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MECHANICAL-INSPECTOH RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER EUILDET DET.CARAIION
<br />Ih.Ebyslrrmundcr p.flatry of pcrjury rhar Im.xc,q EDn llE Contdclm Laccnc L,w for tlE folloPing @$n (Se 7011.5
<br />Bosin ss dn Phfc.sio. Cortc): any Cily or Counry *fiict rcqln r a F.ojr to @nslMl. alr6. iBProtc. &mlhh or rcpst ;y
<br />slfu.nm, rior to nr hsuofle. ole rcluiEs thc llplicor for str.h Fmit lo ,iL ! sisrcd snrcmnl rhd hc or shc h lic.nsd pu*udt
<br />ro rlr Eovisioni ol rlE Conrtulols Lien*d kw (Charto 9. Conmftirg sith S.clion ?000 of Divlihn 3 of lhc Busircri and
<br />Prcfc$iom C.d.)or rnlr hc orshc is crcmo UErcfmnud lhc hd\ir forrn dhgcd.xcnPlhn Any tiolalion of Salbn 7011.5 bv tnv
<br />applic{nl for tr pcmir subJcck lhe atullica.t lo r civil pcndly of not mre than filc hun&cd dollm ($500).
<br />-1,
<br />as own.r ol rhc l,orEny. or hy cnploltcs wilh wags $ ln.n $b 6mpcns0lioi. *ill d6 rlr wo* a,i df, $rtw is ml
<br />intcndd or oflcrcd aor $le (56.7044, Bllincs and Prcftssions Codc Tlrc Conrscbr s Liccnsc L3v do€s nol arply to.n owmr of
<br />rte pEp.n, who hild. or in{'oE ltrN( 'id who ds qch $iL hims.lf or n rrclf or ltmugh hn 6, ho own clrl,loyccs,
<br />provid.d rh.r $ct ir{er@.Bm mr inlold.norofrcr.d lorsb.lf. hovlt. dE hildhg n nr{,oErnl h sld wirhin om F{
<br />afcorylcio., rh. Owncr BuitLr sill haw rh. hrdcn or rmvinS thar h. or shc dA ml blild or in{,mt rh. Poll{rry fo! ll* nu.pos oa
<br />I..sowns oatn.,mpcny, ancr.Usiwlyc.nh.lins qirh liccn$d conlrloNlo@nntud tlE rorEl (S.c. ?044. Arsies
<br />0nd Pmi:ssion Cod€: 'rhc C.nr.s.lols Li.cnsc Low does n r rnnly lo !. o*n r of pmFny who b!il& or i4)tov.s lhcrcon.
<br />,nd who co.lfrdi lor such pmiccts Birha C.nrd.ro(O lkc.sd t)usunl lo thc Co'ndroa! Licc.s trw).
<br />I an.xcmu u cr Scclio B.&PC lorihhlcov,i
<br />Drr. Oin.r
<br />IO85EI5ICQMTINIAIION
<br />D&CIdf,4uAN
<br />I hcEby a,6rm lndcr pcMlry of p.rury om of llrc followins dccls.lions:
<br />Ihrvcr lwillnui rinr(cnifi.rc.lcotr*trrloscllhsurcl'ortorkcrrcort^-i\rri(nl$f,vidcdljlrhys.crid.u(nolrhc
<br />tihtr c(xlc, f*rhc trninrtrEc oirhc *ork f{tr qhich rhc 'trrr ir i\\ucd
<br />f*trtrd *ill mlinrrin sorkcts mmpcnsarion insuraEc. os rcquncd h, sc.rhn l?00 of lhc Libo! Gxjc, fo. lh. I).rfomie ot
<br />rhrtrhNhrhaF.'ntrr^^.ucJM!qorlch'.omnrn'i.,nir'ur,n,.,Jd'.rJtuP.ln)numhc' cFnrr< lt+ <e
<br />Ed ae,73/70-d
<br />-t
<br />cc'1ify rhll inrhcFrronn,ncc ofrh. wort lor shichrhhDerftn ( issu.d.l sholl.or cnrl!,yutryp.rcotr itr onymrnnd
<br />$ as io rNorn subj.cr lo rhc *o.lc6' .orp.nrdion lawr of Ctrlifornia. and lgrc. rhd ir I should tEsm sul*rr ro tlt
<br />wod{cis ompctrEliofl lmvhio.s ofSdion lT(Dofthc trhtr Codc,l shau. f.nhw h.omlly wilh th.s lmlisions
<br />WARNING: F,ilur. ro $curc qortcn ofrpen{rion ..v.ngc is rnlawlul. uid shall cubi{r .I .mplorer lo simin&l Fmhrs ond
<br />chil rin.i up ro onc hundrcd rholsa.d dous ($|oo,{xlo). i..ddnn'n ro lte cod or..nrFnsrion, d.mscs ,i rr.vilcd r.r rhc
<br />(intc, inrcrc{ rldno ry s li{r
<br />Llcn NsFn (l(lNTtr4(lToR
<br />T'EII.AEAIIQN
<br />I hcrchy d ftm undcr p.lalry ur n rjury thd l 0m lienEd undc! Pmenb. or Chrfln 9 (.onrmNi.8 wirh sNrbn ?Om) ol Division -l
<br />ol rhc 8ur.c$ md PmfcsnnN Gld., dnd ,hy licctr* n in tull lorcc ond cfccr
<br />66 czo
<br />CONEISII!:I]IrUIIIDINGrICINCI
<br />I h.rcbt rntm undcr Fnallyofp€rj!ry rhd rh.rc r a.ondru.l6n tnditrElscey ror th. Frformmc ofth. uork for which lhis Fmir h
<br />hsud (Sc. :1097, Civ. C.)
<br />APPt ICANT DECI {RA]'ION
<br />I lmhy lfiinn undcr ltrnalry of n rrury oN ol rhc hlnrs ir3 dcc hrarnn,\:
<br />l). nnirior l,cnnirs sbcsos Norilic0li.n lcd.lrlRcE!luln,n\ (Tirrc ll1). Prn6)
<br />Rcquncd txrrc! ol Nolilicirion
<br />I c.nify rn rhc acdcral rcgllatio.s Egdding rstEslos rcmul arc rct ulPli.lbh h lhh Pmj..l
<br />-l
<br />ccniii rhur I hlvc rcad rhk lprlisalion eld sr.rc lh.l rhc .hlw infoMion k corel. I 48@ ro €t{,ly *ilh 0ll Cn, !ftl Connrv
<br />ordininccs ond SIarc tiws alnrils ro bu ihnr8 conn iotr. ild hercbyrulhoria rcprcsc div.r of lhir Cny ud County to
<br />lhorc mnrioDdpn,r.nt nv msF.lion
<br />Appli.onr or A8cnt Sirnlrurc *V *c->,n *q
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Irilisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh 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 />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 9ltll8 ,4,t-4 4 (q)
<br />Notes, Remarks, Etc.I
<br />I t.nJd . \lJmt
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