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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DELCAIIATION <br />I hcEby darm und.r pcnalry of Friury fiar I m.rcnq ADm llrc ConErclc Lkttr{ l3s fo.lh. folowing rct$n (Se7011.5 <br />Blsincss rn Profc$ioo Codc): A.y Ciry or Counly *hth nquiEs . rtmn ro @Blruct. !lts. ihprotc. &mlislt ot EPln my <br />$rucrm, rior r. ih Lsumc. oLro rcqlircs rk lpnlka for s!.h Fmit io lih a si8f,cd slal€ftfl rh,l lE ot sh. is li.ctrEn ,juruanl <br />ro rhc pmvnioff ot rlE Conrerofs Lkcned br (Chrptcr 9. Conmfting wirh S.clion ?m0 of Divi.ion 3 of$c Busincs lnd <br />Pmfes.ions Cod.) or thll tr tr sh. h eicmfl rhcrcfom Md ,E bdrir lo, lh. !lh8.d eicn{rion. Any vhhtion of Sdlbo 701 1 5 bv rnv <br />alpLcrdl for ! Fmjr suhicds thc rgplicanr io a .ivil Fmny of nol mrc lhd fiv. hu(tt.d dolbB (1J00). <br />t, ns owmr ol lh. PlDFny. or ny emplorr.s wilh w!8.s 6 rh.ir elc ompcnsrion. wiu d. lrr wt a,t lhc sm.rN i! mr <br />inrcndcd or otrced ror eh lse.7o44. Busimss snd Pmfcssions Codc Thc Conracbls Liccnse Li* .tocs trr apll, lo o oener of <br />ih. pmFny *ho huilds or nnpoB rrt6n. 8n pho &.s sch eir hidrctf or h.r*lf or rhrcush hh 6r lEr ow..mployccs. <br />nrcridcd rhar slch in0m\€rds e mt i'neftH do,tdtd for sL.lf. hokM.ln hildiflg or inpmwE issdvnhinoRrs <br />of@,pLtl,tr, dE Owmr Blildr lill h.rc fic hd.n of povitrg rhll tE ot sh. dA m| hrld or iqmE UE pmFny for tlr puqn* ot <br />l. ds.wncr oirrE 0opcny. am cic lusi v.l, .onrELl ing *irh li.ctrsd .ontto.lds r. 6n{,acr ltl nmjat (Scc 704a. BKi..c <br />anl Eofcssio. Codc: Thc Conrhcrols Liccnsc L!* doss nor llply ro anownct oftmFny*ho buil& ot imlmvcs theron. <br />and vho.onrncrsfors.hpmF.rswnhaContEcrontliccnsdpuBumttorheConlEcloisLkcns.tis). <br />I amcrc'npr undcr Scctio <br />wot(Ells' coMpE{salroN <br />DECI,AIANOX <br />I h.rcb, lffrn undB pcnah, ot psiu,, ore of lhc follosinS ddmlionr: <br />-l <br />h!rc !d will minrain s C.nifraie of Cor*nr lo S.lfins!rc fd *ort6 @nltB.tion. Proriled for by Setion 37m ofthc <br />L$o. Cod.. for th. Frfornl!re of lhc ert fd sh!:h th. prnir i! isx.d. <br />-l haklnd willdtrinr.in w.rkcs conD.nsalioo insu.lncc. as squtcdbys.crion1700orrhclrbo.Cod. for lh. pcdomncc or . <br />hich $ic pcmi L is$cd. My workcs @'ry..3dbn inrur"ncc cMiq e'd gnicy nuntrr m <br />/K <br />l.cniryrhd in lh. pcriomunceoflhc work ror whhh rhis p.rmil is hslql.I ihlll nor .mploy tny IEMI in ymmftr <br />s ns to hcco'rc suhj<tlo rhc wo*m'onpc.salbn laws olcllifornia. und o!rcc lhor ifI sh.lld bc.om lubj.d t th. <br />eorlcn'comricnsstio.povisionsofSccriotr3?00ofrncbtnrCoilc.lih,ll.fonh*ilhconDly{irhlhoepmvhions.. <br />WARNTNG: Failurc lo wulo *o .^ .o'np.orlrion covcrNgc is unhwtirl. Md shrll subie! un mplo,€r lo oioiodl Fndl.I and <br />.ivil finc* up l. otrc hundrci lhouend dollu( ($lm,o0o), in 0ddirtuD lo rhc .osl ot comp.nsalion, danEges N l,rov .d r'or rbc <br />L{br Codc, i.t6csr rnd alrormy s fes. <br />LT{:ENSED C(INTIIACT(}R <br />DECLAEA.IION <br />I hcEhyofln'nundcrpcnrltrorpcrjuryrhd I n li.!D*d u rr noyi\n, of Chlpr$ 9 (com'Encins *irh sccrio. 7(xn ) o{ Division .l <br />of rhi Busirc$ 0nd Pmlc$t'nsCodc. rnd nry liccnsc h ir lnll folcc nd cnccr' <br />tlt <br />AL c1- <br />I rq'Lt, o:--dr,,n iL* s-Cri- <br />sNsIElcuoN.&ENDNA.AGElqL <br />I htrby arrm on<Lr F.alry ol p.dury th.l thtr ir . onntulhn k.rling lgcEy for fic F folrl1lm of rlE wtk for which this Frnit ir <br />itsued (Se. 3097. Civ. C.). <br />APPt.I(:AN r DI.:CL lLlI'!ON <br />I kNby nnnxtrlcr |Imlry or l)$jury om olrhc tullowin8 ncchrurion\l <br />l)rnxniri,m l'cnnir\ A\h.loi Norili.rri.n l:cd.rrl Rr!ulf,tion\ (Tirlc.{1, Pln6) <br />Rcquicd Irrtct ol Norili.rrhn <br />-l <br />ccnify th.t rhe fcdcral csllarioB Ea0riins ashcslos rcnFval !,c nor otplicablc ro rhk proj.<t <br />_l cdiryrhnr I hnvc rcad lnis lmlicarion rnd ritrhar rh. abv. inlomlion is cotrc{. t rgrE ro.onrly qi$ allCiryand Counry <br />)nsrtocrion, eS hcr.by rnrhonzc E,r.snhlivcs of'his Ciryand Countylo cirfillhnrtEorlimNc\ 3trJ SrJrclrN\rtLr <br />)*,"*,) <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />l\4isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Deteclors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release n. <br />FINAL ?/ /0t '/Y /afl1 f/ <br />Notes, Bemarks, Etc. <br />t <br />lnstallation <br />1?Cc<(" <br />L nJ.''\ N 'i\_ <br />- <br />llnlr* <br />I <br />----+--