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MECHANICAL.INSPECTOR BECORD <br />APPROVALS ID/SIG.COMMENTS OWNER EUILDER DELCARATION <br />I hcrchy rmrm ud., pcnllly of p..iu.y lhal I @ .i.op fon ln ConFscloR Liee k! tor lh. fouoeins rea$n ls<.rc31,5 <br />Buli.cs ard Pof6sioo Codc): A.y Cny or Counly which EquiEs r pcmn lo oinrud, !lro, irphte. .!.Dlhlt o. EIEI .iy ' <br />srDct@, prior lo ils issue.. dso r.iuircs rh. apptidnr for reh Fihir ro filc a iigrd sr.r.@ lll,l lE or slE k licctrqd PldtJn <br />lo lhe pmvlrions ol tlr Crmr&lofr Licc.*d tiw (ClEptd 9. Cohmtring wnh S.ctio. 7000 ol Divisio, 3 ol tlE Busine$ lnd <br />Prcfc$ions Codc) or rhar lr or shc is crcm rtcdromand rnc boris for tlf, ollcgcrl .rcnplirn. anyyblaliorofSc.rion7011.5byany' <br />.pplic. for ! Icdn sbjers rlE rppli.m t a .ivil pcnahy of lot mR ltun fiv. hundrcd dollars ($500) <br />-1. <br />ss owmr of llE ,rcFnx or ny cmnloles wrh wagls {s rh.t eh comp.nelio.. will d. tlE mlt .d tlE sttEtr n ml <br />irGldcd d oficEd ror sh (Sa.7O44. BBi*s snd tlof$.ioN Cdc Thc C..tmclor's Lkc.s llw .tft3 ml spPly lo .n o*M of <br />rh.tor.n, whot i!t! iqmB th.6r a eb &rs sh uri( hinsclaor h.B.lfor lhrcugh hh ot ls om cmfloyccs, <br />previdod thgr sun inpml4ftnts e m im.slcd orof&nd ld sL. ll holffi, th. tliuing or itrpotm is$ldwi6inoft Fd <br />of@q,leibn. hc Oerc. Buit 6 wiu hllt E burd6 of pmvinS dBI tr m shc did ml buiu or inlmw dr FoFly for dE FllF,sof <br />_1, ei .we. ol rhc pmFny. tr'n crclusivcty .onrrcri.g vilt tiansd .on(rero6 ro conslNcl tl* nmjc.l (Se. ,1X4. Busircn <br />and Pmfssion Code: Thc Conrrelor'i Liccnsc Lrs dfts not otirly ro eown$ofpropcrlyqho tuildsor ihprele! lhocon. <br />a.d sh. .o BcB tu, rkh nojecls wiln . Co.lraddlO li..nscd pus@nl to th. Co rrclor'r Lk.n* trw). <br />lrtrrcrrnlPr utulcrS..r <br />IABf,EI]S:CIIMfjIIAIION <br />DECI.AXAIII]N <br />I nercby .flirm undcr FMlry of psjory onc of rhc rolloviog &clr@rions <br />-l <br />hlvc lid sill minlai. a Ccnific.rc ot Cons ro S.ll-lBuc ior mrk6 .otrucnsalion. N ,rcvilcd tol by Selion 3?m of fi. <br />tjhrr Codc. fG rlE ncnmftc otrh. qo* for phti rhc tdmi i! i3iucd. <br />-l hrvc !.d will oriordio sork n conpcnsarion insuramc, .s Eluncd by Scction 1700 01(h. kbor Codc, for lh. i,ctlornue ol <br />lh. erk for whi.h rhh !.rnn L1 i!s!.d. My wort6 comr.nsalion insumtuc Mhr ,rd polty nunhff m: <br />f ,ni.t Nunrh.r <br />-l_:rpir.\ <br />-l <br />ccnity thlr in rh. n rfo,mrcc of th. wort for vhi.h lhh pcnnn h k$cd.l ihall ool cnploy lny FMn in 8ny Mmr <br />so trs to h.{om slbj.ll lo llE mltsl oqMsrion h8 of Cllifomi& and 08rcc rhlr if I sholld hc@m rub}it lo trE <br />workcs onrlEnscrion pmlisions ot Sdrio. 1700 of rhc Lrb(tr Codc. t snn[. fonnwiln oq,ly with ll$s tovisionr . <br />WARNING: Failurc b suro w .r' conpcnsrion covcbsc h lihwaul, .r'd sh8l subjel s cmtlorr lo dioi.rl pcuxicr md <br />civil fims u! lo orc hundrcd ltousnd dollds (3lot.0O0|. in addirioo lo rhc cosl ol compcnplion. drmscs as providcd ror tlE <br />se! tr,. 1076 ol rhc Ijtor C.dc. in'crc.r d.l annmr\ ift. <br />UCENSELCANIBACIPT <br />DEgIAXA:TIOI! <br />, hcrhy alfiflhrndcr r. rhyorp.rjuryrhd I im lie.*] undcr r( )!ir nnr ol Ctaprcr , l.onnncnc irB sirh Sccrhtr 7(Ix)) ofDi\i\ion l <br />01 thc Businc$,nd Protc$nnN Codc,,.d ry lkcnsc is r fulllbtc nnd clricr. <br />Li@nr Chsr:-Lken$ Nuf, b.r <br />Dar.: CotrtNtor: <br />II)ISIIICIXIN.LEIDING.A(iEICI <br />I hercby .ltirm undq Fnahy or rdiury thrl thcrc is r .o.slruclion lcndin8 lBcncy for lhc Psformm ol rlE work for d'fiich lhis ltmil is <br />issucd tse. 109?, civ. c.) <br />AITLICANLDT.CIIBA.IIO! <br />IlrtbynflnDu crNnrlryoircrjuryoncolrhcLll,)eingdd.lx':riois: <br />I).nn)lirnnrlrcfl!irs A\hc{osN.rifi.rri F.d.ril R.8uhrtrnN(lnlc4), Pun0) <br />Rcqutcd l.ncr.f Norili.orix <br />-l <br />..nity rhar thc l'd.at mgulolions rcs6ditrB asbcstos rclDvol arc nor ardtabL b lhis pojcct <br />-! <br />.cnify rhat ! havc rcld lnh appli.ation si rt!1. lh,t lh. lbow infotmlion is .(reI. I ogc lo 6mply uith lll Cny ud Colnry <br />ordhntucs lnd Srrrc Llqs Ebrirg ro trildirg coistrudion, dd hcEby aurhornc rcpes aliksoflhisCnyandCounlylo.nlduponlh. <br />abovc mnlion n pmpcny for inspadon purF*i <br />AIpli.rtrr or AEr Si!nrru <br />P.mil* naft lrrii0:- <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />ltilisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Toilet Room / Clothes Dryer <br />Residential Range <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 />Meter Release <br />FINAL g/sktrt u4Q1 ) <br />Notes, Remarks, Etc <br />DATE <br />krxhr" Ad&6r <br />- <br />Vents <br />Other <br />Hood <br />Above Hard Lid