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MECHANICAL-INSPECTOR RECORD I
<br />APPROVALS DATE ID/SIG.COMMENTS Ol4I{ER BUILDER DELCARATION
<br />I hcrchy slirm lndcr !.n!lty of p.riury lhal I m cxcmpl fom lhc C.nlr.cloN Licsn* k* for the folLwin8 Elsn (SF.7011.5
<br />Busin ss ,nd Protcssion Codc)r An, Cny or County ahi€h rcqltes a Fmir r.i &mm.r. ![&. inphvc, &@lkn or EIbn 0.,
<br />.ltururc. Fior ro irs h$lre, rlo Equim rlx oppllsr for skh Fmir ro fik a siSn d sralmnl rnd lE or sh. is liens.n puNM
<br />ro rhc l,ovisions ofrlE Conrrerofs Lkensd L!* (Chlpts 9. Commencing wirh S.crion 7000 ot Divhioi I olrhc Bri!$' aaf,
<br />Pha€sioni Codc) or rhd h. or 3hc ii .xcopr rhcEfrim and rhe lEsis for rhr uU.ged cxcniflion, Any riolori.n of S..tbo rol1.5 hy !n,
<br />applic.nr fo, , FmI {b}6ls lhc .ppli.mr lo s civil p.mlry of mr mrc thm tiv. hu.r,nd dollm (tim).
<br />-1,
<br />as o*ner of thc FoFny, or my chplorEs with *.Bca as $en sk oitEnsd io.. will do rt sd< &rr d. irErE k mr
<br />inr.d.n or oficrd f6r sh ls*.71x4, aNiE$ und Pmrcsrhnr Gd. Tt€ c)dodols Lkcns tnw d..r nor .pdy ro !n owE of
<br />lhc pmFfly who builds or iry1m!6lh.tun. and who dcs sxh m* himsclf or hsslf or ltrcu8t ht or hcr oM cmrloyccs.
<br />pDvidcd thd such iopd\adnt e mr hrc.d.rl or ofi.an for sL lf, hokb. tlr tuiUj.g oi iipnwant ir std wthi. om y.e
<br />of bnplcrion. E Ooftr auiBr sill h{w tlr bldcn ofFovins fiar lE or ar dil rcl hnld 6r itrporc tlr pqEly for tlE purF* or
<br />l, !s6wnforrhc top.dr. @.icllsivelyco rerirg *irh lic.nrd .nnr&rors ro.onstrud rlE,,miccl lS(. ?044. B!\in$i
<br />ona EofRrhn c'odc: Tnc Conlrocrols l-iccnsc Law des nor lpplylo m ouic! otproll.ny who b!ildr or innrov.r rheEon,
<br />and who .ommb fo, {ch p$,..ls wirh n cd h.rodt licenr.d tu*u i ro rh. conrr{rol3 Lien€ tiw)
<br />lmcrcmd ud(Sdion .B.&PC.I rhnEslon.
<br />l)ilr (|\..
<br />]T!}Af,Ef,I.CIIMTEIIAIIQN
<br />DECIABAUO!
<br />I hceb, aflirm und.r p.nolry of p..Fry onc oalhc r.[owing d(l@rions:
<br />lh vc rid slllnu' niinCcnillcnrcofcon\cdr,S.lt-lnnrclinsorkcrr(nlpct\rtfr.rsfmvidc(llor$ySccrnu.lTll)olrht
<br />Latxn (irtc. ,,r lhc $ rlanun.c o, rhc sl lnrtrhichrhc,f,'trrr ni\\urJ
<br />I hivc,nd Rilln0inr,in *orkcrr com,,.ns0tio. insumnc...\ r.quircd by Selion l70O ofthc liho: Codc,lor lhe p(for@cc or
<br />rhc work for shi.h lhn p.rmil is nsu.t. MywortcB Nmrcns.rn,n iNuroncc .rricr s'd lxnicy nunt e, uc:
<br />./tfloa26
<br />-l
<br />ccniiylhar inrhc p.rfoirMncc ol rhc work for wnich lhir Frmn n nsu€d.l \h!ll nol .nploy rny pc^o. in a.y tu.n$
<br />b 6 ro h..om slbirr ro rhc wo*.s .onpensdion lnw\ of Culifomin. und agm
<br />'hd
<br />il I should t*o'm subrc€r to rhc
<br />sorlcA onFnerioo povi\krnsors.cli.n:l7ll0orthc Lator Codc.l shdl. fdhwilh.oqny wnhito* prclisions
<br />WARNING f0ilurc lo surc wortc^ conrpctrsolion l. rtrd shlll sohjccr un cn]tk,ycr b ri8innl Jrmhics md
<br />lhc cosr olconD.neln,n. d!tu8.\ rs rn,vidcd frtr rhccivil fincs up lo.rc hundEd lnols.d doll6 (tl
<br />Sdion 3076 oi
<br />'hc
<br />L.bor Codc7i,ftr.
<br />,"",?'lo--ao/Y
<br />l)t(t \R\Irt\
<br />I hcrchyafitmundcr Fmlt) cfroju4lhd lam licnqt undcr rmvn,onofClt
<br />or rhc Buqucs Md Prcrc$nns codc..nd mylEcnc b m tutl rol:j5l4t+r
<br />prcr 9 (conrntncin8 with sccrio.7fiJ0) ofDirnnin l
<br />6-b-ca6-&3 4 6 f/)
<br />o*, 4-/o -;) a
<br />i\sucd ts.c .lorr7. (iv (')
<br />dITLICANLOECIJBAIJO!
<br />Irm$y lllnnund$Nn,[yoif.rjuryoncof ltuldk]*irtdc.l,r,rn s:
<br />I)cnxniri,)tr Pcrmirs Ashcsros Norilicsiion tidcral RcB!llri.n\ l l irlc.l(,. I'd6)
<br />Rcquncd Ir(cr of Norifi c(ion
<br />I cdify rhar ih. r.dfial rceulnrions in8 eshsros rcnbv,l aE nor utplicrhb ro lhh Imjcl
<br />-l.cnify
<br />lhtrl I haw rcod this oppli.al .vc information iscotrccr.I asre roomtlysnh.I CIy,nd Couh(y
<br />ordimnccs and Srol. b*s rclrr eld n rcbyourhrirc rcrcscnrarivcs otrhh Cn, d Countylo enro !F).rlr
<br />ahovc mnrion.d pmpcny l
<br />AnDlicMr or Asc Sistutu 2.-toloE
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulalion
<br />Smoke Detectors lnstalled
<br />Rouqh 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 />Openings
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meler Release
<br />FINAL YL/ClY ,t)/({
<br />Notes, Remarks, Etc
<br />lnsulation
<br />lnstallation
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