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APPROVALS DATE ID/SIG.COMMENTS
<br />pliances
<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 />Toilet Room / Clothes Dryer 1-Z'.t1g xt4"1,0
<br />Residential Ranoe V
<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 />Above T-Bar
<br />Rough Mech.
<br />Meter Release ,A
<br />FINAL t0-il-lg
<br />Notes, Remarks, Etc.
<br />OWNER EI,ILDER DAI,CARATION
<br />I hcEby afltrn undr I,c llyof rEdury lnd I e' cxca'pl tEm rh. Co.rEm Lt.ns ljw for ltc following Earcn (Ss.?0J1.5
<br />Blsinc$ atd Prot siotr Codc): Any Cily ot Cou' y *hth rcqliEs a pcdir lo conntud. .lld. inErorc. &Nlirh or E!,r My
<br />srudurc. fii,to irs is$mc..l$ rcqoiEs rh€ lrplkdl for shFmir lo lile. iigrcd arcmt rhrr horshe t liercd pw r
<br />lo ln pmvisions of tlE ConBrols Licnsn Lsw (Cllrprd 9. Collmmi.g *ili Serion 70m of Dilisiotr I of rtE Ausin.$ lnd
<br />Pmacssions Cod€) or thll n or dE is cxcmpr rl*rcfrcm and rn b6sir for llE llLgcd .ktrprion. Any vhhlhn oa S..rb. 701 L5 by tny
<br />applic,nt for s pcmil $bjccls llE st plicant lo a civil p.mlly of nol mrc thu fivc hundEd doll&s (5500).
<br />l. a( o*trcr oih$ l)a)|)cny. or nr! cnrdotccs wirh sneN is rhcrr nir..onl|xn\d()n. Niiido rhc lnrk and rtE srrucrucn nor
<br />inicndclt oroflcrLat tor {lc lSN.7(sr. Bu\ims lnd P.olc$ions Code:'lhc O'ntucxtr \ l,iccnsc l.r* does nor aitly t, rn owtur ol
<br />rtu|n)jEny who hurlds .r nnDnncs rhcN . r'tl qlx) dd: suh qo hnn\cll.rh.,a.l{. hn)ughhis.rhsrownctrrpl.y(c\.
<br />t()vnhd rhar \uch i'nnmrcfttrrsrfx, ifrcndcdorollcrd ft\ lc ll lx$!vc', rhc hriklir! or nqn&itd ir$lds{hhot! tur
<br />oi conlt)lcrbn. lhc Osmr hrildcr wiil hrvc itE hur dctr ol fmving rh hc.r\hcdtl mr buildor improrc rhc pDpcn, nx$.N!-{ol
<br />-1,
<br />.s owncrotrnc nmlxny. !ncrclusivclyconhcring *irh liccnrd conradoF ro consrtuct rh.,,mj(r (S*.71x4, Busift\\
<br />dnd hbi6si{C.dc: Thc Co.ko.loar Liccnsc tie doer nor apply 16 6wnr ofpri'pcny uho builds or inFrovcs lhcrcon.
<br />.od vho snla.G for such Imjds with ! Conrmdo(, liccned pusuur ro thc Co Bcror's Lkcnc l-lw)
<br />-lmcxcmfl
<br />undr Setio a. & P.C. forfiis rcawn.
<br />_l havrsxtNill nni.rii', rCcnilic rc ol (i,n{nr h Sclfl n\ur. br wo' kcn' conrlt \rii(tri. r\ trovidcd r'or hySccriotr l7(x)ol
<br />'hcLrlxn G{lc. rarrhc n rntrn NcornrMrk nrshtnrhcttnnn isi\Nrcn.
<br />I l[vc andwill noinrrnr *o rtfiJ .. nrf.nsrr tr n iNuruncc. as r.quied b, Scction l71X) orrhc hhor Codc,lor lhe perforroncc of
<br />'hc
<br />sork for which rhh !.mil is issud. My workcr' smp.nsdn insuron c cmicr fll Fli.y nunrti.r us:
<br />Ic.nifyrh.'inrh.Frfoir:EnccofrhcworkforshahrhisF.rmir nsu.d.I shallno' c iployany pc6on in any mn.cr$ us ro h€@m qhjEr ro thc wo.tc6 c.drnsltion laws ol Califomia. !ft| !s@ rhai i, I .hoold lE om subFr ro lttr
<br />sorhcrs .onlli(.\urionnDvNi{,n\oiScrri,'n.l7lX)of rhcbhrC.dc.l \ltll. lnnhsirh.o
<br />covlrgc i\ rihqiil, r ,l nhll
<br />cieil itrc1up L, onc hunnrcl rlroutrtl dollrr irion b rhc.on of.odlttreriotr. drmgcs-:"""w'!'t'g'\Y"
<br />D!!L Arlllll]
<br />I h.Ehy aififln undcr pcn.lly ol lien$d und$ p$vnio. ofChr,rts 9 (co'nmming wirh Sccln,n 7O0o) olDivi{,n:l
<br />of rhc Bu\inc\\and Pn, f.\t ions Cod., md mr li.cn\c ( in full fo(c dnd cllcd.
<br />0 7?
<br />I hcEby a,Itrm undcr pcnrlty of Ic ju.y
<br />hsud (S(.1097. Civ C ).
<br />rucrion hnding 0C(rcy for rlE Isfomtuc of rlc wk for which rhi. Fmir ir
<br />d.tt[tcal|Dlrc].a-BAlt0N
<br />I ItFhynltnrun(l.r ricul', oi,'tr iurr onc ollhc li,ll.$nrA dc.lirri,) I:
<br />Drnx,lirn'n Pci'nirs Ash!no\ Norilicrrid, Fcdcrrl R.gularion\ (Tilc,l1r. l)rnh)
<br />R..tuircd L.ncr ol Norili.rii(
<br />i. crllrc[tldi,,nsrc8udirr rsh(io\rcnn,vr1rr.nor rfplilJhlck,rhi\I,RI.cr
<br />rcrd rhi\Jpplicrri('hdxlndcrhr rh. *x*t infitrmlrtr,n ncofrcr la8r.lb.omllyBirh.llCiryrndCounlt
<br />s
<br />'Y
<br />lding con(tucrion. and ncrcbtnur
<br />III
<br />III
<br />)rufrt4
<br />MECHANICAL.INSPECTOH RECORD
<br />Final Test
<br />O*..c
<br />IIIBtrEIN:.GOMTBIAIIQN
<br />DECLABA.UA!
<br />I h.rchy afllrm und.r p.nalry ol pcrjury om olrh. folbwing ddludrions:
<br />WARNING: ti iLurc h scu.c work.^'
<br />u4/e)
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