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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OI'IT{ER BUILDER DDLCARATION <br />I lErcby ,t&n undq p.nrlty of p.riury lhal I ffi cotrpl frnm in. Conlracto6 Licctr* Llq for thc followitrS rctsi (SLr.?Ol l.i <br />Busin.ss snd Prefcssion CodE): An! Cny or Counry slrth r.qlirs a |tmh 16 @nnruc! aller, improw, rhmlnt or EFqn ,ay <br />srdluc. prirr ro irs isr@c.. dso rquircs rl* ,rplter for slch FmI to fih r ti8f,cd srar.mil thd lE or shc is liansd Pum!,rt <br />ro Uc ,nottioos of tlE Conrrerols Licco*d t * (Cn!pr.r 9. Comcfting wilh Sccrion 7000 ol Divbion 3 of lhc Ausi..ss md <br />Pmfessions Codc) or rhat lr or shc is cxcq lneEiiom ald lnc hsir for lh. 3ll.!Ed excngrion. Ary vhlalion of Selion 701 I 5 hy $y <br />apnticlnr for ! lErnir subr6B rhc Eirlicanr lo ! civil pcnulry ot tur ea 6e liv. hundrod dollrs ($500). <br />-1.as <br />o*Rr ofrhe,,opcny. my.mplorrcs Dith wa8.s ss llrt $lc on ctrerion. will do dE wo* .,n ll* $trw k tul <br />inrdd.n or oficrcd fd sh (5€.70{4. BusiE$ d Pret sidB Codcr Tnc Co.rodols LiccN Ljw des @t tppry lo r. ownf ol <br />ihc pm,Eiy wno builds or im0ots lh.dn. dn sho dcs skh Mrt hio€ll or hc6crl or lhmu8h his or hcr oon.tploy..s. <br />pmridcd rhsr 3kh inlllDwnB ft ml inr.nLn n ofcEi ftr slc. ll hoqcE lhc ldilding o in4rewmnr is $k wnhin om tE <br />ot sq,hrior rlE Owmr Brildd *ill h.w tlE t{r&n of lorin8 $sr lE d stE dn d hild ., in{mE dE pDpcly fot tnc p{qr* of <br />-1, <br />!\ow*rofrhc popcdr. dmcxclusivcrycofi.crinB wirh liNnscd conlr0cb6 lo.onntud lhe pNjccr (SN.7044, Brlincrs <br />dd Pisf.sbnCorl.: Tn Conhcrols Licctrsc L!* docs flor aprlyro an osmr otnroDcrty who builds or iolprolcs ltcrcon. <br />and sho conrrcIs for su.h Fojcc$eirh{ Conm.'onc) licu*d pusu rhlhcC. mlols Lirne L!w) <br />-l <br />amcxcmpl undcr Ssl <br />UOAf,ESS:.CITMTENiAIIotr <br />DECITaAT T <br />I h.rcby amm und.r lao.lry of,Ejury oa of ln lolowinE dqlnmlioftl <br />-lhrvcurdwillnuirunrdCcniticrr.orGrMnrk,S.lrl\urcr.rworkcn.om|]ctrsalior..sprovincdforhyS.dion1700.rrhctalx" Codc, r.r thc FrfoirnarEc oilhc*ork fin whichlhcFrmil i\ i\lucd <br />Yal hrrc *illnrhcin w.rk.d conrr.n\arion nr\uraN.. rs icqurcdhys(lionr7(x)olrhctihorcodc,,,rrhcpdfo unccof <br />rhewo,klrtrwhi(hrhi\ptnirist\ucil.Myworkc(.on[ctrsdn'nrn\ur!.cc.lnicrlndnolicynun$.rdc: <br />E ll. Lf.L. Fr- € Ca-s.,-l{' <br />Oo-', >t?cso <br />I..nifyrharinrhct'nlormnc.ofrtc*orkforwhicnrhisrcrnirknsucd.lshrllnor.mplorrnyp.rsoninlnymanncr <br />s N to hEoar slbFt ro r he $odcu' .omp.nrd joo hsr of Califdmi! lnd 08d lhd if I should tEom sub,c(| ro lrt <br />so.s'str{En$rionpolisionrofSccrion:l7L{)6flhchborCrd.,Ishall,fodhwilh.onplywilhlh.stmvirionc. <br />WAnNnC: Frilurc t. cur. wortcn compctrslion.ovcm8c is unlawlirl Md rhdl subid m .mpnrrtr to siiiml ltnuLic !.d <br />civil frncs np to onc hrndrcd lhols.rd dollnn ($100.m0), in lddition ro Oe.ost ofco'nFnsli.n. d!ro8cs 0s F,vidcd aor lhc <br />c.de [lfrd ald liorEy'l rel_- <br />-7 lz t?Aoottnla -->r*rlA- <br />uoilLtur-l;aNrlAcltl& <br />DECIA.BAIION <br />I hcrchyllfirmu crprnllryofFrurrrhnr L li&n{d und.r I'ovi\Nn .l chinrc! 9 (commmin-! *irh SNlir T(xxr) of Divni(,n .1 <br />ur rhc ausi,rcs Md Pblcsions Codc. Md nry li.cnsc is ir rull nmc anl rr'licr <br />Czs 66+'ts> <br />?tz l? <br />COISIEI,ICIION.LENDINC.AIiENCI <br />I lErcby affim undcr pctutry of F iu.y thd $e k { @DslDclbn bndi.g .g.ncy for lfie pcif{)llj,M of lh. ftr* for whkh this pdhn n <br />trucd (Se. 3097. Ci!. C.). <br />ATIUgANLIIECIAAAIION <br />I lmt y aninn lndcr Fndlry of D.rlury onc ofrhc fdlloqirt dNl[.rrn\: <br />D.mlnion P.rmir$Ash.slos Norificolion lcdc.rl RcNl0rions Onlc .10, Pan6) <br />-Rcquncd <br />Lcllcr of Norifi cnln,n <br />I ccnify rhar rhc fcdcral Egulslions EgsdinB asbcslos rcfrrvrl arc nor afttlsabL ro rhh pej..r <br />-l <br />ccnify rhul I h.vc r.d rhir .0nli.ario6 rnd nol. rhrl lhc ltrvc iorbnmiion is .oret. I lsrc lo oddy wirh .[ Cny aod Counly <br />ordinlmcs rnd Srurc t qs Eiariis ro blildiog .on{ru.tiotr ,rd hcehy .urtsrtc rcprcsntalivcs ol lhh Cny and C.unly lo .ntcr utEn rhc <br />&,rc nEnrioBl pnl).ny fff insF.rn,n rurIix$. <br />Afnli.rnl or A!.rr SiEtrrl <br />91."..,'..r"./- <br />zl,rln <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Smoke Detectors lnstalled <br />Rouoh 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 />Openings <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL 9lrflrf 21417 t '/9) <br />Notes, Remarks, Etc. <br />lnsulation <br />lnstallation <br />rJ,qJre <br />I <br />I <br />tt