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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcEh, am.m ud., pe.alty of Friury lhal I d .rcnfl ftun lne Conltacld LtcnE Laq for lh. following rc@n (Se.?O]|.,
<br />Auqilc$ .d Prcfcasion Cod.): Any Cny o. Courty *hict Equires a Fdjl lo d(srtud. 8lt r. iopEE. d.mlnh or Epdr any
<br />slrocrE, prior ro ns issumc. .L$ mquiEs llE rl,pltanl for srcn Fmi b nk a ligftd sial@nl thlt lE or shc ir lk6ed purunir
<br />ro rh. Fovisions ol rtE Conrtuloas Lktnsd kw (Chlptr 9, ComBEirg *ilh S..lio. ?000 of Divthn 3 of llE Baincis a.d
<br />PrDfcssions Codc) or rnlr h. o rlE is cx.opl ln.rcfton aid lhc bssn for rlt all€ecd cxcd{!lio.. Any viohdon of Sntion 7031.9 by sy
<br />arnlicMr lo, a pcmil rubic.ls thc dppli.dnl lo aci{ilpcnlllyofnol mrc rhm 6vc hundrcd dolles (it00),
<br />-1.
<br />ss owmr of th. prlFny. d my cnrPlolEs wilh saget a d.t slc ohPcnsdion, qill do th. sot &d llE filde is ml
<br />inrcn H or ofEEn for sk {Sd.?eB. Bu.i6s sd Rsft$ions Cod.: Thc C.' rdot r LieN ks des nol .PPly lo .. owm, ol
<br />r,re rFrxn, who hril.tr o. inplffi dEmn. !d *tF &G sEh slt hiBcll or hcBlf tr lnreust hi! d ha on .nployccs.
<br />,rcvid.d rhd such i,t{,mwEolr c mr inl.nd.n oroficEd for sL. lf. hoftw. dE trilditS or nrpoEfrnr is &U wnhj. om )Ea
<br />ol sEphtion. llE Owmr Buitt r eill harc $. hndor of pmvine tld hc or slrc dil ml hiu o. i,pmrc dE l,mFry fo, 0E FrFe ol
<br />-1.
<br />rs o*ncr of thc rDpcny, d cklusiwly conlra.lins wnh liccnscn conrlcro6 ro .onsrucl llf, Imjccl (SN. 7044. Bus'm$
<br />lnd ftofcsri{ Codr Thc Contrelol s Liccnrc Law docs nor dtply ro 0! owmr of Pml'.ny who builds ot improv€s lhcr€on.
<br />.nd who .ontmcrs for soch pojeck wnh a Conlnclo(r ltcnscd pusu! rb lh. C.ntrrctoas Liccn* L!*).
<br />-l
<br />ucr.mp lind S6tioL- B, & P.C for $i. Een
<br />WO'IKF[S' COMPF.ITSAT'I(IN
<br />DECLAMIION
<br />I hscby d0irn un&r pcMlry ol pdjury ot of rhe fouo*in8 d.*lahrioNl
<br />lrtxtr(itrI.- turrh. nr.lanuhcc ol rlrc wurk li)rwhich rN Ixnnir i\ irsrJ
<br />-l
<br />Mw nnd will nBinrsin workc( comrcnialion in$rutc. ar EquiEd hy SNlion 3?0O of lh. l$or Cod.. fot lh. PcrfoM of
<br />llE work for shth rhh pcmil is i$u.d. My sort6 comtcns bn insuEm cehr un IDlk,
<br />ln t.fjo-t on.. r Ll a-bt lr L\ * Tirc
<br />L<)I
<br />-l
<br />ccdityrb.r in ihc p.rformrcc of l,E wo* for which rhis permn is issucd.l sholl ror cn loy dny pcson in any Mn.r
<br />s rs to B(onrc subiEr lo rh. wortoa .smpcnslion hws of Cslirorni., !.d dC6 rhd if I should ttcom slblti b lhc
<br />work s ompcnsslion !,,ovisions of Sdion lr00 of lhc tnhor Codc. I slull. lodhwnh.omply wnh thoc polisionr.
<br />WARNINC. F,ilurc ro scurc mrtcr' onp.nuion ovciagc is xtrltwlul. and snau {bFr 0n cnrrloytr to rinnd Fmkis MJ
<br />cilil li.c( ut, ro om hundrcd rhousstrd dollari (lloo,om). i. add ion lo $c co\l ol.d'qEnstrrion. d.rBg$ as Fovia. nn ric
<br />-1-.?'
<br />IICEISEIIJIJNISAEITA
<br />DECIdMIIAN
<br />I hcEhy0finr!nd.r pcn0llyottrrjuryrh l oD liencd undcr pmvisionof(:hrlttr9(comnEncins wilhSdi,n7uD)ol Divhtun:l
<br />ol rhc Bu\iks\ ud P$fus\ions Codc. {rl nly lrd\e n i. lull ,nr.c 8 cficct.
<br />A-(-oSZ io
<br /></zg, r t .-,-o- ( C- L" s -\I
<br />COISIAICIIIINIDNDINGAUDX(.I
<br />I hcnhynfilr n.d$ rtr(ltyolpcrilryrhrrrhcrc is r.otrinBrion Lndints lscnc, t, rhc Frrann{ncc ofrhc sork r.r shi.h rhh rm is
<br />i\strcd rscc l0q7 Ci! C )
<br />AEL&ANUIECI,ABAtrO!
<br />I My dninn u ndcr l1cnihyof l€rj(y onc olihc iolbwin8 dcclar.rioF:
<br />Dcmlirion Pcrnlns Ash.r.s Notificarion ltdcEl R.gnbrioor (Tirlc r0. Pan6)
<br />RL{tun d LItrcroiNolificdlk n
<br />-l
<br />ccnifyrhar rhc rdt.rul rc8nlnlions rcsnlinB asti\lor rc'tuvdl drc tror {dic.hlc lo rhn poid
<br />-lccnilyrhd
<br />I havc rcad rhknprli.ri rMtsatcth.t lhc uhrtr nrl(,rrorion isc.tret.Itrsrero..dplyunh,llCnynnd Courv
<br />ordinan..s i.d Shrc ti*\ Elarins !o hoildihS connrudior. oi hcrcb, nurhorirc reFc*nrarivcs ofthis Cilyand G nry t' cnicr upon th€
<br />abor. mntiomd pmpcny for
<br />Arrplic.fl or Agem SigBluE:-,,*,.f'27
<br />-18
<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 Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />FINAL T/[,/lb 5u
<br />'16Notes, Remarks, Etc
<br />Above Hard Lid
<br />Meter Release
<br />S.dn,]076 oirhc Lijor Codc. inrcrcsr ond dnotuy\ fN{.D.=-"*, 5 '23'17
<br />Lcndcii llmc
<br />-
<br />I
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