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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hd.by alno urdd poslry olp€jory rhar I @ dcofl toh rh. (bnrEclo4 Licc.* kw for rh. folhwi.s r6;oi (Sc.7011.5 <br />BsinB &d hofsion Cod.)r tuy City or Coui y which .!+t6 ! pqmn b cotr tocl, !lls. inpl!v., &ooli9t or Epd $ystrucluq Fio. lo iG i$u.rc.. rle rcqliB $c appli.dl lor such pdri lo filc r lisn.d st6rodt rhar lt or snc is li.a&d pusdr <br />ro tn. previsioa offi. Conla.loa! Licci$d Llw (Chafld 9. Commdcins with Scrion 7000 of Division 3 oflh. Buin s ed <br />Prcfsiod Cod!) or llal h. o, shc i5 q.mpr lhedoe dd lh. bais for lhc all€s.d d@ption. An, viol,rion olsc.lio! 7031 ,5 by uy <br />applicant lor . Ftrrh subjels lh. .pplic&l lo a cilil poalt, of not 6orc th8, nvc hldrcd dolles (1500). <br />_1. a olrc olthc Fopdly. or oy .n!lor6 wi$ *ag6 a lh.ir elc conpa&lion, wiu do thc Nolt ed c studm h nori didcd oroltcEd for sal. (Se.?044. BEin6 ed P,obtioNCode Tt. Contra.loir Licft.tlvdo6@rspplytouoM(ol <br />tn pmrsty who hil& o. inipoG rh@!L &rl who dod Mh w* hinsclf or h6clf or thoush hir or h6 om anplorr.3. <br />provided lhat sucn inpm\EmIs e mt ir adld oroftr.d lor eL. l[ ho*do. $. hiildiig o. ii{ro6n fi is eld (itni. o.. t@ <br />ofmmplclion, th. O*M Builda w na!.d!.hdrd otFoviislh, h.orslcdid tut hoild oriEp.Dvelh.popqty fortllpir!.sof <br />-1, <br />s ownd ofln Fopaty. m .rclBiv.ly .odr.din! *Il li.otsld .onractou ro .oNlrud rn Fojd (Se. 7044. Bun6 <br />ald Profrsb. cod.: T!. Co,k..tols LiccB Law do6 nol apply lo d ownq of propqly who builds or imprcv6 rnr.on. <br />..d *,ho conlBcts for such Fojels wirh ! Co.lmcror{, licmen pmrmt ro th. CoirEctoas Lic@ kw). <br />-l <br />@ .reopr urdd S.dion-. B. & P.C. lor rhis r€en. <br />WORKERSI COMPENSATION <br />DEgdaaua! <br />I h@by srm und6 pa.lly ofpEjury oG oflhe following dc.ldrioE: <br />_l tavc rld will oainlain a cdrificar. of co,hr to s.lf'lNurc for E ldr' @nDa$tion, a Fondcd lor by Sdio! 3700 of rhc <br />r$or C.dc for rhc pdfolfu@ olrhc wort lor {fiich l! pdnir i. i$u.d. <br />Xl h6vc dd will Eai .in rcfto @op.66lon iBulmc. ,3 &quid by sedoo lToo of rhc t bor cod., tor $c pafolll@c of <br />rh. wl for shic[ thh poEn is isu.d My mlta @apdsriiotr iBll!@. @ia 6rd poLicy n@b6 e: <br />I -z //-//- 2atg <br />-l <br />.cniry $al in lhc p6for]Mc. oalhc wort tor which $ie pmn is ia!!.d. I shall nor mploy any p.6on in my mm6 <br />e a lo b6oo. subjd ro rh. qo*6 .oapdsaion las ofcalifonia. dd ssG lnar il I should b6oa. subjer b rlr <br />wort6' comp.sarion poviioG oa S.dio( 3700 of rhc t hor Cod., I s\!ll fonhwhh onply wirh thoe povisioa.. <br />WARNING: Failur. lo sr€ &rk6' codn trerioa cowr. is unlastul. ..d shall subjd oployq lo giminal FBhi6 d <br />cilil 6nes up ro odc hundroJ lhoBdd dolld ($ 100.000). in addnion ro lhc con ot conFMrion, dan s6 6 provid.d lor rh. <br />s(ion 1076 olrhc L.bor Co(lc inrEd d.rorney' <br />,"*. .l/- 9'24/ n,o,*,,x/* <br />UCENIEI.CONIBACIAA <br />DECI4AAI,IAtr <br />I h6Eby afim und6 ,@aty of pdjury thal I @ lico!.d ondd pr!vi3i@ ofcl'.plq 9 (.oMtuing wnh Scrbr 7000) of Divtion 3 <br />or rh. BBi!B &d P.of.sioB Cod.. @d oy tic@c b i! tull forc &d cff6r <br />/,<-1 c/)77 3)tr7 <br />,*r, t 1/-r-2o/g c*r*a,x ,h.-t.l^ /2-- <br />CIIIIIBIICUON.IEIDIIG.AGEBSI <br />I hftby .lIm ud6 F..Iy oa pajury lhn rb@ i5 ! @Dtdctioa kndiag .g@y for th. p6fo@.. of th. wl( tu whEh lh! FDn b <br />isu.d (Se. 1097, Civ. C.). <br />t nd6 r Ad(to: _ <br />AIIIJCANI.DECI.AEAIIO! <br />I hadry .f'rf, urdd poaXy ol pcrjury oi. oilh. following dcbitio8r <br />D.nolirio. PmteAsb6ros r,roifr..iion Fcddl Rcsul'rioB (Tirl. 40, P.n6) <br />-R.qun <br />d Ldlq oatlori6elioD <br />-l <br />cqdry rbd t. red6d '.Sulrlio4 r.s&dins ahslos r@ovrl @ nomppliobl. lo this pDj.cl. <br />rll d iry rhrl I hav. @d lhis 6pplicalion od {rlc lhd th. .hovc infomdion is coner. I asre to .onply wirh dl Cny ad Counly <br />o.di!ac6 ed St . Lls ckrillg ro bilding .on{Nctior, rDd h4by .utfioriz. rcF6orxtiv6 ofthi3 Ciry ed Couty lo dlq ugon $. <br />abolr mdrion d prcrfty lor isperion purpos6. <br />Appli.dr or Asdt Sisnarurc:><4 <br />r*ir**"1p".g,.K Aap Ja.lron <br />7y_ e_2ots <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 <br />Vents <br />Toilet Room / Clothes D ryer <br />Residential Ran ge <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. D Test <br />--ffi lkzt-/u-./)rJol v-fh <br />( <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL V2-l/-/l r /r+/*-a"k <br />Noles, Remarks, Etc. <br />Above Hard Lid <br />Above T-Bar <br />--r------ <br />[ -T------ <br />f --T_------ <br />f --T------