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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE 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 />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Banqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Y
<br />Fire Damper
<br />Openinqs
<br />Installalion
<br />F.D. Drop Test
<br />)
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.I
<br />'l,ln ,l n <'/./Yl*fl-,If-\ ,
<br />Final Test Lt --tl " t
<br />....-t{lt1flrcFINALtJ,l4r,ln try'
<br />Notes, Remarks, Etc.
<br />v
<br />OWNER BUILDER DELCAR TION
<br />I tcEby rlfrn undd Fulry of pedury rhar I m crcmpl fism rhc Conradm Ltccos. t w fo. th. foUowing Elsn (3N.?Oll.5
<br />Blsincs and Phfcishn Codc): Ary Ciry or Counry which ,cquircs a Frnir to con(rocr. .ltc, impmw. dcmlish or EPlt sy
<br />strucnlc. nthr ro its iismc, sl-s rcquir.s !h. applicdr lor suct F nit lo lilc . sigmd srd.tunt $d h. or .lE ii li.cMd pusuai
<br />lo rlE pmvisiom of rlE Conrrctoas LietrEd Li, (Chsfld q Comcming vili Sslion ?0q) of Divishn 3 of lhc B8incss lnd
<br />Ptuf.ssions Codc) or rhs! hc or ihc is cxemp theslion.nd rhc bssh for lnc alL8cd cxcfrplion Any viohlion ol Serbn 7031.5 by any
<br />aprli.e fo. a p.ml subiccrs rhe aDplica.t lo!civilp.mlyofml mElhM nlc hoidrcd dolhrs(3500).
<br />-1,
<br />!s osid of th. pmrEny, or my cntloyes virh wrgc$r rh.ir sh 6mp.nstion. f,ill do lL qoi ad $c nn @ii er
<br />inlcnd.d or oncrcd for slc (Se.?044. Busimss and Ptnfcssions Cdc: The Cont6.roa. Liens Llw docs nol aplly to an owmr of
<br />rhc pmlcny who txilde o. h{mEs 0mr &d who dm st Ni( timlf o. h.elf or ihmuSh hir m hd own .mployeF.
<br />Imvidcd rn such imlrc\tftnis @ mr hr.nded or offdrd for eL. It hvevr. lh. lrildins c itrtftwftm is $ld si'hh om rr
<br />ofarphtio,L Uc Owmr Auild6 qill lEr lhc burd.n ol Fovin8 rhd lE or nE did mr hild or in'lDE li. prcFty for tnc pulpos of
<br />-1.
<br />ar o*ncr of the pepcny. ,m cxclusivcly conlBclin8 wilh liccnsed conlrlclos lo onitrucl lh Imixr (Scc. 70,14, Busifts
<br />rnd EDGsir Con : Tlrc Contrcror's Lic.n* ke doer tur ,rpl, ro e owncr of pmp.ny who builds or idpotcs lh.mn,
<br />lnd who onrrrcrs fd uch F.irls wnh a Conrtrto(s] ltcnsn plrMnr ro rh. Conreroas Lie.o L{s).
<br />-l
<br />mcr.mpl urd.r Selion- B- & P.C. aorrnis Mon.
<br />.EIIBtrEBLS'MIEIIA-IION
<br />DICIAEAIION
<br />I hcrcby lalir und(,Elrlry olpqjuy oc orth. follovi.8 delarliom
<br />_lhrvc!ftIsillnuinhinrCcdilicdcofCon\c hS.llln\urctursork.6'.onrF_n\rri(rr.a!F,vidcdli,rhtSc.ri(rl7U).frh.
<br />Lihor C{nlc. ior rhc lcrliflmrcc ol rhc $orl( k,r * hi.h rhc Frmir i! n\ucd
<br />- lh"'",,n,1{,ll-,,n,,,n s,' c^lotrll..n<JrB{i,}ur.r.c,r\rL\lundbyScdion3?(x)orrh.L$orc(dc.ri,rrhcrfoi,ninccol
<br />ihc *ork nrwhichrltrs pcnnir is tsudl Mt*orl.n conlE.snlion insuftmc clri.r arl polkynunftd -.
<br />1*,
<br />\",n,
<br />(Jc.tJcqo?593
<br />-lccnilrrh
<br />in ih. Frrormmc ol lhc *ork lu whth this Frdi ir nsuc{. I rhrll mr c,{,loy my p.Mn in ,ny n rct
<br />sr r ro bcem subixl lo lic qoll6 orycnerion hws of Cnlifomia. od rgm rhd if I should beom sobj*l lo rh.
<br />workc ompcnsolion pDvtionsofsNlion STO0orrhc Lat t Co<lc.l sh.ll. lonhwilh onrply wilh lhos Pmrisions,
<br />WARNINCi Failurc to sw M cF' .onp.nstion mvcEe€ ir lnhwtul. lnd $all sublr m .mphltr ro qiniMl FMIts ud
<br />A:,,,iner up b onc hxndrcd lhousand dollrs ($100.000). ir .ddiln,tr to lhc cosr of com,!.nstion. &nEBcs s ,rovidcd lor tlx
<br />ol rhc tjbor codc, inrcrcs .nd ctrormyt fas.
<br />2
<br />uctruiDlQNlx,ttloB
<br />DICIA&II.ION
<br />I [crcny ifi-rrn uDdcr pcmlryotIrcrju.t rtur I an ]i..nwl uidcr provhi(n ul Chitrcr 9l.omnrcncing sirh Sccri,n 7(XD) ofDiui\i,)n l
<br />of rhc Busirc$ Md P,nlissidr\ Codc- nRl myliccn\c is lull li,r( utl.ftccr
<br />,/r-",.Czc>11qvo.+
<br />lz t8\
<br />IAISIIIJC-IIANI.INIINC.&{jEN(I
<br />I lrruhyr nDlndcr rnrhyolfnrjurylhdr rlNc isr.oiitu.ri( lr dill3 n8cNy for lhc pcrlonunce of rhc work for shi.h rhi{ NrnliI is
<br />hn'c (Scc .1007. Cir C )
<br />AI]LICANLDECI.A8^IION
<br />I lf,a.by a|inn udd.r p.idlry ol p.rjury onc oflhc follo*in8 delmtii,n\:
<br />Dc skiotr Pcir h-AsbcsosNotillcalion Fcdcral Rqolniions lTnh &. Pd6)
<br />-tuqrircd
<br />lrrrcrof M ilurhn
<br />I c.rlify lhd $c Ldcrul rcSuhlions rcSarning lshcslos Emval rc mr {pli.abk ro lhh pm}f,1
<br />-!
<br />.cnify rh.r I h.w rcad rha.r applharion .,i stl. fid lh. .bovc infornElion is coBl, I .88 lo 6nply sirh .ll Cily a.d Counly
<br />lid Srrrc Liqs rchri.s ro buildirs .oonrucriotr uti ll.Eb, Nurhoriz. rcl,tsnltrlivcsof lnn Ciry!.d Cdnnrr ro.nrcr upon trE
<br />iuul pmpcny i,r iispccrn,n luryJsr1
<br />\'.r''
<br />I
<br />IIII
<br />ID/SIG.
<br />Meter Release
<br />O*mr:
<br />I'l,r
<br />4,4u
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