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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNA& BUILDER DEI{ANANON
<br />I t rcby lmrn und.r pcmlr, of Ilcrjlry rhll I o cictr'pr frln rhc Co 116 Lieo* ti* for rhc aollo*ing 'te. {S.{ 7011 ,5
<br />Eusi.cs rnd Profe$ioi Codc,: Ary Ciry or Co!.ry which requircs { |t mi lo comlrct .lrd, in{rcE. d.mlish or EFn my
<br />struclurc. prhr lo ns issulm. dm rcqliEs lhc atplicmr lor such Fmit lo filc ! sigmd sl8rcmd $at bc or sn is liensd !!N!nl
<br />ro rh. Imvhi.n\ offi. Co.locld s Lienscd tls (Chdprcr 9. CodftncinB wirh Se.tior T0OO of Divhion I olrhe Businlis aid
<br />PmlcsionsCodc)orrh{rh.o.rh.iscxcn r lhcrcfrnm{nd thc b.sh for rhc alhecd .rc mpr io.. AnyviolaliooofscdionT0ll.5byany
<br />atplicanl for o 0.mil subjRls lhc appliclnl lo !.ivil pcnlllyofnot mElhm fiv. hudrcd dollus ($500).
<br />-1.
<br />$ o*rcr or rhc pmFny. o, ny .nploF.r wirh *rgcr ai rhct $le onpenslion. sil d. llE {o.t aid (r nnrlE h mr
<br />inlc.d.d or oficEn for elc (Se.?044. BusiBs lnd Pmfcssio.s Cods -rb ConiE loas Lien* t:, do.s nol 3l,t,ly h d owr of
<br />rh. lmFdy whot ilds or nr{ms. rtEFn. rd Bho drcs *h wo.lr hinrlfor hcKellorrhmughhis or h.r oM cn[loyccs.
<br />pmridcd ln{r suct impmEm s @ hr irrd{hd or ofien for sk, Ii ho*cr. rnc hilding 6. nr{ldctu'n i.s $U sithin @ Fe
<br />oaNnlpklion. tne OwNr Buit]n will hare lhc budcn or rrovin8 cat hc or shc did ml tnild or Lrpmw $c l,mFny lor lhe puqbE of
<br />-1,
<br />asowncr ollhe pmpcrty. rm€rctusivcly.o.lrocting wilh lic.nsd conractoN to onslrucl ltr roirl lse 1|44, Busincs
<br />fld Pbftssii. C.dc: Th. Conrrtr.ttr s Liccnsc trs do6 nor +nly rd d o*.d of lropnry who builds or imtDrcs lhcr.on.
<br />!.d *ho.onractslorslcn!'rcjsls*irh0C.nrBcio(rli..trsdplrslurrorhcCodrmrolsLtensllw).
<br />-l
<br />!m.xennt u.der 56r A & tC.ltrlhi\.cr\.n
<br />uoxf,E&s:gtMPrlsArltN
<br />PECIABAtrON
<br />I hcrcby affirm undcr pcflalty of pdJury orc oflL follo*ii8 delmlions:
<br />-l
<br />tuvc ud will @in!tu i C.nifurl. of C.n{.'
<br />'o
<br />Sclf-ln{uE for s&cN ..nD.nsr'ion. as povid.d ror by Scrion l?0o of lhc
<br />Ilh.r Cod., for rhc p.rfbfrEtu! of rh. srk for whi.i rhc Fhir is i\sEd.
<br />rH-*;3trd will mainlain sortcB coml]ensrltun inrunrc. ei rcquircd by Sction 1700 of lhc L3bor Codc. Ior lhc Frfomncc ol
<br />for $hichrhnErmil k,sscd. Mv*orl6s s@n'dion D$rb.ccMicr mdpolic) numbcr e:
<br />A"ar'*,, l/*^t Au.na--- C"
<br />i/\/ C Of o)l-4 l, /z- >o
<br />I snify lhar in rhc Frfo.mnc. ofrhc work for *hi.hrhi\ pdmn ir L$x.d, ! stullnor cmplot a.t p.son in ony "mncr$ s ro hcqnrc sub.ist to rhc *ortch compcnsarnnr hss of Cnliforniu. Md aBrcc rhrr il I should l$.om $bl-yr ro ilE
<br />so c^'.o.Dcnssrionpr.visn,ns.fSrcrionlT00olrnchhrCodc.lshall.li)nhwnh.omrlywirhtho{pmvirions.
<br />WARNINC: Failur. r. s.un work rs .onq{n\arbn cov.tusc t u 6rl. Md shnll subj.{ d ctrrplo)Er ro aininol peMltis and
<br />.ivil fib.r ul b ore hundEd rhousna dold ($loo.qlo). in
<br />Sctio. 10?6 ollh. Litrr C!dc, inr.En md dromyt lfts.
<br />of camFnstion, damScs as proviLd for lhc
<br />^, ?hq(uy ^**,,K.
<br />I herchy"nrmundcr FMltyofFrju,ythll I am liccnsd u n ofCtur)ls 9lconrmncing Nilh Sccli,n 7000) ofDiehn,n:l
<br />ol rhc Busircs 8nd PDf.sions Co.lc. !d my li..ns. G in
<br />ctQ c lro YsoTlbL-t,",J!zl-u*-.-,-,*(-
<br />I hmby rf,jrs undci Fndry ol ,.rjury rhd rh.rc ii r onnoci.n
<br />isrlcd (56.1097, Civ. C.)
<br />ndnE,!.ncyror rh.pd{orm..c ollhcp.rk forwhichrhh lcnnir is
<br />l..diltrhrr rhc ndcrrlr.!uIri,,trsrcErnln,! r\l!(o\rctrxrrirrr mr]pllic hlr h rh$ lnijc.r
<br />o'rlinonccs lnn Sr c lnps rcl inslonliB ion. nnd hcrcl,y0urhorirc rcpr.scitorilcs ofrhh CnyuM Cou.ry'o cmd uIi). rlt
<br />ak'!c nrnrn)ncd oropcny i,r irstEcrion
<br />^,, *lnf u>,,
<br />Appliances
<br />Metal 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 />RouOh Ductwork 4L-"o r-< lo,
<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 />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 2-2b.2.D D6aerq,
<br />Noles, Remarks, Etc
<br />L.ndcir Addrcssr
<br />-
<br />,rpprrt.iiffi
<br />I hd,y iFtrn undr pcnrlly oipcrjuryonc oflhc f.lhwnrg dc.laturions:
<br />Dcmnnion Pcrnirs'Ast nos Notification rcdcral RcBuhrio.s (Titlc 40. P,n6)
<br />_Rcqni,cd Latrcr o, Norifrrrion
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