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MECHANICAL.INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.
<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 />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />FINAL Y.ur.Lg (4e zt
<br />Notes, Remarks, Etc.
<br />OWNER B('!LDiN DELCARA'I'ION
<br />I lrroh, rlln.r r drr l.Mkt or Frjury rhar I rm cxcnr0 riom rhc (inn&ur Liccn\c 12* tur rhc r(,lbwin8 rcr$n lsc.70.ll 5
<br />Btrsinc\\ n rl Profi\sn r (1xlc) Atry Ciry or Counry shich rcquirc\ r Frnrir n, .o nfl.r. dXc.. intmvc. d.nxni\h or rrsn rnr'
<br />iru.turc. Jlli kJ ns nrurncc. als rcqunc\ ihc alplicrnr f{x {,.h pcrmirkr lllc r siSmd (.tcnEnl lhrr lror \hc a li.cn*d N^urnr
<br />k) rh. pmvi\nna orrhr Co.tr.xtr \ Lic.nscd ti{ (Clrilild 9. Crrnrncnci',g snh St.ridr 7U)O of Divisi.n I oi rhe 8trlilcss ]n.l
<br />Pn,tsnr\ C.dc)orrhd l[orshc i\crc Dlrhcrclronrnnd rhc hr\i\ irrhcalLlcdox.nfrion AnyviolalionotSe-'ran70.1l5hyriy
<br />4'plicr tur a ltrnir suhjc.rs lltr aptliunr b r.ivitNMlryol dor xtrcrhan ivc hu t{d{olhr\(S5(nr
<br />-1,
<br />,s owncr of rhc lmlErry. or my cryloles rilh qaBcs as rhcn sb @nFnsalion. wiU do tlE eoit !d tlt 3mt|w b Dr
<br />i .nd.d or o6.rcd for $lc (Se.7Ol4. Blsircss od PtDfcslaoB Coae: Tnc ConlEclols Li..n* Llw des nol erply lo M owmr of
<br />0E prFny vho bond..r inpbB ltENn. end who docs s*h qoli hnnsclf or h*lf ot rhreueh hi or hcr oM ctr9loy..s.
<br />pmlidcd rhd luch iremkftnr. m mi inr.Bkn oroifcr.d ftr sb. lt hoEE th. trildins or inprntm i3 sU enhin om lra
<br />ofconpLrion. rl* Owr BuiBcr wiu haw $e hnhn otF.virg rhd rr or sh. did ml build or in{rct ilt p,otsiy for rhc ,uq,$ or
<br />-l-
<br />esoqncrolrhc Iml).ny. rndclusivelyco octing wirh licc.*J conlr.clom lo .onsltucl llE tmjecr lS(. 7{X4. Aurnc$
<br />and hDt$sbn Codc: Thc Cont.*roas Li..ns.l,w des nol applylo !n o*nd oapropcny who builds ot imProles fiqcon.
<br />.nd who onracB for sch I'olecrs Birh s ConlFdo(s) liccnsi lu^utri h lhc Conlrucloas Licctre Liw),
<br />-lanrcxcmpl
<br />undcr SNI B & PC. tb.rhisrclsotr.
<br />EOBtrIEIU;OMPJNS}IION
<br />DF'CI A&TTT{TN
<br />I hcrchy a,tirm utrdcr ocnrlry of perjury otr of rh. follo*ing d(lraln,ns
<br />-lhr\c
<br />Md $illruinrrin n Ccdili.d.ofcoi*trr () scll.ltrsrc fr, sukc^ con,Fnsrri,,n. r\ t,Rri,bdntrhySccrhn]rooofrhc
<br />lrhtr(qlc.l(trrhcpcrlbn,uccoIih.trorkfdshichrhcl,cn ir n i\s&d
<br />-l
<br />h r rnil will nsinrrin uorkss compcns.lh inslEncc, as rcquncd by S.crion 37m of $c tjbnr Codc. l'o, rhc pdformnc. of
<br />rhc work for which lhh pcmit is issucd. My trortcn con{rcnsdion iNufn.. cMi.r and Policy numbs ml
<br />PoltyNur6.r ExPiE!
<br />-l
<br />c.nify rhal in th. Frformrc of $c worl for ehii:n lnis r,croil as i$u.d, I shtll nol cnploy lny IEBon in &y nmmr
<br />s !s ro 6c.oB $blccr ro rhc wo*6 oq).nsrion bss olcolilornia. !d a8rec thlt if I shnrld tE o@ subFct b llE
<br />slkc* oq'cnsurion rDvirions ol Scciioo lT00 of lhc t h('r Cod.,l shall. fonhwnh.dnPly wirh rtbe pmvirioN.
<br />WARNING: Failurc t, {.rc vorkcd oflrpcnslion l,wlul, ,nd shall subj.cr 0n coploycr to sininal Fnalric* md
<br />cilil lincs !p r. onc hundNd lhoussnd dollars ($l ion. d!ro-qes F p,.vidcd fttr
<br />'hcg/e (e
<br />IIES.AEAITAN
<br />I rrrby,fiirnr un&i r.n!lr, ol t'.rjury rhlr I am liccn{d unJcr pn,vision .r Clqnct 9 (comrrcncinE wilh Sccrion 7000) oaDilisid' l
<br />of rhc tlu\incsrhd Pn,fcsrions CoJc. n nryliccns h ir lirll nncc and cficcr
<br />C-IO
<br />e \
<br />I hcrhy a{ltD u.dcr rcMhyolFrjDryrhrr rhrtu i\,..n{d.r
<br />is{rcd rSc. :l097.Civ Ci.
<br />l.din80scncylbrlhcrcrlonntrnccorrhc worx lor*hichlhhI'c mil h
<br />_l cdity rhar rh. f.dcr.l rcEulalions Egldin8 lstEslos Emval ue nol
<br />-l
<br />ccnifyrhui I hrvc ru rii\ ,tpli.arhn otd
<br />ordinomcs {nd St0rc kws Elarii! ro blildi
<br />0hovc mnrioncd t'ropcn y to. inrFccr
<br />Appli.d.l orABd SiSdu
<br />I
<br />COMMENTS
<br />Meter Belease
<br />Lcnlcis Addrcs\
<br />nr, r-rc,l-"rf rlrr.Cl lr4ttrn
<br />I lm$y rllnN u cr lrnrll y ol trrjury otu ol rhc tu11,,* i',s dcclrrr iotr(
<br />Ocnrnirt,n l,cirnirs Ashc(os N.ri,lcrrion Fcdcrul R.8uIrotrs (Iirlc4l]. P 16)
<br />_Rcqun d l{rr$of Norili.dkrr
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