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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 />= <br />I