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MECHANICAL.INSPECTOR HE CORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />liances
<br />Metal Fire Place
<br />Ev ative Cooler
<br />Furnace
<br />Com ressor
<br />Misc.ul ment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnst alled
<br />Rou h Ductwork
<br />Vents
<br />Toilet Room / Clothes D er 2'zo-t
<br />Besidential Ra
<br />Other
<br />Hood
<br />I HoodT
<br />e ll HoodT
<br />Grease Duct
<br />Fire Dam r
<br />o ntn s
<br />lnstallation
<br />F.D. Dro Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rou h Mech.
<br />Final Test
<br />Meter Release
<br />FINAL
<br />Notes, Remarks Etc.
<br />()llNllll ItrII-Dl.R D!:r.( ttRA l li)NI l*rcty amrm u.d.r Foahy of perjnry rhar I @ exeq,r 6.m rhc ContBctou. Lkcnsc t * fo, the foltowinS rc.s. (se.?otr.:,
<br />Busincss .nd Professio. Cod€): A.y Ciiy or Cou.ty which Enui* a l*rmit lo 6n..er. ahcr, iq,.or., dcmtish or r@air ,nyslodm, I,nr ro its hsu.6. rlso rcqlircs ih..pptic. for such Fmil lo nh. si8n.d starcmnt lhal lI or slr is tiened plNet
<br />to lh. phvhions of ir Conlrsttr s LienEd tf,v {Ch.!tcr 9. Cotmrcing *ilh Selion 70Oo of Dilisio. I of r Blsim$ odProfcsio.. codc) or rhdi h. or shc is.xcmpr rhcrcFo( and rtE hdsir tor E allc8cd .xcmDr io n. Anyrior.rionoasc.rion Tolr 5 6y rnyaptlica aor ! p.rn su$jcck th. lrtliconl io a civil I'cnlhy of mt m,. rh fivc hlidEd dold; ($jm)
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<br />_l.rso*osof tlD Frpcnt_ inrcx.lusilLtycontu.ri,r! sith liRn\.{t cotrrra.ior h mn(rucl rh. lhv.cr (Sc. 7(ll4. Buni.s
<br />otrd lhrrl\\btr cdlc:'l he C.nr0.kr's t_iccnsc Lnw docs Dor dt)nty lo n.owicr.fpn,!.ny trh. hliidr o, irpn,rN rrrc.n.rnd sho c.nlncrs rir \rch pmFcts wrh J on h.r,( 9 ticcn*"a t[*,u r,, rt
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<br />undcr Sc.rir'._,ll. & p C turrhis rcr\on
<br />w( )R(t R\' (IlNt pFNSAT( lN
<br />DFCLARATIoN
<br />I hcrch\ Jlrtr'n undcr F1i,hy.fI{ruryuk o, rhc totlistrr,j dNtJrJrh,n.
<br />-lhrvcmdwillmoi.i'rin,c.niftircorconscnrxrscrfrn\rrcforsorkdiq'nD.nsdion,asF)videdf(rbysccrion:rTuJufrhcljlu codc.lor rhc |xrr.rmrnccofthu work forwhi.h rhc l].rni ( i*!cd
<br />I h.rotrd*ill roinlrinvorkh comr.ne i6n insur.rce, !s rcquircd by Scdion:17(X).rrhc tlho. Cddc, for rtc p. hntunc.of
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<br />.o"{E.ration insumtr. 6icr rd poli.y tuhbcr dcs
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<br />enilyrh.r in rlE Frf.rm*. of thc Mr* fo, ehi.h lhis FrDn h issucd. ! sh,U not cmrtoy dny pcnon in 0ny Mftrs 6 lo i.com subJc.t to rhc wortsa comrcosa! ion hwc ot Catiforni!. snd !!Ec rhal if I sb;U t"..,. *r,i*r rJ rrrwoitc6' conlcosat ion pmvisions of Selion tTLx) of lhc Lah-r Codc, I shdt. aonh*nh com/y enh thoe nrotBioni
<br />WARNINGT Failurc lo scurc solk.^ conu.nsario. covcmgc i\ u.ivil fincs uF lo 6r hundrcd rhouund dolt6 (St(jo.(xx)). in {ddir
<br />trhntul. ,nd \hrll suhFr an $plo!!r ro ain nrtrrDtri$ ond
<br />iotr to rh. con ofcomp.ns6iion. domBls a* prorided for th.
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<br />LtcENSFn C(lNl-Rl(:ttrR
<br />T,FCLARATX IN
<br />I hcr.h, nlftnrund* rchhyoitcrlury rhui I rn ticct*rr unds p."i.r,i,,r.Cn,t,r* u (.,n."n.ira *irh scclkrn 7t[0J orDivi\ion.]of rhr llusincs Md t,ro fcsio n s Codc_ ud nry ti.ci{ i\ ir fu f(trccJndctfN(.
<br />c\ta 1oz\to\
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<br />(:ONSTI{I(:]'ION LENDIN(: A(;IJNCI'
<br />I h.'L.hy urlirnr und( p{nrl,yofl"rjury thur rhcrc is u.r,nslru.rn,, tnihg us*,y'* rr".p", ri,u*ncc or rhc wort tir whih rhi\ pc,inir i\
<br />isrLcd (s& :1097 air a ,
<br />APPI ICANT DF('!.AII,IT!(IN
<br />I h.rt+,y li undcr pcnrtryorr.rjuryoncot'hc rothwnr8dcclaarion\:
<br />Dcnmliriun PcrmirlA\h.nos Noti6.arion F.dcrat RcSrhtions (Tirtc lO. pan6r
<br />Rc!utcd trfi sr ol Norifi cari.n
<br />_l adiry$ar rhc acdcral rcgx!,tions Eslrding astrsos rcmlatarc nor.ppltabtc i. rhis tmjcct
<br />-J ify
<br />sr l(l
<br />trborc ftnrio.cd pmFny for
<br />Applic.nt o, Agcfl Sismlrrc:t).1I t \.\L
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