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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DELCAR IION
<br />I hcrcby a,lirm undd Fcmlry of Frjury rhlr I M d.mfl fibm rhc Co.rBci.^ Lt.nF Llw for lhc following ta$n (.d.7031.5
<br />Bnsinc$ !d Profcsion Cod.): Any Cily or Counlt which Equn.s . ttm lo con$ru.r. .h6, inpmw. &mlnh ot rcrdu gly
<br />sricuc. prirr ro irs issuancc. lle r.gun6 rhe aplli.dr fo! $u.h peolt ro lih 0 si8md sl&mnl lhal L or shc n liccn*d puruani .
<br />ro rlE povllions of rE ContBctoas Li(nsd Li* (Chsplcr 9, CommminB snh S(ion 7uJ0 of Division 3 of th€ Bosincar ad
<br />Pofc$io.. Codc) or lh.t lE m slE n crcq,l lh.r.ftom &d llE h€sis fDr lhc llhecn cxcnPlhn. A.y viohlion of Sftlion ?031 .5 by ey
<br />apllicanr for ap.rmir subjecls thc anpli.a ro a civil pcnalry.f rot mr. lhan fivc hundrcd dolbr ($5m).
<br />-1.
<br />as owmr of thc rroFny. or my cnt,)loyes with wsses &\ thcn sh ompcn*elion. w do OE wd* and lhc{n re h ml
<br />inlcdcn or ofrcrcd for sle tS€.7Or4. Blsiners .nd Proresio,r Cod.: Th. Conttrtol s Limn$ &, does nol 8ml, ro 6n owrcr of
<br />rhc I,6Fn, wh. build. or irymws llrcmn. uxl *ho dcs trh e* hiosclf o, hcielf. hbu8h hk or hcr own emtloyes.
<br />proridcd rhll soch inFsmrtr! m mr inrcnd.rl or offeEd for eL. If. ho*cEi th. buildina or irrqrlmmnl is sB wnhin o@ ,@
<br />ofonplcrion. rtr o!,ns Buikjd sill harc |he UlrLn oa Foviog thd h. 6r .h. dil mi hih or nrFmE lhc pmtEly ,or rlE I,nrpo$ or
<br />-1.
<br />uso*rcrofrhc tmlerrr. dci.lurieclrconiracrin! wnh I i..nscd .oblrncr or lo onerucl lhc I,+d (Scc.7044, Burh{q
<br />a.d Arf.rsim codcr Tnc Contactor's Lic.ns. Llw docs mt orply lo un oercr or Drop.ny who builds or im[ovcs thcEon.
<br />lnd whn onrncB f6r quch pmlxk wiih e Co mkr(O li..nsd nlsunr tortcContEtolr Ucc.s L,w).
<br />-l
<br />mcxcnF unr S$lbi.- B. & PC. for lh* rcdsn
<br />I)xlr O$ ur
<br />IIIStrEIILCOMIENSAIION
<br />IIECLAIAII T
<br />I hcEb, atnrnlodcr I,cndlrrolr.rj!ryon..f rh. fou.eine dcctsrtions
<br />I hrvc rfll$ill nBi,nrinr Ccnrfi.dr.orC. *[ k, Sclf.li\urc litr*tr(c^ compotrunni.r\ privnl.d trhvSccrirr ]7rx)ol lhc
<br />lnhlnCklc- turrhc pcrtnrnrxncc otrhr qork ntr qhkhrhc Nn rNissuL\i
<br />-l
<br />hivc rnd will mai,train worlcs compc.snlion insur!rcc. as tcqltcd by Se! ion l70o of lh. tihor Codc. fo. rhc PcdoM.e of
<br />rhc work for *hich rhir pcrhn is h$d. My vork6 o,If, erion inor.m .Mir ald Flicy numbcr ac:
<br />3\uk trnr,fq2\)5 (/\f 5t2 (,/tR
<br />-l
<br />ccnify rhrr in rhc Dcrf.nna@.rnr work lor whi.h lhn pcrmn is hslcd. I snallnol cnDloyanyncso! in ony
<br />'nmncr$ as ro bcsm {bj.cl h lh. wortm'om!.nsal ion laws ofcolifnni!- lnd Jcn.
<br />'hd
<br />if I sh.uld iE€orE subj.rl to lhc
<br />*orrcn.ony*nsalionrovisionsofSdionl?00oflhcLltnrCode.Ishau.fonbwnh.onPl,wilhlhos!rcvhions.
<br />WARNINC: Failurc to sc!,c wort6 6dp..sotion .ovcr{gc is lnt0wtul, rnd shau subirt !n enPlo,tr ro diminal Fmhis..d
<br />cilil fincs !n to onc hundrcrt rhou$nd d.llss (Slm.om). in addilion lo lhc cnsl olcoq)cnsdinn. dirogcs.r plovilcd ior lh.
<br />Sstion 3076 of rhc L,trn C.dc. intdesr ond anomy s l6s
<br />-7125/tb /l*
<br />LI(:INSIDI]ANIIAI;IQB
<br />ITECLIAAIION
<br />Ihctohyaltuoud.rFnrlryolpcrjuryrh l or liccnwlundcr prolnn,n olCn4'cr 9 (c\rnnrEndnr8 wnh Scction 70(x)) orDivision l
<br />"f rhc llusiNsslnn Pmrcsn,nsCodc. rl 'nyli.rn* it in iull ntrc nrd clfc.r
<br />tonq3rvffit,a-
<br />COISIBUCIION.LDIIIINIiIIiENCI
<br />I h.Eby lrtrh udcr pcnlll, ot lcrjury rhaUhft ir ! on{rudhn t.dinB 08cmy for lhc Frfomtc or th. work for qnich lhis lEmil is
<br />irsucd(Sc. l0i)7, Civ C )
<br />ATI'ICANLI}&CIABAIIO!
<br />I lEatyniinnundcr n€nrlryofpcriury om orrh. tulb*nrx dc.ldrdit rs
<br />l)cmolibn Pcrnirs A\hLso\ Noliri.r'ion [cdcnl Rcputirnns t'lnlc.l0. Pani)
<br />Rc!uircd k(cr orNorilkrit)n
<br />-l.cnilythor
<br />rhct dcrulrcrrhrhns rc8rdi.E istrnos rcnFq'l lrc nor lnnlic$E ro rhi\ !fl,r.rr.
<br />Z4l
<br />""nlty,tu, t t'u"" r"u,l,t lr uprlicali,'fl dxl {arclhlrrh. ah)vr nrtunnarion h core.-t I lsre lo coqny wnh rll cily ntul counly
<br />ordinriccl nJ srdrc lrN! rcl0ling ro huiUnrs consrrucliotr. !.d lrcrchyaurhtrnc ftFcscnlJrivcs oflhn Cirymd Coonr, k, cnr& ulon rl'd
<br />$o!c m ioned F)r.dy ror insl'.rr
<br />Amli.unr or Agpnl SiSMrurc:
<br />-712s/ /3-frb,tlv-Z
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Besidential Ranqe
<br />Other
<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.Vqn,{bDg6
<br />Meter Release
<br />FINAL 6ttilrl ,5\BY
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Pre-lnsulation
<br />Hood
<br />lnstallation
<br />Final Test
<br />I)xr
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