst..: ,^*r*^*lW- -rxpu.s:- rn" *r., *.i n r u..o,npr.,"o,trr'.ffi' to, & nuna,.a aoltiR lrt0ol or t.s) l..nily thai h rh. paaolmn . offi. sort fo. whi.h rhir pdnn Ls isu.d.anploy.ny p.soo inuy mann.rso sto ih. wo.ker ' 6np..$r ion laM of crlifornia, rcto tecuGwort.s comp.nsalFn covsrge s u.l. and shrllstrbjecr rn enrplo!er ro cn 'nalpcn.ltes rid.'v,l fm6 up ro oN hddrcd tlDwlnd dolh6 (1100.000).in .ddnb. ro rh. .orr of .omF@lion, &mg.i 6 pbvid.d for llE S.cliotr 3076 of rh. hbo. cod.. i.rqd rnd rtuNy r l* t.l( l:\\I:t)(o\IR.\( t()Rsl)[( 1,.\t{\Il(r\ I hcrcby afilim u.dr pmh, or pnjury rhi I m li.6s.d u.d.rpovilionoa (comm.mins wilh Sation ?000) oa Division I ol:^y; I h.rcbyamm tr.dcrpcnelt,ofpcrjurr lhar rhcr.isr coBrtuclion l.ndins ry..cr aor lhe pcrlomaoc. olthc voA lorwhrch lhis pcnnn is is r.d(s6 1097-Civ ('.) APILISANISDICI.ASAIION D.molirion PdneAsb.sror Norific.lion F.d.El R.gulaiotu (Tirk 40, Prn 6) _ R.quiEd Ltlld of Nofi,l..rior _l ..nify rh rh. lcdd.l i.eul.lio$ rcgadins rmov.lrrc iol lppliclbl. ro thi p@j<r I ..niay thar I hav. rad rhh ion is cord. I asr€. lo comply sith .bov. rcorioo.rl pop.ny aor APPROVALS DATE ID/SIG. Appliances Metal Fire Place Evap Cooler Furnace Compressor Misc. Equipment Duct Work lnsulation Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release FINAL W1c"\S,A M:WP51\P6.mil-lnspoc!on Fo.ms\M6chanicallnspector R6cord.doc 03,31,06 r.pr6mr.liv6 ol lhb Ciry ..d COMMENTS Pre-lnsulation Smoke Detectors lnstalled I/IaBEEBS.C!TMS!!!4!Q!.pEC!484rO! I h.r.b, rmrm und.r pcmlrr o aF.jury on. ol rh. tollosing d(la6rioB: __l na!.udEill mainlain!Ccnifical.olCoccnlro S.lilN!r.lor uo.kerc' co.rp€nsron, 0s provd.d lo, by S{tDnl70oollh. t b.rCod., ior (h. pnaolmm. of rh.work aorshi.h rh. p..mn is nsu.d. I h.ve ind w'llmrinhin uortcrs conrp.h$ho.insuran...!s,equtr.dbySecuonrT0oofth.l,borCod..forlh.p.rformnc.ollhc 1?00.fih.lrt[r(.od. I odinincB and Statc l-aws f-T- I