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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.owN0R IttJtt,DttR Dnt,(ARAl'toN
<br />I hc,chy drlin ull(r F-,r"lry,, FUU'y,l-r I n r\c'trrr r"{r,h. nrnr.tr1 F' Lrchc Ls f.r rhc n lh{'lF .J",r ;scc.1rrr '
<br />Bu\inc\\ dhd I'rol[\\n,n Gilc) y Cirt or cotrd, whi.h rcqtrtcs r tEmir r, con(ocr. llrcr. imtnrt. drtrFlirh .r rFn Jtry
<br />(ru.rui.. prktr k, ir\ is\untr... r(o rcqutcsrhc dmlicnfl rbr such $nnirro nb ! \isrcd drrcmn hr h.or \hc i( li.ctr{d puNrtrrl
<br />ro rh. prori\ionr olrhc Co.r!ckr'\ l-ic.i\rd trw rChrlrcr 9, Coinnrmrne w h Sccrbn 7fiIl ol Divisi('n.! of rlt Burirr.s thl
<br />Pofcs\ion\ Codc)orthrrh.orshc ncrcnu lturcnomnnd lh. h.si\ Ii)r rh.xllc8cd.rc Dri(,n An!!i.l$iqnorscclirnT0.ll5byony
<br />appliconr lnr a pcnnir nrhj(hrne applicnnrbxdilp.mlryol rnr m,crh,tr lllc hund.cddolh6 (S5lr).
<br />-1.
<br />as owBr of lhc pmpcny. or iy chplores wilh s.8cs s lhcn sb corwtrdion. sill & tlE vst &d lhc in$@ h hr
<br />i .1d.d or oltcrcd fM olc (56.7044. Busire$ @d Prcfcsio.t Cod.r Th. ConFactoas Lians Llw db6 nol sPply b e owmr of
<br />rlE pmFny sto boitltor inpmhs tlire !d wlD.tBsh h.t hin.clror h.Rlforihrqh hn orhsoM c,{rloye..
<br />r,.oyihd rhar such in mm.rs e mr hrcnd.d noltu for sh. li tn"l$. rlt brildirg o, i,pohmd G $ld vhhin oe Jer
<br />of6'r*tion. dE O*M Builid will h.E 6. boldei of F.vi.g thd lE or slE did ml hild or inrrot thc lEpory fo. IIE pu4D$ of
<br />_1. ri ownc, of rhe p.Fny, d cxclNiwly conrmclinS wilh licc@d ndfld rtE poj.{ (s... 70{1. Busimss
<br />dl Pnnil\ii, aod.' Th.kktr s Liccnr ljq des frn tw
<br />prcirrs *irh u coirdclod n
<br />I hcrchy trlfirnundcr pcnoll, orpcrjlrroic orrhc lnlk,w
<br />-l
<br />hrvc rurd willnri ainaCcnifi.rrcolCosrtrrhs.lflnn&r,trs.ikorjcoqxnsdion.as!tridcdfo.byscctn:17{Dnrrhc
<br />Lrh, c.dc.larthcl[rfonnrnccollhc so ntrwhi(h lhc pcflnil is i\su.,l
<br />rhc *ork f{rshichrhi\ lcnnir is i1\ucrl My$ork.N conrFn\ili(r i.\tr!r.cclricr il lx,liy nu'hb.rdc
<br />l cnify rhor itr lhc r.rformrrc ofrhc wort for *hich rhis pcrmir t hsucd. I shrll nor cnploy a.y F(on in any mnmr
<br />so !s lo b.rrB subjcct lo thc wo,lsl omrEisarion lass oa Cllitomia, and agm rh,t if ! should beom slbj.tl lo lhc
<br />works$ or{xnsalion pmvisions of Serion lTUt oa thc Llhr Code. I rhlll. fonh}arh .omply *nh lhE prcvisions.
<br />rhousnd dollar lSl00.m0r n. drm8cs .s Fovidcd lor lh€
<br />il
<br />I hcEhy al[flnundcr pcMlryorF jtry rhar I in liccnyi u.dcrl]ruli\n,n rciry *irh Sccrb T{Xx)) olDivki ]
<br />ol thc Busir{s.nd PrclcssionsCodc, and mr licensd i\ in tu||tuft itui cffd.
<br />-
<br />Corlatoi
<br />c(rNsT*ltc'floN r TNDINC AGni\cY
<br />I hcrcby ltfim undc. pcorlry ol pcrjury rhar lhcrc is a consdcrion lcddinB r8cn.y fo, thc pcdbrmane ofrhc work ror shich thh P.nnil is
<br />issucd (S( 1097,Civ. C )
<br />dTIIIC,/INI.DLIJ,IAAIIQN
<br />I tmtrrlllnnunlcr pcmliy ortrturt onc ol rhc follownrS dc.h6rnlr
<br />ocmliiotr P.nnir!AshcsolNoriiicrrnrn [:cdcr!l Rcs!hrn,n\(Tirlcl0, Ptd6)
<br />-Rcqrtcrl
<br />lxrrcr ul Norifi rdidn
<br />I ccniryrhm rh.lid.nl
<br />I ccdily rhar I havc rcnd rhis imli.atio
<br />odinorces and Srrrc ljws eurine rol,xiU
<br />n i\ c.nc.i I agrd. r{) ..'npl! wi
<br />rhoria rc!rcrc arivcs of ltis Cily lnd
<br />aholc Entiorcd ropcny for
<br />Appli.dnr .r Gctrr Signrrurc
<br />Pqnit6 nam (Irin0:-
<br />q
<br />v
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<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 />Hough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL ;f*lq n ',rta\t&li,/2D)
<br />Notes, Remarks, Etc r rl \t
<br />COMMENTS
<br />Duct Work
<br />Vents
<br />Hood
<br />R,lic' Nrn,hcr:-Expircs:
<br />-
<br />norlPplicnbld ro rhh rmir
<br />tt
<br />I
<br />=
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