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MECHANICAL.INSPECTOR BECORD
<br />APPROVALS DATE ID/SIG.
<br />Appliances
<br />[\/etal 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 A
<br />Toilet Room / Clothes Dryer 7-zslK e.v{il]
<br />Residential Ranqe
<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 />Ro ugh Mech.
<br />Final Test
<br />Meter Release ./..--..1
<br />FINAL hw)/,1(-19.1Y
<br />Notes, Remarks, Etc
<br />OWNER 8I'ILDER DELCARATION
<br />I hcrcb, a,iirn undcr Fmhy of F.jury th8l I m cxcnpl lom lh. ContmloE Li.cns rjw lor lh. Lllowing Eason lscc.?o3 1.5
<br />B(inc$ an<l Prof.srion Codc)r Any Cny or Counry *hkfi r.quircs ! IBmrir ro consrrod. !hr. imorcvc. dcmlist or rcFt ary
<br />slrudm. t,rh, lo ils irsulm, al$ ,cquircs th. applica for such l,cmir to lilc o sigmd stlrcmnr rilt hc or stc is liensed ituNlnr
<br />lo lk tmvisions ofttr Conlraclor's Licn$d t * (Chaprc.9. C6nmn ing eilh sccrion 7Im of Divhio.I of ltE 8usires {DX
<br />Pmfeisior Codc) or lhll h€ or sh€ h crcmrl thcrcfon.nd lhc bask for lhc alhScd cxcmplion. Any viohlioD of S.di.n 1031.5 by any
<br />lpplic0 for r pcrml subhcrs rhc rtpli.aff ro !.i!il psnalry ol mr mE $!n fiv. hudrcd dollss (3500).
<br />-1.
<br />G owftr ol lhc p,DFny. or my cnployr.s wilh sagn 8 rrEt $lc 6mt.rsrion, sill {ki thc wdt and lh. slnrlE b ml
<br />ifl.d.d o, o,Icrn 16r sL {Sc.7Ol4, Bosaftis and Prefcsshns Codc Ttc C.nrErols Lkc.* Ije d*s .or apply ro dn owncr of
<br />rhcI,FrEny wtr hiil(Is d i',rmB lhelga un who &B sh mrt him$lf o! hc!*lf or lhmush hh or hcr own.drloyccs.
<br />pmvidcd rh.t su.h inpmkmnls e ml idri.lcd d otu lor slc. lr, hoMa. ihc boildoS m mprchtrni Li $ld sirhln om Fd
<br />of conplcrt L rhc Os8 Buildrr *ill h,r rlr hrd.. of prcvin8 lhd t* or $c dil rct hrild or inrmw th. pDFn, for tlE l,nqbp of
<br />D.r. (r*Er
<br />Won<rr,nV crr,lt Prr,lS,lrlotr
<br />UICLAf,AUqN
<br />I hcrch, afi irm utulcr !.nrhyof pcrjuryo.c of thc follow s d..lmrions:
<br />-l
<br />haw and will tuin|uin a Cc.rifi.arc olconp to Sclf-lnsuE for workc* omrcnsrion. !s pmvidcd for by Selion l?00 of rn
<br />Labor Code for Ih. p6fol]1u. of lhc work for whi.h ilE Fmjt B irsucd.
<br />_l hdvc lnd *il|mrinkin {o.k r'con{tnsalion insurercc, a r.qun d by Sdtiofl 3?(I) oflh. L{bor Codc. for lh. p.rfomrc of
<br />pcmijJi+tucd. M, wortsi aprEnqion iNulm fftr e,n polky nunbcr E:
<br />C'*-- * ?\
<br />a/*nny,*, *,,* 1*r**c orlnc work tor rhich rhis pcmit ,r hsd. t shattmt chtlo, sny pcson in a., hMn6
<br />J slo tc.om subjcct to rhc worlcB'ompcnrd'on l.w\ofC,lrlnmia, rnd igffi th.r rr I should bcom !ubF.! ro rhc
<br />work6{ omtensalk'n pmvisions olsNlion 3?0oolthc t bor Codc I slall. fonhwithcomply wnh tho* pDvisions
<br />lvAnNlNGr Fdilurc tu surd w.ikcn .onlrcnuri,,) colcrase i\ unh*f!|. rnd \hau slhF.l o cmplotlr k, riminal Ftulrid ed
<br />.iril ftics uI h otu hundrcd rhoo\rnd dollrr ($100.(XXD.o{ comncrsrion. darogc\ !s prolitcd f$ rhc
<br />Scclion J076 orrhc t b.r Codc. intcrca.<be/t
<br />LltrNt[D_c0.LrB (Ioa
<br />IJECLIBAMI
<br />rxmhy oI Frjury th lmliNnrdund.rtm Charrd 9l.omftn.in! wnh Serbn 70tlo) ofDivisio.l
<br />P6Lssio6s Codc. and n1y li..n\. is in
<br />tLtr
<br />.{
<br />CONIIIIJCIION.LENDIIC.ACIN1;I
<br />I h.dhy rrfifln urter Fnllryofpcrjury rhar rhcrc is { cotrsttucrbn hndi'rg $cncr lu rhc,Erlbnmo.c olihc rork tu *hich rhi\ rErntil is
<br />n\u!d (Scc :1097. Civ. C ).
<br />APPLICANT DECLAITATI(}N
<br />I h.rr,y .irm undcr p.Nxy ol tcrjay or of rh. follo*ins dccl@tions:
<br />Dcmlirion Permirs-Asbc(os Nolificrtion Fcdcml R.gulariois (Tnh 40. Pdn6)
<br />-Rcqlird
<br />Lrxer of tlolifErion
<br />-t
<br />ccnify rhar rhc fcdml rcBuLrions rcruding asbcsros Emval m nor rl,rltablc b thh pmj..r
<br />-l
<br />enilyrhar I nurc Erd rhhappliclriona srorc rhnr rhc ahovr irfomrion is cord I agE ro omply wirh all City and Colnry
<br />ordinarces otrd Slarc Llws EhrinS ro huildin8 con flcrbn rurh.rircrctrr{irJri\c(of rhi\CiryM Cuu ryk,citduB{r}r
<br />atovc n$lioncd !m!.ny for z/a/ft
<br />I
<br />COMMENTS
<br />Other
<br />I. a\owncrofrhc E.p.ny. !ncr.lu\ivclycontlclin8 wilh liccnsLi contu tom ro con(rucl lhc projccr (SLr. 704,1- Bu\incs
<br />xl hrrL$sbtr Codc: Thc Conrn.ttr s Liccns.l-uw d..s nor rpply x, rn own.r oapn,pcny uho bxild\ nr inlprolc\ rh.rcdn.
<br />atrd sho .onlmcls rbr such po]cclr sirh ! Conrftcro(sr li.cnscd pu6utrtrr iorhcCbnracrols Li.cnr tjq)
<br />I a crcnfr tid.r Sccrn,n_. A & PC ntrrhnrea{n
<br />R,licyNun$cr: / ErtircL
<br />:
<br />I
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