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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNER BUILDER DELCAXATION <br />I heEby lrrd !d4 pcn.lry of Dcrjury that I m er.mrr fod lhc Conrdom Li.rn* Li* for rhc f6llo*in8 Er$n (1470315 <br />Blrincss and Pmfcsiofl Codc): Any Cily or Counry *hkh quircs ! Fni! lo strnrud. tlrs. in{,ovq &mlirh or rqrt snv <br />srtucrurc. prior b irs n!uai.c. ,ko nquircs ln ll'pliclnr tor such Fmil ro fiL a si8ncd sralcrnl lhnl hc or sh. k liansd Iu?$d <br />h rhc pmvhiom of thc Conlrocrols Li..nsd hw lchufler 9, ComncinS *ilh Scclion 7000 oaDivision I of lhc Busiftss 4d <br />Polcsions CodO or lnll h. or shc B excf,Pt lhercnnn ud rh. bsh for the rllcg.d erer{iion. Any vhlarion ofsccrkrtr 7011.5 hv mv <br />lpnlicrnl for s pcmil subjccls thc dppli.a ro a.ivil!.nahyoftul melhrn tiv. hundmd douars (5500). <br />-1. <br />N o{er of rh. rftp.iy. o n} $Iployes wilh w.a$ !s lh.t $L @npcnsriotr, will do tlE wo* a.d lt! slrulr is rcr <br />intn!.n o. otrcEd ftr slc (Se.?O14. Burie!. ind Pmf6sio.s Cods Tnc Conlridoi3 LiccM t:w docs ml arply ro d owrcr ol <br />rh. FarEny shot ildc 6, inpmrs lllm atdqn dcs rch slt hirelf or hcelf o, .hftu8h hk ot hct own c'r 016. <br />provid.d rhll slch itrqhlmnB e ml inldrH orof,.td for slc lf. hoftwi rh. hildins or inPrftm h $ld witlifl orc rle <br />ofcor{,hriotr r O*ncr Blildo will he ihc bor&n ollmvinS thd h. or ste did n.t buiE tr in{,ot L!r. ODlfiy lm tlE l,urPs of <br />-I. <br />as owmr .f rhe Eorcny, am cx.l!.iwly mnrkrinB wilh li.cnscd .onlreroB ro oBrru.l lhc pn'rc.l (S( 7044 Busmrs <br />ond t\oftrsi.n Gnic: Thc Contmlols Lic.nsc l-aw docs ool lnply ro u owncr oflm|,cny who bu ds or imlmts rheron. <br />s.d *ho conhcls lor such poFts wnn a Ci.rado(s) liccnsn ,ru6u.r lo rh. C4nlmrols Licc.e liw) <br />l0flcrc'rpl undcrSslion-. B. & PC lorthnm$tr <br />lyQf,f,lxs:loMlENs rlQN <br />II&CLIEAUA! <br />I hcrcby 0ffirfl undcrycn.hyof Frjutyom of rhc lbllowitrS debErions: <br />-l <br />hlvc id will Eintain 0 Ccnifrarc of C.n*nr er scl n\urc tu sortc6' comlE slt ion. 0s lmvidcn (, by s..(iun 1700 of lhc <br />ljbor Codc. lor rhc lcrfomrkc ol llrc qo,k lor which rh. Fmir it issucd. <br />I h.vc and will moinhin eorkcB .onFr\alion insurane. as rc{uncd by S.crion 3?00 of th. Libor Cod.. for lic pcrformd of <br />Ihc Rort for stich lhis tmil is hsxd My *orkcs conpcnsalion idsutue ffis and lDlky otrfib.r m:lrt. <br />1lt I t1II <br />-lccdilyrhor <br />in rk pertor@mc oflhc work for qiich lhis pcrmit k issucd.l siollflor crplornntl).son in anv monct <br />s {\ b rr.om subj.rl lo ltu uort6 @dp.md io. laws or C.lifortria. aod as@ thar il I .nould tEom rxbiti ro rhc <br />work.tr'ompensorionpmlhioniolSdion3TmofrhcLiborCodc,lshnll.fonhwirhconDlr*irhrh.s,mvisions.. <br />WARNINC rrifurc tu *\urc workcn comncn\rrion unhstul. and \hnll \ubj$r an cnDloyrr ro 6min.lPmhic{ lnd <br />cilil n.c. uI ro om hundrcd lhousand d{nks ($l 6l.omFnslion. dm86 13 pmvidcd for rhc <br />Lltert lzT111 <br />l lct.r\.,stit) (t()N1 R.\c t ()lt <br />DICI.A&IIION <br />t h.ehy dlth undcr ncnlllyofpcijury rh,t I an liclrsd urdcr Pmviio. otchrrr.r 9t.onrmncing wirh sc.rhtr ?tuo) oll)ivisioi.l <br />of thc aDsims and Pmfcssions Gdq ari 'ny liccns. is in tull forc a.d cr'tuI <br />220 <br />i L(/l,^- <br />(rtNst Rl( tr()N t,t.:Nl)lN(; r\(lliN( \' <br />I hcrcby affirm undcr ncnltry of rctjfiy rhar lhcrc n 0 conslruclhn lcndins tScncy tur lhc Pcraomncc ofrhc work ior ehichrhn p.dir i\ <br />iqsucd (sN 109?. civ. c ). <br />L.ndr'r Add..s: <br />A.STIIIANIDECIAMIIO! <br />I hrchyrfitmundcr Fnnlr] ofpcrjury onc ofrhc followinS dc.l$ io.r: <br />D.molnion Pcrmih Ashcsros Norificrrion Fcdcnl Rc3uhnrns ('1ir1..10. Pd(, <br />_Rcquird ktr.r ot Norifi {d0r <br />-l <br />.cnif, rhd $. f.d.ftl rcSul.lions Eslrdins !rt*{o\ 6mvd ,rc nol smli$bl. 16 lhis !o}:t <br />I ccnilyrhlr I hlvc rcad ihnlmlic thd thc dt'vc inrordion t corcct.I ssxe ro.onpl, wirh allCilyand Counl, <br />ordlkn.cs rtrd Shrc Li*s ElutinE I hcrcby uurho' i/c rqm{nrrrivcs o <br />abvc nEnriorcd nslcny lor in <br />Tr*!\ <br />f rhir Cnv,Jd Coutrrv ro lnlE umn a <br />^,.' t /za/ls- -T----- <br />Appliances <br />Ivletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Itrlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room i Clothes Dryer <br />Besidential Ranqe <br />Other <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid ilzaln t vl4n4c,ou (''rr/ <br />Above T-Bar Jr <br />Rouqh Mech. <br />Final Test <br />Meler Release <br />FINAL x-s-t1 <br />^.\4UNotes, Remarks, Etc. <br />lnsulation <br />Hood <br />/n\ <br />---T--r <br />I <br />I <br />-T <br />tD/stG.