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MECHANICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcny atfrn !nd* lcnuh, ot Frjury rh l M cxcmfl linm rh€ Conrridor' Li..nse Liw ror rh.followi.g ersn (Sc?031.5
<br />Ausi.css ,nd Profcri.f, Cod.)r Any Cily.r Coum, shich rcquirs a Fnnil lo consldcl, 8lls, improt. d.mlish or ElEn any
<br />ntucturc. prhl ro ns issu.re, also rcquiEs rhc nlrplicor for sucn p.ni o filc ! si8ncd srlrcftfl rhar lE or she liccnsd pu^usr
<br />b rh. ,rcvisioos .f th. Co.l6mli Lianscd tiw tchaprr 9. ComcBing wirh Scctio. 1m0 ot Division 3 of thc Blsincss and
<br />Pmfc$ions Codc) or lnrl lE or sh. ir cxcnll lh.rcfroo ad lh. tasis lor lh. alhBcd cx.ftr,tion. Any lioklionotSc.lion 701!.5 by rny
<br />apllic! tor r lcmir su$rcck rhc applkafl ro r civil pc.lhy of not mrc rhan fivc hund.d dollaB ($500)
<br />-1,
<br />as owmr of lhc proFny. or my cn{loyes *ilh ws8cs !s lh.n st onlpctrslhfl, *ill do rhc wk ajd llt smrr@ ii mr
<br />inrcded or o,rcdl fo, slc (Se 7014. Brs,esr and Potcssioos Code: Thc Co relors LiccnF hw docs ml apply lo d own* of
<br />Itc rm!'c.ly vth toilds or inu,o6 lh.@a ,nd who des Mh ei( himiclr or h.nclt or lhm!8h his or hs own.mplorccs.
<br />,mvidcd rhar snch inpm\ttrnB s d in.nd.d n oitu ror sh. ll how.M. tlE building or iqmtml h $H wirhin onc ,!u
<br />ofco'r{,lctbc rtr Ovrcr Buildd eill tar deh e. of lhvin8 $d hc or stc did m lioild or iqrcw $c lrop.ny for rhc pflns of
<br />-1,
<br />as owft, of rh. pmFdr. m cxclurivcly .o.rodinE wnn li.cn*d .onrract,s ro oncrrcl llr omjEr (S*. 7044, Arlio.st
<br />ad P,trltssbn Cdc: Thc Conincrort Laccns. Lrs des nor lnnly ro an own ol propcny who btrilds or improrcs lhcrsn.
<br />snd who onrmts for suci Foj(]ls with c Co.ttrro(s) lkcr*d puBu&r lo rhe Co Ecrols Lhnsc kp)
<br />l rcxc rt, uM.rs..rn . B & PC f(trrhl\ rcxnrr
<br />!:Of,KEB.t1;OIITENIAIION
<br />DEOAAAIION
<br />I ierehy ottunru.dcr pcnlltyolpcrjurroN orrhc f{nhwins dccllrrrn'n\:
<br />AI hxvc {rl will nEinraii r C.d iararc or con{n! b sclf lo\urc ln sorl.B $npensnttun. .s Imvidcd ror by Sd ior 3?00 of lhr
<br />L.txtr Codc. lhr thc pcliornutrlT of the \ut for *hich lhc pcnni is nsucd.
<br />_l hdvc dd wjll ndinrdn work tr .o'npcnsun n iuuancc, ui equircd bysdrion l7t() olllE t borcndc.lor lhc pd{or.ec of
<br />ihc aort ror whth inis r..mn ir h$.d. My workds onFNdion iNrrmc cmiq .nd roli.y nun$cr ds:
<br />- lA< .- l,+14<,Vt L..
<br />Ll
<br />-l
<br />ccnify lhat in lhc rrfornEme ofrhc work lin *hich rhh pcrnit is islued.l sh,llnor cnploy u.y rcso. in 0.y fl0ncr
<br />$ as ro tE oc snbirr ro rh. workgs .on{Ensdon la*s .l C,lifomia. rnd !g@ lhol if I slnuld tE{om s!bi*' ro lhc
<br />woics omp.nsri.n pmvkions ol Sdio. lT0o of lhc tihor tu.. l shall. fonh*ilh comfly *ilh ttss !rclhioni..
<br />WARNINC: F{ilurc lo *c@ sorkcn orycnsrion orcEsc i\ unhwful afld sholl subjc.l !. cmplo}ir ro dlminol Ftrlkis and
<br />civil nncs up lo om hundrcd lhou$nd dollm (Sl n to rhc con ol comn nsarion. d{m*es &s prcvA.d for lhc
<br />DIICLAEAIION
<br />ol rhc lluincss od Eoic$ion\CodD. d my licersc ir in iullhrccrtrdcrlccl
<br />o t za
<br />CoNSTRT'(:T(tN I.FND!N(i A(;I]NCY
<br />I hcrchyallirnrundcr Fnnlryolpcturyrh rhcrci\rcon\lruclionkniiisugctrc,tnrrh.pcrlonrn&ofrh.trorktar*hi.hthl\Frniris
<br />h$.d (Scc :1(D7. Cir. (-)
<br />AIILlCrlltLl2XCL III0N
<br />I lRhy illi' rr un(lrr |[frl!y.Ilcrju!.nc ollfu l,irlii*ifr n.clI i,r,\
<br />I)rin,l i.n P[n,ir\ A\h.no\ Nori,ir]rinr lrc ..rl R.FUlntrnr r'l Lllr 10 Pr'16)
<br />._ R.(tun.tl l-.rh ol Nohli.dion
<br />-l
<br />ccrliay lhd lhc ltdcml Eguhlions rcrddin8 ostEslos HmEl m not lppltabh lo rhi\ pojcct
<br />-l
<br />ccnirt iha' I havc Ead rhk atplilrbn nnd {arc thd rhc ltrvc inrornuiinr is.otrsr.I u8N to clmpl, wirh ull Cirrand Cornrt
<br />.rdi'rn.cr lnd Starc Lqwr rclarins ro hilding.onsruc!io., rd her.b, rhorirc6p$cnr{iv.soarhisCiry0ndCo!trlytoc.t.rupontnc
<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 Ranoe
<br />Other
<br />Hood
<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
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release A
<br />FINAL il-5-t I x.wlL)
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />/ -7a
<br />Scdi(in 1076 o,&.]4!, Cklc. i crc( and
<br />"*, r-L7-ll/
<br />?t 4'lL
<br />l..n Ldt ttc
<br />-
<br />Llndq! AddEs
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<br />^-,
<br />q-L)-/8
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