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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DET,CAR TION <br />I heby a,Im und6 p.Elry of pdjury rhn I d dcBfl nln lhc Conl&,roB Lic.Be kw aor$c lollowirr l@n {Sc.?Oll.5 <br />Buinds ed Prof6sion Co&): A.y Ciy or Coufly whicn r.qniG a Fnn to conse(r. all6. in!rcv.. ddDolish or <br />'r?6n <br />ey <br />str!(u.. Fior ro iE s@cq atso rcqune thc rpplicdl for such pdni lo fiL t si8f,cd tlaloal thtl h. ot slt i! lic@d pwad <br />lo ln FovisioB of lh. Conrracroar Lic.n*d Llw (Ch!/Gr 9. Com.ociog qit sction ?000 of Divbion 3 of lhc BalB ed <br />Pbfsions Codc) or thlI t or shc i! dcmpl rh6.ton ed rh.bsi.lorri. alLged qmptiotr. Any viol.tionoasetion 7031.5 by My <br />ap?licetforapdnisubj(liln.pplicetlos€ivilp.nanyofnolmorcthdfivchundrcdd!ll6(1500). <br />-1. <br />s owd oldE proFny. or ny .mplorE with wag< 6 fi.ir $1. ompsBalioi. aiu do 0t @* otd $c nrud@ i @l <br />ifldirkd or ofi6.d fo. sl. (SE,7OI4, BEi.B 6d Prefcgsioa Cod.: Thc Conrrlcloi3 Licc@ lrw &B .ol 4ply lo e 0116 ol <br />llE Frp6ly who hil& or irproG ttogs dd vlE {h€ tult elt incclaor h*lf or lhmus}' his or hn o@ cmPlorc. <br />proridcd rhal !u.h @Fov@at mml i.t6.LdorofftEd for uL.li ho@.lhc hiildiiS or imFDrErcil is $B vthin on.,@ <br />olconpkrion. th. OMer Bdld6 will harc 0E hlda oaFoving lhd h. or shc did ml hlild or inFov. tlE poFry for dE purpos ol <br />-1. <br />s oMd .f rhc pnFty. e .rclcilely conlrs.ling wirh licG.d conlmloB lo oisltud lh. F.jcd (Se. ?044. Bsiod <br />,i Ploftsbn Cod.: Th. Coorracroa, Lic.os. Law do6 mr rpply to s owq o lpropqly pho buil& or inprove thdon, <br />md who @nrads tu slch p.ojd! win. Cotuacro(, lic.c.d p!6un to lhc conrr.crois Lic@ ti*). <br />-l <br />e.rdpr u ld S*lio!! , B. & P.C. forlhii lte. <br />l4aS6EEE-gqUrEN$rO!DEcldtalla! <br />I hdcby aflim unda podly ofpsjury of,c oflh. following dddlrio6: <br />-t <br />h!v. dd *ill @inl.ia . C6lifi..r. oacrBal lo sdf-lN for $ql6 @nlPo*lioi, s Flvid.d for bI Sdion 3700 ofth. <br />kbo. Codc for rh.FfoM. of lh. rcrl for sni:h th. FEir it isu.d. <br />_l hav. sd will minl.in mrt.R @npcetion L$utrq B r.quircd by Setioi 3700 of th. L.bor Codc, fo. d! Ff()tfu.c of <br />is issu.d. M, s'ork6r conp@dion insu&ce c.[is md policy numbd d.: <br />I ccnify th.l itr th. !..fomn.. ollh. No.k for $nich rhh prmil i! su.d. I shall nol dploy ey pa$n i. ey ntud <br />$ 6 ro b.conc subj.cr rc lhc mrt6' compqEslion laws ofcalifomia dasE lhal ifl shoold b..omc subjdl loll'c <br />wo*d' conpmalio, poririoN of S.clion 1700 oath. ljbor Cod., I slDll, fonh$ilh omrry wilh ltose lrovisioB.. <br />WARNINC Fdilur. to suc NorL6' comptrarion covdaec i. u.Lwtul. ed shall 3ubjd tu dplora to cininal FullB od <br />civil lincs up to one hundrcd rholedd doll6 ($100.000 lhc co$ of conp.@lio.. d,n.ad 6 providcd lor lh. <br />f th. Lpbor Cd.. in6..t @d .nocr's <br />U(EXT.UDjI)NIAAI:IOB <br />D[Ct BAUq! <br />I nscb| 0mnn und6 pcnaLty oapcru.y rh,r I tui licda_d tndd p'ovisio. ol(-h.prs 9 (co'nn@cins \nl s.c(id 7000) olDilision l <br />ol rh.Irusinsad Prolssions Cod€- ad ny lic.nsc is in lull rorcc dd cfittr <br />c6rl.0, kf Lerqfu-e, <br />colsrf,lcuoll.ElDDclclNg <br />I h@ty drm urd6 Fnilyofpcrju., fid rhd. i! a coE(fudba k'dils rsdry lor lh. Ffotfucc ollh. e ( 6r s'iicnthis FniI b <br />iso.{ (Sd. 3097. civ. C.). <br />AfxulAd.r.DEctaSALp! <br />I @ rtrun u.d6 paah, of pcjury orc of thc followins deldatiou: <br />D@olhioi Pmn$A!b6ro! Norilierio! F€d.r.l R.gul.riod (Tnb 40. Pdr6) <br />_R!qun.d tntg of Noiftdbn <br />-l <br />cdiry $.r thc f.dd.l rcgrlarioB rcradi.s ab6tos mov'l d. ior applicabL lo rhG poj..l. <br />-l <br />cGrify thar I have rsd this .pDlicrrion ad sl6lc th.l thc ab.v. i.aomarion is cor.cl. I agle b onply *ilh dl Cily and Counly <br />odinanc6 dd Sute Lass r.lding ro building coctucrion. dd hdcby aulhorEc rqr.$lativq oflnis Cilydd Counlr lo ord ul,on $c <br />abovc mqlioned pop.n, aor <br />Appli.ml or As6t Sigflatu.1 <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 Dryer <br />Residential Ranqe <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 />Rough Mech. <br />Final Test <br />Meter Release I <br />FINAL z//1/14 4)Lil ) <br />Notes, Remarks, Etc.