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MECHANICAL.INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<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 Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinqs
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />i.lcv,,.c,4 It Tj 6r)Rough Mech.
<br />Final Test uJ
<br />Meter Release
<br />FINAL lzz)
<br />Notes, Remarks, Etc.U\
<br />OWNER BUTLOEX DEI,CARATION
<br />I h@by .mr'n uodo pcnrlly of pcriury fiol I m crcmpl ftom lnc Conlr!.lo6 Lic.nE Las for lh. fouowing E sn (5(.?031.5
<br />Busin*s md Pmf.sior Codcl: Any Cily or Colnty qhi.h cqoiB a Fmh ro con{rud. all.r. imprcw. &mlish ot tprit oy
<br />srru.ruE. prior lo its i$am. abo EquiEs rhc lpplher fo. $ch Fmil lo lik ! si8*d rla|cft thrl lr 6r lhc i! licqsd l,ur$trt
<br />io rhc pmtiionc oltlE ConlEcrols Liccn*d l,w (Chlprd 9. Comdcncing wirh Scclior 7000 ol Division I oflhe Busincss and
<br />Pmlcssions Cod.) or rh.r lE orshc is.xcd rt cfiom and rh. he\t to, rh. alkeen cr.nq,lhn. Any viohlion of Serhn 70l l,t br .ny
<br />applic! a6r a FmI flbiects thc alplicml lo a civil p.mlly ol Nr rmE lh fivc h!ftlr.d doltds llt00).
<br />-1,
<br />&s ownf of rhc pioFny. or ny .n{lort s wnh w.gs B rlEn $t ompctrglhn. *ill &, llt wdl ard 0E sr.xrm is ml
<br />i,rcrH or o6.Ei for elc (Se.?044, Busimss snd Pref.ssions Codc Thc Conr&rofi Ltc6F liw docs nol apply lo .n oercr of
<br />lhc pmpcny who builds or nq,ors rhc@n. od {ho dG. Mh mrt himslf or trn.laor thrcl8h hie or h.t ow..dplo}tc.,
<br />prcvid.d rhar such ioprowftdse ml i cixH trorcEd lor$L.lthoMEi llE hoildnu or iqmtd ir$ldsithinmFm
<br />of@n$lcrbn. tlr Owrr Builkr eill h,w {E buncn ol Fmvin8 lh,l h. or sh. did ml hojld or irstoE Uc pDtBry aor rlE purlbs or
<br />l. ss.wncr ol lhc l,opdy, omcrclusivslyconlrsrins *ilh liccnrd .oildro6 !. .oisrod rh. rmjel (Scc.7044, Bu5im:r
<br />lod Prot6shn Coder Thc Conrddoi, Lic.nsc Lrw docs n6r trptly ro un ownfi of prcFny uho blilds or imnrovcs lhcton,
<br />and *ho conlBdsfor such pmjc.ls wirh uC4ntmctorls) ltctrsd 0lrsunr lo rh.CodDdors Li.cnsc ttr*).
<br />-l
<br />.m.rcmfl urd.. S€tioL--. B. & P.C. aor lhir l.en
<br />Osn€.
<br />UAf,TEIN:CAMIINSAION
<br />DEII.AIAIIT,N
<br />I herchy rrrnu.d.r p.nlhy of pcrirr, otu oflhc tollosiry dccllDlio.s:
<br />l hrv..rkl will hinirinrCcnific.tcolConscnrroSclfln\urcnrsorlc.sco'npcns tun,Nlro\idcdlarbySccrion:lT0oofrhc
<br />lintr Cod.. li,rrhcp.rturnri.c.lrhc work lorwhich lhc t6mir n hsucd.
<br />I how and will m,inrnif, worlcts compcnsalion instrrrcc. as rcqlircd by Scclioo 1700 ofll[ tlbor Codc,lor rhe p$fortucc of
<br />thc sort for wnich lhis lcrmil is nsu.t My lorkc6 s,mpcnsrtion i.sutuN.Micr and polky nun$.r ar:
<br />WARNINC: lhil!rc ro scue w.rkE cof,p.neri.n cov.i8. is nnllwtu|. ond shall subjccr a. cmplorcr ro diriml JEmllis lnd
<br />civil fitrcs u! to orc nundrcd thougnd doUa ($100,000
<br />Sccrion 1076ofrlE L{bor tue, inrcrcd and dnomy s rccs
<br />.ddnion ro rh. cosr ofco ion. &@gcs a pmvided for tlE
<br />I hcrcby lmrn u8l.r Fnahy ol Frjury lhnl I m lieflrd u prolisio. ofCh.prcr 9 (.om,Encing wilh Sstion ?000) ofDirhiot:l
<br />of lnc Busiflcs lnd Prcfcsions Code. ed ny liccnr is in full loE. ond .ffel
<br />I hcEhy s,firm undcrycMlr, of Friury rhdr lhde h u .on.r
<br />i.rucd (sN. 309 7. civ. c.).
<br />nding lg.ocy for lnc ncrfomtu. oflhc wort fot which lnb Frmil h
<br />AIzuIANI.D&CLAIAIION
<br />I tmhy rnim un,lcr Fnrlry or tf,rjury o c ollhc rbllownr8 dcckrrlnnr!
<br />Octrdilion PcirnirsAst (os Norifi.nrt'0 Ftdcral Rcgthrnrn\ (1ir1..10. Pd6)
<br />-Rcqutcd
<br />lartcr of N.rificrir)i
<br />-l
<br />cc(ity rhar thc fsdenl Esulalions rgeding .srrsbs rcnDvd m d 0ldicahlc to lhh I'Io]cct.
<br />I *diiy'hrr I hrlc rcdd rhnarDlto trand (arcrhnr rhc atnlc inrornurn,r i\.oftc.r lsarNrocoDnlywilhallCirrrndCou.ry
<br />.rdiorftc* a.d sbrc tlws rcblin8 lo b!
<br />ltrve trnrb.cd ltupcdy ror insFdn'n
<br />ofrnis Ciry Md Countyrd €nre! ution 0r
<br />t
<br />b
<br />II
<br />I
<br />E
<br />IIilE
<br />lnstallation
<br />Poli.y Nnnlb.i-Expncs:
<br />-
<br />-lceaifyrhdr
<br />inrh. p.in,mn corrhc worl for rhichrhis p.rmir n issucd.l sidlnor cspk,, rn! P.son i.any m rcr
<br />$ as ro tr$nr subi{l lo lhc worten omp€nsation lass ofc6lifomi!. dd 4m Ih,r irl stould tsom suhicl ro ll'c
<br />workcN .onlpcns ionrmvtions ofSccln,n lT00ollhc tihtr Gxlc.l shlll. rodhwirh.onrrly with rhos lmvhion\
<br />t ndd r Nrfr:
<br />-
<br />I
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