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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.OWNER BUILDER DELCARATION <br />I hctcby sffifln undcr lEnahy or pcr!ry thll I u c*mpl 6om lh. Co.lra.lo Liccn* l,* for lhe followint @sn (Se.7031.5 <br />Busircss n n Profcasion Codc): Afly Cily or C.lnly wni.h rcquircs ! IE il lo s,sl cr. dl6. in|rlove dbmtish or quit dy <br />nodlE prior ro irs irslaN. als equiB rhc al,llic r lor such Frmil ro 0L r ligocd fl.lcenr lhd lE or shc k li.onsd pursa <br />ro rhc pmvisions of rif, ConrEclols Liccnsd Law (Chnplcr 9. Commin8 $nh Sc.tion 7000 of Divnbo I of the Businc.\ and <br />Pbfcreionr Codc) or lhd Lo, shc ir q€rpt rhcEiomo.d rlE b8ir tor 0E alk8.d cx.nprion An, vioLlion of Sslion ?011.5 by lny <br />a ,laco fo, . lcmn subjcls rhc .mlica.l ro r.ivil pcEll, of nor @G lhm fivc hundEn doles (5500). <br />-1. <br />as owmr ot rnc prepcny. or nry cnployes vnh s!sc\ Er rh.i, $k $rpcnsrion. will do llE sort and ltp sl*lw is ml <br />inlgldcd or o,lcEd ror slc (Sd 7o{4. Busirc$ lnd Prof.ssions cod.: Th. Coflrretols Liccn* Liw d.Ds nd apply ro m owNr of <br />rhc F$p.n, *ho hoildi or inpbws rrEM, $d who rkB sch sA hims.lr or hcMllor lhmr8i th r lEr own.rpk,yccs. <br />p,ovidcd thrr such iq)rolcmnls rc mr inrcnrkd or olIcE{ for sh ll'. hNcEi rhc hlilding or i'rpfmm k $ld qilhin oflc re <br />of..npkliotr lh. olxmr auitlr will h!re tl* tud.n o,r,mving d,l tE or shc dil ml b'rh or nrgot rhc poldl, hr llE Orlb* of <br />-1. <br />!sowncrofthc,rmpcny, amcicllsilclyconrdcrins snh liccnsd coir.a.r@'o cor{oc h. ln)irr (sc.7044, Busircrs <br />turl hbfissbn CdrkrIh. Conhrol. Lic.ns. trw de! rer rpply ro M orn$ ofpropcnyvho builds nr imlmrer rhcrco.. <br />lnd who srrEcll lor slch pmj.ds wnh c c(,ntEcro(9 liccnsd plMtrl ro rhc Coor,scru s (r.bs t w). <br />I dDtxcnr utrdcr Scclio <br />UOBKEEIIJI]IIIEIIAIION <br />DECI.ASAIION <br />I h.rb, rmrn ond* Fnalry of Fijury om of rl* folL*ine .l&lroraom: <br />lnhtr Co(|.. |,tr lh.|rcrntrn(Nu ol rl[ $u[ k{ s[ ch rh! N'n,ir n nwtl <br />_l hav. Md willDsi.l'in workdr'.onp. srion irsBncc. 6 rcqun d by Ssrion l?m of llE Lalior Codc. for llG p.rroM.! ot <br />rhc woik for which rhh p.mit is is$.n. My worl6 comp.ns.lio. insurMcc .aricr and policy nunbd m: <br />-l <br />ccnilyrhd in lhe !.rlortuftc df rhc {ork for ohich rhir Frnir is nftd.l chall ml.mploy lny I'.mn in !fly nUEr <br />s f ro tEcom suhjed io rhc wo{cro' comp.nsdion hws of C.lifornh. and ryE riar if I sl$lld b.co* iuhjecr ro rh. <br />mrkcre'o'mpcnsarionpovisionsolSdionlTO0oflhcL{borCoJc.lshlll.fonhsfiqnlalyvirhlho*Provisions.. <br />WARNINC loilu.c lo Bcurc sqkcF nsc n urhetul. ml shdl subjd m mplorrr b aimiml pcruhics ond <br />, in ddnion ro rhc.orr 6f .ontrio\ariod. ddnrgcs !s providcd for lne.ivil fincs ut lo orc hundrcd lholsond do <br />Scction 30?6 of rhc lj&tr Code, i crc( lnd <br />L(:ti!sIIx:!JriI&r:Ia.E <br />Df(,LBrIll0N <br />r, rl[ lru\irc\\ d rnnc{tnNCo c. ud nrvli.cn\c i\ in rnllriftc rjklcl,i.r F <br />sa/'7. <br />(r{INSIRtJ(r'tl(rN I IINDIN(I Acl,N(11 <br />n\ucd rscc rorT cir (- | <br />AIILICANLDIiIIAEAIIO! <br />I lr(6yrtllmxhdcr pcnrlry oltcrjuryotrc urrhc rolbBinS dc.lahrnnrs: <br />DunDhnr Pc u'A\h{os Norili.alion fcdcrul Re8uhti()ns ( lnb 40. Pan6) <br />_Rcquirc! tr(.r ol Norifi cari(,n <br />I c.nify rh0r Ihc fcdcrdlrceubrions rc8din8 0shqros emvulnrc ml amlknhlc lo lhis proj.rl <br />lccniltrhrrlhrlcr. lrhisrppli.nrionunlnnrcrhdrhc i,vcitunn i rscotrccr I tr8rltro.or.|lywilhrllCirl !n,l Counly <br />orlinlnccs rnd Sl|rcliws rclnriry r tuildiisorrtodion. ud hercbyrurtutriT! rcF.\cnrr'i!),rrhi\ cnr md c.unryh cnrcr ulM{r <br />ut{vc mnrn)nL{ ptup.ny lor <br />Atnli. trr (tr ecnr Sittrahtrc:tu", c4Le. <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />/A <br />Toilet Room / Clothes Dryer g-23-lv x.wtqy <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Rough Mech. <br />Final Test <br />Meter Release ,/,\ <br />FINAL 1"( -/r *.V-/rc\ <br />Notes, Remarks, Etc. <br />COMMENTS <br />Duct Work <br />Vents <br />Above T-Bar <br />,',d 8r/2/A <br />tt <br />[------T------ <br />I <br />=