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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDAR DELCARATION
<br />I h.Ehy a,firm undcr pc.ahy ot p.r.jrry rh l m ci.npt tsrn rhc Conr&ro ' Ltcns Lrw fo, thc following l@n (5€.?031.5
<br />Busi.csr aid Ptufcs.ion Code): Any Chy or C6u,ry shth eqliB ! n6nir to .onrru.l. dln inpmt. .Lmlish or ElEn uy
<br />.nuduic. pri,r lo nt i$uare, also equica lhe .prlhel for rkh Frnir ro 6L . sigBd sl.lcm rn l h. or shc is liccn*d pumd!
<br />ro th.Imvisio.s ofrhc Contnctoi'! Li..ncd llw (Chaptcr 9, Com.ming virh Sc.lion 7fl10 nf Division 3 of llE Busincs ond
<br />Prcfcsio.s Codc) o, th{ lE or shc k .xcmll lhcrcftom and lh. hesis for rnc allcS.d crcnflion. Any vk,blion of Se$r 701L5 by ay
<br />lpl)li@nr for o lEmir sbj(h rtE appli.afl b d civil l,edlrt of mt mE lhd fivc hundcd dollri (t500).
<br />-1.
<br />as oqner ot th. tmlEny. or my.nploltcs wirh wacci a rhci $h sq,.nralion, willdo llE eort i tn. sltucnft ic mt
<br />i.nddl u.ffcrcd fo. elc (Se,044. Busim$ and Prcfcasio.s C.dc Th. C. r<r$LiccnsLlwdocsmlatplylotrov6or
<br />rlE lioldr, who ltuilljl or itrlorcB r.6a.tt eth des seh,r* hidrclf or hdFllo, rhrcueh hi or lE own cmphy.s.
<br />provi&d rhar sh in0mwmnls N d i'n6ncd ffofr@d lor sh. lf. howcEl r,E hoildins or irImEEnr ii sU pittin @ t@
<br />oforpLlion. lne Ownc. Buildo eil hsE ltE &nhn ol pmvftg rh,l tE or rh. dii ml toild or inprow 0E pbtEly tor thc Plrpoc 6f
<br />-1.
<br />$ ownfi ol rh. !m!.ny, M cklusiv.ly.onrDdin8 wnh lensd .ont do6 to connrud lhc Fmirl (Ss. 7044. Duiifs
<br />aid AotrsbnC^dc Thc C,nr6dor'r Lkcnsc ks docs .or aorly ro un oe.fi of pop.ny who huilds or improves lhcrcon.
<br />lnd who .onlncrs ltr such pmirts with r Conrncto(s) lkcned puNMr lo rh. Contrrctols Lien* L!w)
<br />I rmcftmD' undcr Sfrrm ,8. & PC. forrhs Eason
<br />IIIXf,E8S:C(MEEISAIION
<br />D&q.68Ar&N
<br />I lErcb, rfftrm on<lc. p.nalry of ps.iu.y oE ofrlE tollowiiS d..lreioii:
<br />lhdvc rnd willnrinrrinr ccnill.ircofcotr\c.r k,sclilNUrc r(, qorkcr{ conDctr!r!ior. rs pn)vidci lnr hyS&rioi:r?(x).frhc
<br />trhi, C{ r, nr rhc p.nnnnrh.. ol rhc s.rk lnr shkhrh. If,nnn is isucd
<br />!4havc idsillnrnnrin workcra ..nrNnsrri(,n in$nn.c. r\ rcqurcd byscdnr rTrDol lhc L,6orcodr. r,nlltr n rionutr.coi
<br />rh. w.rk tu' *h i.h rhis |[nrir is r*rLcJ My sor kc( ..nUcD\ i nr) Nuntr.c crn icr !n1 Nlicy unrh.r m:
<br />sE&UOlrrt
<br />-l
<br />.cdily rh,l in rn pcraordec oa r,E wo.l lor whi.h thir l,..dir t hrkd. I shall not .mploy any F$on i. lny Mrcr
<br />s * to trsm subiEi tt lh. m*nl con{Ensation lavs ofc.lifomi!. lnd agE lhar it I rnouB h.<om slbjcd ro rlf
<br />workc* co,q,cnsrtun pDvisionsofSdion 3r0O oflhc Lobor Codc.I shlll rodh*nh comlly wilh lhoc pDliqions.
<br />WARNINC: Failurc kr slrc qrkcrs @6pcn{rn,n covcnsc i\ lolo*Iol. and shau subi(r ,n cmrlo)er ro niminal lcmllics and
<br />.i!il nn.\ up ro onc hurdrcd rhourlnd
<br />q g"-"-'rl I I
<br />DEgL &u10N
<br />I hcrcbynfin'nu'dcr ncnrlryolr.riury rh0r I anr lions.d undd tovhiotr ofCh.I)ts q (comnEncine $irh SNlbn 7(n0) orDiri\n,n.l
<br />of rnc Blimsslod lons\ionsC.dc, *ld my lkcn\c is in liill fu( uld.l1i{r
<br />Cv) b
<br />caNsrx.urJlQxLltiDMi.dcENcr
<br />Ihcrc$yrlimunlcrncnllryof|xrtrrrrhdrh.rci\tr.oiinkrir.Lindm!rgcNynrrh.!c'onmmcolrhc$orkLrshichrhkFmiris
<br />i\srcd (S...IID?. Civ C.).
<br />A-tflll^Nl-Ulj!.trlll llllN
<br />I lurhy rllnmun,ltr D.trr]ry ofprrtu,, oN oIlh. n)ll,)$i,a J..lxrxri,nN
<br />ll blirirnr I,crnrir\ ni\o\ Norll.di, li\ldnl Rcgultrri,[\ l IIlc Jl). I, rar
<br />.-R!,ttrtrr(l l.crrcr l N.r ll.rii{!r
<br />-l
<br />eniiythlt I hdlc Rtrd rhhrpplic{rnnr dstlrcrhar rhc0h,!c irlonMnr ncotucr.Irrrelo.o rtlysnh0llCnynndCoutrr}
<br />Appliances
<br />Iti'letal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />[/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Besidential Range
<br />Other
<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 />Meter Release
<br />FINAL d-ls J g I'-!LOC)
<br />Notes, Remarks, Etc.
<br />Hood
<br />Final Test
<br />of.omFn{rion. damgcs
<br />"s
<br />pmvijcd for ltc
<br />j I cuo.r-, !(=
<br />-l
<br />ccnilyrhar rhc rcdc 6l rcE! hr ions rcsrdins !sl*(os rcmrllac to,r atpli.ahh ro rhc lmjer.
<br />ordinrftcs lnd Srdc tlws rl,rin8 lo huildin8-n'
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