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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNER BUILDER DELCARATION <br />I h.Eby r'lm undo p.mlly of perjury lh,l I m cren fioh th. CotrtreloB Liccnsc ks for rhc following llsn (Scc.loll.5 <br />Busincsr oit Pmfcssion Codc)r Any Cily or County ahkh rquidi a tEmir Io consuu.l, alr6. imtor. &tulish or rpe dy <br />sEtrcturc, Itrkrr to ili is$Mcc. at{ Eqlircs rhc arplicanr lor sEh lrmi io nl. . si8md shrcmnr rld lE o, shc i! lkcnsd pursa, <br />to rhe lrolisions of rlE Conr6crois Licrsd t w (Chaprer 9. Contuncan! sirh Sccrion 7000 of Di"isirn 3 of $e Au.in.s lnd <br />Pmfssions C.dc)or lhll hc orshc h.remflllErcfom d rh. besis for rh..lh8cd crc,grion. Anyviohrionofsftrbn?0ll.thyrny <br />spt,licrnl for r Frnil subi.cls lhc lmlicanr io o civil ,cMhy ol not tur lhd nrc hundr.d dolhs (S5m). <br />-L <br />as owftr oa rhc I&Fny. or ny cnplores wirh wl8ss as rhcn ek omp.nslrion. will do rlx wk &i rrE sttrrw is mr <br />inlcdcd or o,Icr.d lo. elc (Se.70{4. Busim$ md Prctcsiir.! Code Ttc Conttu<lo,'i Lt€n* Li* docs not lpl,ly ro an ovtur of <br />rhc tftpcrly aio buihs or irynrts llEmr ud *to das Mh w t himr.ll or herslr or rhou8i has or h$ own.oplote' <br />tmvid.d thrt slch ihpmtf,Enls @ ml ir cnlcd or oficRl for sh. I[ hosM. rn hlildine m inlmwm i. sn wnhin om )M <br />ot 6r{,lcrion. rlE ourcr Blihd will h,vc rlE blihn 6f pmtns $d h. or nic dij br build or iqrch thc ForEty for rhc nurF)* oI <br />-1. <br />as owH of lhc pmlErty. ,a .xclusivcly codmljrg wnt [ens.t conl'acloF ro consrru.t thc pmir (Se. 7044. Busm$ <br />tud Pnft$id Codc:'thc Conlrslols Lkcnsc La* dms not applyio 0.pn$ oapro!.rty who builds o! implovc. th*con. <br />$d pho @ @ls lor slch |'ojrtrs wirh a Conrn(lo(, lic.n$d pusu r lo tl*Coflrmctols Li.cn* L!w). <br />-llncxc <br />rrr und.r Sc.rnnl .B &PC forthisrcrs.n <br />t)nr. {){ rr <br />WOR(FfS' COMPENSATION <br />DECIdAAIION <br />I hcrcby olfrmund.r Fmllyoipdjxryon oaih. Idlo{inE d6ls0rion(: <br />-t <br />hnve {nd will @i.'rin . Ccnitmie of Corsor ro Sclaln$E for sorlm @'npcn$tion. as ,rovidcd for by Sstiotr -1700 of thc <br />lrbr Crxic, ror thc lcrfo@ne 6f rhc wo* for *hih rhc pcrmir t i$u.d. <br />_l hovc.ftl will meintain wortc*i comp.nsrlion inrumncc,ar rcqlir{ by Seltun 1700 of rlr Lrbor Code. tor lh€ pcrlortume of <br />Ihc wort for *hich $is prm l is isucd. My *ork6s cxrtr !d polty nlmbcr sc <br />-l <br />enify rtat itr rtc Ilc formnc. of rhc wort lor w lhh pcimil is issucd.l sh0ll nol cnDloy o.y rc*otr inrnymnmt <br />s' I lo lx.om {bJcd ro rtu soris oqicnsarion lass of Ctrliaornio. lnd aEEc rhar if I should tEcom subisr h tlE <br />workcrj con{rdurion pDnisions ol Srclion l?00 of lhc t trr Cd.. I sh.ll. ionhwiln omply w irh ltFs povnions.. <br />W,{RNINO Failu,c lo s.uic wo.kcs com,rnsdion qrvcmg. i\ utrltrrfrl. lod shDll srhjdi !n cmnbrr x, simiul pculrics ond <br />.iril fi.cs u,lo orc hu rcn lhousnd dollors ($lm.Ou),ddirhf b rhc .osr of com!. {rion, danEgcs as pnvid.d for rhc <br />Sccr i{,. ]0?6 ot rhc I ltfr Codc inrcrsr on,l .t <br />7 <br />ucENsgr.golirxactaa <br />DEIJ.AAAII!]N <br />I hcrcby rfirnt utulcr pcnahy rr r.rturr rhlr I am liclncn undcr provision ofgrl|rcr 9(.onnmrcin-q {irh Setion ?000) orl)ili{ion 1 <br />ot rhc Busincs rnd Prcfc$ions Codc. a myli.cn$ il in rull ldtuc Ml.irccr. <br />e <br />AITI.ICANLDTCLANAIIO! <br />I ftNny r0nn uDdcr l)cnokyol p.rjDry otrc orrlr rollosint dc.lsrariims <br />Ilc@lirion PcirrirsAsnclt.s Norifi.0liotr lrcdc.rlRcBUlahutr\ (tirlc4r, Pan6) <br />R.qun.d lx .rolNoiificrriD <br />I ccniayrhdr lhr ltdfid rcguldnJns rug rdin! a6cno\ rcnnvrlrc not{plic lerorhispmject <br />I cdify rhd I hale r.ad rhis applicrrion ad srarclhlt lhc trtnvc infornurion k cotrc.l.I aBN to ondy with all Cnyund Connry <br />.rdinores lnd Sratc La*seloriryto lditrBconstruclion,oidhcrchyaurhorncEpE$nrlrivcsotthkCiry0r Counrylo.nt.upo.0E <br />!h'vd Drnii{,nc,l protr.ny i,r <br />Appliclnr or A8!.1 SiSnaru <br />Zz-----^ <br />f <br />., <br />Appliances <br />Metal Fire Place <br />qvaporative Cooler <br />Furnace <br />Compressor <br />lvlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents A <br />Toilet Room / Clothes Dryer lo-z-l{*.v{st) <br />R esidential Bange <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rou gh Mech. <br />Final Test <br />Meter Release <br />FINAL l0-2r-19 \.w46 <br />Notes, Remarks, Etc <br />ID/SIG. <br />coNsl RUC fl(rN I tNDtNc A(iFNCY <br />I ftnhy rrlnrr tid$ frtlrt.rr).riury rhd rhct n r connnEriot lcndirA rsctc] rhr rhc ncrli]mun.c olrh. Bork lnr $hi.h rhir pcnni n <br />L\nrd tsor .t(I)?. ci! c ) <br />l.n,lur'. NJr,c