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APPROVALS DATE ID/SIG.COMMENTS Olc-Buildc. D..lelion
<br />I hcrcby aflirn undd p.rlty ofp.rjury firr I.n .,.npl lorn rh. Conro.loB L'c.nc tiw for rh. folloyins ro$nG6.701LJ Buinds
<br />dnd Prol6$ion Cod.)r Any Cily or Courry *hich rcqui,6 ! p.mi lo codrrucr rn.r. imprcv.. dmolsn or rcp.t !.y Jldctu., prior to ir3'
<br />i!ru!ft., lbo r.qui.6 rh. .pDli6r for euch pdir ro 61. . 3isn d rt't.ml thll lE or rhc l, lic.Md p@wt lo th. povirios olth.
<br />Cont..cloi! Lic.nsd L.s{Ch.Drn e. Conm.Ninx wnh S(rion ,mO of Dlvton I oath! BB'iB3 id Prof63nrB Cod.} or th.t h. or
<br />rhci!.rdpllh6.6onddln.b*iiforln.U.gcd.r.mprio.,Aiyviohrioiofs*rionro3l.5by..,lpplic! for ! pmn 3ubjcdr rh. -
<br />,ppli.. to.civil pMh, ofnol hor.rhrn fiv. hundid doll@ (J500),
<br />lll. * o** orrr'. p-pory. or my.mproro enh y"gB 13 rhci !or. .onp.N.ri6r. *irr do rhc worr ed .t,. lrtuc1e L tur iirdd.d
<br />or of.r.d ror !1. ( Sc.704a, BarB! lnd Profdlio Cod. Th. Conlricblr Lic.N. L.w do6 nol tpply to., owE offi. rmp.ny
<br />*no buil& or inpro6 th.@n- lnd who do6 3uh wort hirolf or hellor llroush hi. or nd own .mploy€. pro,id.rt thlt !!ch
<br />improEhdB e .or i.t.trd.d or ond.d tor !rlc, !t ho*.vd, rl* blildins or ihprcvch.nt i rold wirhin on. y.!r ol conpl.r ior. lh.
<br />Owf,.FBuild.r will h.v. lhc bnrd.r of poving tlr.l h. or 3hc not build or i!trp.ov. for rhc purp6. of slc).
<br />_1, a owncrofln. prcp.ny. !m cxclusiv.ly co.t.c'in3 with lic.ns.d conr.ctoB ro coattu.t th. proj.ct ( S<.7044, Baii$ od
<br />Pma.$ion Cod.: th.Co,trclor'3 Lrcctu. liq doe mr lpply lo.n.wn6 ofprop.ny who b!il& or impmvGlh.rmn. rd who
<br />.onticrs ror such prorers w h i Contrlcro(s) I 'c.n!.d poBuir rorh. cont.cro.! LE nr. Llw )
<br />I an.xcmpr uhdcrsc.lion .B.&PC lor rhis rcso,r
<br />raa{Eas_callrEttaIj9N-0Ec!4aarlo!
<br />I h.r.by rllirm u.df p..alry otpcrjury on. olrh. aollowias d€claftrions:
<br />_l hrr. rnd sill mrinlrin r C.nificlrc olcoM lo S.lf-lBu.. tor ert.B cohp.Mtion, r! provid.d for by S.d 6n ,?00 ol rh.
<br />trbor Cod., ror lhc p.rromn@ olrh. uorl for which ln. pmil i3 issucd
<br />I hdvcrnd w,llnrd'nkin *o.kers cdmp€n$ton inslrlnce,0s r(totr.d by Sccton r7o0 ofrhe lnborCode,lor rhcplriornEncc olthc
<br />worllorwhi.hrlnspernntrssu.d MyworkeE comllneno,, nrloruc. a(!.,.trd !{lrcy nunh.r dr.:
<br />car auefiqNlErDtrcjiiElcr
<br />I lE Chy afliirn und.r!.nalryorll.dryrhalth.re isa consrrucrion l.ndins s!.ncy rir r lE ,€rlonMncc ollhe $ork lor$hich lht rc.,nit is
<br />issucdlscc 1097.( n. (-)
<br />Atllle NrtpEc!444r.!a!
<br />D.ftolirion Pmn$Asberd N.ri6cation [cddal R.sulstiotrs (tl. 40. Pln 6)
<br />R.quircd t.cun of Nolincdiotr
<br />.lc.ni6rha'r[.r.d.rrlr.sJlAr:onsr.!ard'nsi"b.noi'.no'slircnnr.nrl,,ib'.r^rh(f'cr.d
<br />[I'1[r..niry,r,,rr'*.,."a,r)i!,!t]' r(nind{ir(rharOcabv.iifornllioniscod(r.Iagr..loco plysirhall( yand(-ounry
<br />ordi.an6rndSl.t.llNsr.l.tirsrobuildins.oisrrucrion..ndhcr.byn!$orncr.prsnratir.sofrhirCily.nd(tunryto.nrEuponrh.
<br />,ho!r m. ion d prop.n, for
<br />Co lkxp
<br />Appliances
<br />Metal Fire Place
<br />Evap Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough 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 />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 7-224s 'h.u16)
<br />M WP51\Permil-lmpeclion Forms\M€chanical lnspeclor Reco.d.doc 03.31 06
<br />MECHANICAL-INSPECTOR RECORD
<br />Policy Nnmbcr: Erpt sl
<br />(Ihhs.(lionn.qdnorb.conpl.r.d rrh.p.rhir isfo.on.hundrcddollars i$l00lorle$)
<br />ll,ll.nnr*r, *. o-.-strc. or rh. sork .o, *hich rhis p.nni! is i3s,.d.I shrrrnor nnproyrn! ps.n in rny nmn.rso 6lo
<br />b.ca,n. subjd brh. &.kds conrp.nenonhwsolC,lfornia,lndlsrdlhar'rlshouldb6om.suhccrtolh.worlc(
<br />.nmncnsi,nn nin\sions olS.cri.n l'00nfrhc I .b.r C.d.. I shall. fnnh* h(ornp\([hrh.s.pr\s'Ts.
<br />*", 1( X l Lf App,i..n, lk"ta.-" /lv*-J
<br />WARNING F!,lur.ro rccur.workc^ conrp€ns0lon.oveiis€ rs u.lawaul,0nd shall subJdr & .mplor.r ro amrnilp€nal!'6ind.'r'l
<br />fincsulrloon.hundr.dlhoBdnddollirs($100.000).inadditionrorhccotofcon{.nsarion.dirMs.sasprovid.daorrlEScdion10T6oa
<br />rlt hborCod., 'nreren ind itrorn.v\ I.es
<br />UCEISED-CONIAACIAAiPE(I4.EAIIq{
<br />I h.r.by !0im und.r p.nrltt ot pdjury lnar I m lic.ns.d u(lcr pmli5ion ofchaDr.r I (comm.ncins \ynh Sdion TGlr) ofDirision:r or
<br />lh.lrNin.ss and Pmf.sions Cod...nd nry lic.B. i in fullforc.ond.lYdr.
<br />Co@l.tor:
<br />Pmirretutu(prin0:
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