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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<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
<br />Flesidential Range
<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 />Rough Mech.7/4ltu ,\ 81
<br />Meter Release
<br />FINAL 4/t2/4 cl\Kl
<br />Notes, Remarks, Etc.I
<br />OWNER BUILDER DELCATATION
<br />I hcEb, afinm hdcr I'.nlhy oa r.rj!ry rh.t I d .xcm0 ftlm rhc C.nrretm Liccns L{w for lhc n hsing !c!sn (ftc. /031 .5
<br />Burarcs aid Prcfession Codc)i Any City or Counly whhh rcquircs ! psmil lo dnnML dlld. inll)Dve. dcmlth or ElEt lny
<br />std.rur.. prior ro irs i.suamc. als rcqlies $c appli@nr for such Fmn b f b 3 shmd 3lrlcmnl thar tp or slE k lieded pwer
<br />ro rh. tftvkions or iE Conrlcfft Lic.ned Llw (Chltlcr 9. Commrcins wilh S.crion IlO0 ol Division 3 of tlE Busincs 8nd
<br />Pmfcssions Codc) or rh0l tr or shc ir rxcnfl rhftfiom r.d rh. bash for rhe .llcecd .x.mprion. A.y violalion ofSedionT0ll.5 by rny
<br />,pplica for ! ldni subj.rri rhc sppli nr ro . civil p.m[y of rcr @rc rhrn 6v. hudrd dolles (3500)
<br />-1.
<br />$ o*f,cr of lnc pmpcny, or my cmployBs airh qls.s as $cn $b conp.$alion. wi dollEvmt0!dthcsttr@brcr
<br />ioreftkd or oficEd for slc (s( 1N4. BusiEsi ,nd Ptofessionr Codcr Th. Conlr0crols Liccn* Llw &es nor .p,,ly ro 6 owM oa
<br />lh. t,opcny wto builds or iqmB lhemn. aid *ho dm *h h* hntucr or lEr$lf ot rhreu8i iis or ncr oun cmplolccr.
<br />!ro{d.d rh.r slcn itrlPh€mnE @ nor inrcd.d or ofiedl lor sic lt h.rcE dE trilding or i,prckm h$ldwarhinomFa
<br />of.oqilcrion. llE Osrcr Blil&r wiu haw E bu,lbn oa In*ins rhor hc or dr dii mr t ild or inpmE dE t Dlsly for llE purpos of
<br />-1.
<br />asoencrof rhcl,q,cny, anerclusiwly.off,kri.g wirlr licc.d co r*ron lo con(rucl ln poiccl156.7{x4. Businc$
<br />ud ltrt6sion C.dc: Thc Co.rsdoas Li.cns. t:w docs not aprly lo m oqmr ol prcpcny who huildr or inprovcs lncrcon.
<br />{nd who .onlmck fo! such ImFcrs Rirh ! Coihcro(s) lienscd I,urler lo e Conl.i.r6Cs Um* rj*)
<br />I mcxcmD' u.dcrselion .B &PC forlhnrcr$n
<br />!0xf,1:tt-g)!t!jNtAll0N
<br />DECLASAIION
<br />I hcrchy !fiirnr undcr p.trdly of prrJury orE ollhe lollowir8 d(hnrnrns
<br />I hrvc,nd w,ll nu,nrain a clcnilrarc fconsnrtoScl nsurc for workcri compcn\att n. !s pftJvidcdlorbyScdbn3?O0orrnc
<br />trftr Codc. fJ rhc pdfortuftc of rh. w.rk for $hich r hc lxihii is nsucd
<br />-l
<br />hrvc rtrd *ill nuinhin solken .onFnsarion insuan.c. as dquncdbysccliotr3rmoflhcti$orColc,rorrhcrcrrornDrccol
<br />rhc ruk hr which this pcmir i\ i\s.d. M y sorkm ..mJ*nrr io. irsurancc cnEicr &i l,olicy nu mber ae:
<br />Mi/wr*l Errloluteis Casuallv (^nt,odtt tIIIrl-aN i.l Na0 Aqo 1n
<br />-l
<br />ccdifythur i.the ller(orffirc. of rl!. work aor *hth lhh F.nil is issucd.l shall N,r cmtloyanypcNn in 3ny nutr
<br />F rs to be.om \lbirl $ rhc mrk6c coqrcnsalion l.ws of Califomh .nd asm rhal if I stE d rrorc subjel loltr
<br />e*c6 corpcnqrion povirions of Setion 3?00 of lhc tjbor Codc. I snoll. lonhsilh .!t@, snh rhoe povnions..
<br />WARNINC Flilur. ld Ecrrc wo.kc^
<br />.ivil llncs ut ro otr hxndrcd rhousand
<br />Sccrion 1076 ol lh. tihor Codc. inlcrcsl
<br />cont .sarion ov.nlc is unl.wtul. lnd shall $br.r d c,iployf ro dimi.rl tEMlrts ad
<br />dollus ($lm.Om). itr ddilion ro rhc co{ oacompcoerion. damees as polid€d for rhc
<br />o",,j-?oJ1-
<br />D[l;LAldrlolt
<br />I hcruhy rlltnrundcr pcnulryolr.rjury rhr! I ! lion*lriJcrnn)!i\nr,flfchrlrcr9l.ontrNncingqilhSc.rhtr7(x$)ofDivni,{:l
<br />.f rlr ausircr\ rM Pn,fc{si()ns (od!:, d my liccnsc is h lirlllnr.rrnl.llcrr
<br />CONSTNUCTION I FAInING AGFNC"|
<br />I hcrchy amrm undcr lEtulry of ncrjury thd rhd. h n snsto.rbn LndinS aecmy for ltrc p.rfome of lhc mrt fot whi.h lhis Fnn k
<br />ir.kd (se. 309r. civ. c.).
<br />APIUCANI.DECIdAAION
<br />I hcR.b, nrfirm und{, pculr, o, prjury onc orrhc rinlownrg dr.ltr,rions
<br />otnx,liri.n pcrm sAsb.stos Nurili.0rion I'cdcml Rc8ul0rions ('l'irle.lO. Pan6)
<br />-Rcquncd
<br />t.ncrof N.rifi calion
<br />i( n'nud (arcrhar rhc ltxrlr iilnmirt i\.of,c.r ,,prNhcrn.plyril[nllCirtdnd Counry
<br />consrrucrion. ad hcrc6y ourhori& rcle*.larivm ol lhis Cily md County lo enlet ltEn th.
<br />q I
<br />Furnace
<br />Above T-Bar
<br />Final Test
<br />Doler Owner:
<br />*,",*. ltlllqa{,
<br />L.nddc AddlE
<br />-
<br />I c.niiyrhrr rhc fcd.r.lrcsuliIion\ rcErdi.g a\bcslo\ rcnDlrlarc tror !Ipli.$lc h rhir prlccl
<br />f, *nrr,nn , i-."o,no
<br />ordi.rm.s r.d Sr . tiws
<br />,bov. mmiomd pmFny for
<br />--------r------=
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