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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARAIION
<br />I hcrcby arrm ud6 ncnalry ol p.rFry rhar I d cxcnfl fiom lhc Co .i.t 6 Lk.ns llw ror ltu follo*im.caq'n (3(.?011.5
<br />Ausincss ard Profcasion Codc,: Any Ciry or County whth EquiEs a pemn ro coisrtud. .nd, inprorc, &mlkh o. Ep6i My
<br />sttudorc. prior ro irs issue.. also Equirs r& .pplicMr for ruch pcmit b fik ! iigrcd slarcmnr rhrl h. o. .h. i\ lien*n NrsMl
<br />b rhc Fovisions of tE Co.lhclor\ Lic.nrd trw (Chapm 9. Co.@rcing silh Scdion ?0m oa Division I of lh. BBi.cst md
<br />PEfcsrhns Codc) or rhlr lEorslE h c*mo rhcEftohand rh. hssis tor rt alhsed cerlprion Any liohrion of S6rb. ?oll.J hy oy
<br />aoplicdl for !Fmi subids tnc rppli.! 16.civilpcNnyofnot eE tho fivc hu.dEn dolr, ($m).
<br />-1.
<br />6 owr of rhc pDpcnr. or my c.plorEs Dirh sag€s &r llrcn $k 6trqr.$i.n. *ill do llE *dt a,i 0E sturr h ml
<br />inr.ixLd or otr Ed ror sL (Se.7044, BNiB3 .nd Prsf.sions C.dq Thc C.ntr.cltr s LtcnF tl* do.s tul aDrly lo M owM of
<br />ilE Ftrp.try whoboild!qirlroBtE@n,8rn*lnd6ochm hio*lf or h.ell or lhough hh or hcr own cmtlortcs.
<br />prcvidcd lhll such i,{mwnnls e ml inLndcd nolLEd lor s!h.lL howw. fic bilding or itrFmtftnl i! $U wirr, oN )et
<br />ofoqrleion. tlE olrM B!i,:br *ill hrw rlE b!ftkn of fovin8 lhd lt or rlE dil ml hrld or tilms thc petEly fm tlE purpos of
<br />-1.
<br />as osrcr olrhc pmpcrly, smcrclusilclycontrcring vilh lien*d cotrrBcroN ro consrtucl rh. Dojctt (S(.7(x4, Bu{trc$
<br />ad PNrdshn Codc:Thc CoirrD.rors Li..nr. Law do6 ior aIIly ro rn.wncr.rpropcaywho builds or nnpolcs lncrcon.
<br />lnd vho conhcls for such,,ojccrs with 0 Conltocro(s) licc.sd puru. rothcCo rucrolsLiccn* ti*).
<br />-l
<br />on crcnpl undc. Sc.lion- B & P C. lbr lhh rco$tr.
<br />Drle ()Yn.r:
<br />woRKEn-s' c()lvlPliNsaTloN
<br />DECIABAI]ON
<br />I hceb, lfatrm undcr p.ndry ol p.rjury onc or lnc ,ollowinS d(lnmrions:
<br />_l hrvc aJld willminrain a C.dilK,ic of Consnr ro sclal.surc ror *0*6 omp.n$li.n.ds pmvitn for bySNrion:1700 ofthc
<br />kbor Grjc, to, rhc psfomdc of rhc w6rt ftr whkh rhc pcmit ir is@d.
<br />-l
<br />h!v. lnd Nill minl.in *o cs comFnrodon insumrc.. ss Equircd by SNl ion 1700 of rhc Lihor Cod.. tbr th. Ixrrommc of
<br />lhc work for whth lnis p.rnil is k$.t- My work6 oq,cnslion insuome oris dd Fltcy nunlE ei-iv- r:^-,,.re- t r,r r
<br />( rr)ST* \'l ct rlJ(6 q-ll-(1
<br />I ccnily lhd in Ihc psforrrumc oflnc work for qhi.h lhis pcrn l is issucd.l shull nor crylo, nny If, son i. any
<br />'tunntrs !s ro tE om suhj.rr ro rhc *o,kcn cohpcisltion laqs oiColifomia. a.d a8B rhd ifl ihould bc..m subJ.{' ro ltr
<br />trorlcn oarpcnelionpmvhion\ olSccrion 1lrcoflhe titnr Codc.I shlll.lonhwirh.omtly wirh 'hor
<br />pft'rkions
<br />WARNING: Failurc to $curc workcr compcfln ion covcra8c is unlowtul, Md stlll sutjccr un cmflotlr x, dinn.d Fnalri.r and
<br />civil lincs up to onc hundrcd rhousund dollns ($lsj.uxr). in oddirion ro the cosr of com,,.nirrion, d!ru8cs a{ providcd lor thc
<br />Scdion 1076 of lhc tjhor Cod.. ir cnsl lnd llrorrcy s icrs.
<br />LICEMEDJONIIA!]IIIB
<br />IECI,ASAIION
<br />I ttEb, a,ltd undcr llcnahyofpcrjurr rhar I !n liccoed nndcr In,vni6n orChrrrr9 (.omnf,kin8 wirh SrctM rO0O) olDivi\ion 3
<br />ol thc Busim$ and Pnlcssnns Gdc, md m, liccnsc i{ in lull lbre and cficcr
<br />b-(q
<br />q-\8-\b
<br />ATIUCANLI]ECLIXd.IIAN
<br />I lBlhylnimund.r n flnhy ol E-rjur y on. ol lhc rblk'*n,x dcclnrxri,)nsl
<br />Drnlni!n,n l)cnnirs Artinos Norill.ati{r Fcdcral Rcg!lari,nF(Tirlc 4). Pan6)
<br />Rcquncd htr$.f N.riioridr
<br />trJ;ffi ffiffi ffi*ffi ::ffi ;ffi H.i:r'r,,:,ii"r"*:H,,"
<br />atr'v. mnriokd ptuFdy for i.\Idrn,n
<br />Amlic t or Aecnt SiBMrurcl >(
<br />(
<br />q'\s-t6
<br />Appliances
<br />lriletal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<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 />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />FINAL td@Lq <t Hlwerl,'7)
<br />Notes, Remarks, Etc.{I ut
<br />-
<br />Furnace
<br />Smoke Detectors lnstalled
<br />Meler Belease
<br />*n,i--3:-!E:\L ^o,0-,,-
<br />c9NSIBlg&lli.I[Np! llGErrI
<br />I hcr.b, nfimund.r F_n0lly ofpcrjuyrhrr rh.rc G o.on(rudion Lrdi0g i8ctrcy for rh. lcrfnourcc ol rtu work f.r whi.h rhil Fi,nir ir
<br />i\sucd (Sc..1097, Civ C )
<br />L.iJfl . Nrnr
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