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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.OWNER SI,ILDER DELCARATION <br />I hcrcby arfo und.r p.n.lly of pcrjury lh.l I m crcmpl ftlm lhc C.nlrnctoN LiNn.c L.w for lhc aolheing rca$n (Sd.70]1.5 <br />Blrincss and Profcssi,i Cod.)r Any Ciry or Cou y lhich tcquircs , rEmi ro hnsrd.t. rlrd. inprcw. .kmliih or o,Eir ary <br />rmc,@. iirtu lo irr issuet, als rcquiB lhc rppli.{it for $h |l.mir ro nb a s'gNd stalcmnl lhal hc or shc L liccn*d llrunl <br />l. lhc l,Evisions of tlE ConlE lor's Licn*d La* (Chlplcr 9, ComnEnciry ,ith S*lion 7000 of Dirisioi 3 oi lhc BNincs ond <br />Pblcsions Codc) or rh n orinc iscx.mfl rlEEfromand rhc b8h for rlE alhgcd qcnip'ion. Any vblliio. ofS!.lhn'r0l1.5 by any <br />aptlimnt f6r , Fmir sbjsk lhc applic&l lo a civil pcn.lr, of rol rcG ihan fiv. hundrcd doll&s (Ssm). <br />-L <br />as owkr olrh. Eopcny. om crctusiv.ly co"lraclirg wnh lienrd conlr(loF lo onslrucl rtr pmirl (S.c. 7014, Buii*$ <br />ad Protsshn Codc: Thc ConrErofr Liccnlc Lrs dfts nor alply to an own$ of llro!€ny sho blild1 or imlmvcs thcaon. <br />lnd who 6nr..ts f .ucnF.j.(s with ! Co.rfttorl9 lk.nsd prsunr lolh. Conrraclols Ltcne L.w). <br />lmct.mrr uiddsGlon , B. & P.C. for rhn B$n. <br />lhla Or... <br />-l <br />cc(ifyrhar i. thc pciforrotuc otrlE *olk ror whkh this rrnir h is\ucd. I shrll n6r rmplo, ny persn in ony mnncr <br />$ as b hccoft suhje' to rh. worlc* comp.nsol ion laws of Cllifornia. ond o8e lh.l il I shorld becom subjcd l.r rlr <br />*ork6 comp.nqlionrmvkionsofSdion 3?00 ofthc t{bor Codc.l sh.ll. fonh*ilt comply *ilhlln$ pmviFio.r,, <br />WARNINO: Failurc to surc worlc^ c.'npenuion crlcmsc n unhufll md \hull *uhjcc' an cnploycr to aiminal lEmhics ind <br />civil fincs !p t0 orc h!lhousa.d dollaG (!100.0m)iriotr n' rhc cod ofcoilFn\arion. d,tuB.r 0s lrolidcd lnr rhc <br />inrcrc( and lnorrcy\ ltcs <br />ucf,NsrlleQNr&tqra.8 <br />DtillA[.IllQN <br />ol rhc RusincsnDd Pn)L$i,,n\ Codc. tul nry l'.c sr n r fullfrcc rn .ft.r <br />N <br />t codmro+( <br />AIPIICANLD!:CIAf,AIION <br />I lErcb) llim oD.tcr IEmh y nf pcrjory o d ofrhc fd!,si"g dcclarrrn,n(: <br />Dcinrition P.irni'sAs nus Norificrrnr ltdcrulRcAuldnff ('Iirh a0. &d6) <br />-Rrqtt{d <br />Urlcr ol Norili.nrn,n <br />_l rd ily OJr rhr rc .El Ee! l,r id$ reBdrding r\b.(os rc hul irc n.r trlplicdlc io rhn [ojccr <br />-lcenilyrh <br />l nivc rcrdrhisrndicrrion!fr1srtrrcrhr rlEnh,r inlnrmlri0r n.nft..r !rFLrro.oflplywirhallCiryatrdCounry <br />(( <br />oullrtrizc rctrcscnloliles o <br />*"61 a <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 />Rouqh Ductwork <br />Vents <br />tOfagnrr'Clothes Dryer ?- t7.18 I t4oo et) <br />Flesidential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release tl <br />FINAL l0 ,ty IY l r/t^Dt({7/ <br />Notes, Remarks, Etc. <br />COMMENTS <br />lnstallation <br />L as ow.o of rhc p.rEny. or ny cnploFcs wirh wagcs &s rhcn sb ..mp.m.rion. sill do rh. wort alt rlrc *rructlE is ht <br />intcnd.d or o,fcrcd for $h (Se.?044. Busincs and Pmfcssions Codc Thc Conlrucrois Lic.nE li* dms mr apply lo an owm. 6f <br />rh. potxfly lho blilts or iqmrs Urmn etd eho des sch hd( hituclf or hchcll or rhrough hh or hf own .np!oyc.s. <br />pbvidcd rhrr suct iq,ll)l€fuds d @r i.r.rd.d or o,Icrn for sh.li hoqMi rhc trilding or iqlorftn h $ld whhinom re <br />ol o,{lcrio( rhc Owmr Buildcr will hlE rhc hds of povin3 rhal h. o shc dA mr build or itrprorc fi€ pmrElly n,r rtr puqbrc ot <br />W{IRKTRSI C(ln'PFNSAIION <br />IIECIJIAIII,X <br />I hcrchy itm undcr Fnnllyofr.rjuryorc olthc following ddlrmrions <br />-l <br />h!!c ard willminllin ! Ccniararc nl C.nr to S€lHnsu.c for workcB .dn .nsario.. rs povidcd r.r hy Selion l?u) of rhc <br />Labor Codc, r'o! thc pcrloiourcc otlhc qork lor rfith lh.,rcmil is issued <br />_l hnvc nnd *ill nuink workcB .onpcnsalion insuBn.c, as rcquncd hy Sccrion :l?(D ol'lne Laboi Cdc. for rtc Frlotmne o, <br />lhc rort lor * hi.h lhh ,xrmil is hned. My workcN omlens.l ion insuroncc cMicr dd plicy nlmber e: <br />CrE*r <br />C!]ISIBIJCIIONIDIDINO.&OIIII <br />I hcrb! aflln undcr lErohy of pcrjury lhll lhcrc is a onsrrucl.n lcnding o8ency tor lne l)crfolr1@e o{ rhc wo.k for whi'n lhh Fmil ie <br />issuc{ ts* :1097. civ c.). <br />L.ftlc.\ Narm: <br />- <br />ordinrmcs dftl sral. Lrws elaring lo <br />nt.vc nrnli.n d pmFnt for <br />I <br />tt