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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEL(IRITION
<br />I hcrcby lffim undcr pcnohy of pcrjlry rhd I d cicqr tmh rhc Co rero6 LixB Llw for thc following Easn (Scc.?011.5
<br />Bu.incs atxl Prof.ision Codc): Any Cily or Coutrly vhkh Enui$ ! IEmil lo onslrucl. all€( itrrrolc dcmlish or allaa. ay
<br />sro.lu.. Fio, ro n. bsumc. d$ r.qlircs lhc $plicmr for such pcmir ro fik a siSn n sldcrfl rhar hc or 3h. i\ lic.nsd puN! ,
<br />ro th€ previsions of lhc Crmt&rci3 Liccrsd Lre (Clq'rct 9. Co@mEif,g wilh Sccliof, ?0m of Dilisiot I ot dE Bulin.sr .!d
<br />Pmf.*ions Cod.) or lhal tE or shc is crcmpr rh.rdiom md rh. h$ir for rh. alkgcd cictrrflion. Any vk,laridn of S.dbn 703 I J by any
<br />lr,plicanl for & Fmir su6j.rls rh. alpliqnr ro . civil pc.!lr, of mr mrc lhr. live hu.drd dollr$ ($500).
<br />_1. Ec ow*r otrhe prcpcny. or ny .mploFr wilh wa8g a{ rlEir $k mnp.nslion. will do rlE qart .d dE n rE b mr
<br />irrcid or ofidd for sk (S(.?O44. ausircss ond PrDfcssions Code: Th. Coot rdols l-im* t v .roB ml 9r,ly lo d oetu of
<br />'lr pbFdy whb t ildr d inlmws rh.m.. ord who des skh wo* hin*l(or lENlf or tleush hii d lEr oan cDpk yc.s,
<br />provitcd rlnl seh inplwnB G d ini..d.d or oflad lor s].. lL how6. E boilding tr irprcEm is $ld wnhin otu }s
<br />ofcorybrb( rlr Owrcr Blil&r will laE tlr tnd.n of B,vir8 lh.r lr or siE dil rcl hild or inprcw dE l,stEty for llt Pqhs of
<br />-1.
<br />N o*mr ofthc pmFny. mcxclusivclyconlEctins wirh liccnscd contracro^ ro connrucr rh. pDj.d (s(. r()44. Ausmes
<br />aid att!\ri,n Codc: Thc Conh.ror'. Li.cnsc Llw doB no',pplyb.n owncr ofpmrny wto builds or inpnvri lh.ren.
<br />ond who contnchfor such pmrcr\ wirh i Conrm.ro(o liccnscd pusla ro rhe C6nractoas Lic.r* tjw)
<br />lancxcmDl undcr SRrion .B &PC forlhirttan
<br />ln,nr.
<br />l4axSEIts:l;oME[NtAIION
<br />D&CLIIBAITA!
<br />I heEby amrfr udo pcmlry or Frjury oB ot rhc Lllowi,rS delsaiions:
<br />-l
<br />nr* sd *ill mintain . CenifrrG of Cons.nt lo S.r'lnsuE for e*dC ooFB.lio,L a previLd for by S*don 1700 of lk
<br />trtd C.de ftr thc p.rfolmtr of $c mrk fd $,hth lh. nsnil t hren.\-1
<br />,E hlk lnd qill mfllin *orkcE' conipcnslrion ,rrEft.. !s !.q!iEd b, Serion l7llo ol ** tab.r Code. for llE Frfomtu. of
<br />rhc sort fq wl*h rfii. Fmir is ised My eorl6 @q,.B'lion itumre tri.r a.d policy nuEt r E:
<br />A7,I4E7Z/24) Z ctz2l?4
<br />I
<br />-l
<br />ccnify rh.l in rhc l*rformK ofrhe *ork for which lhn !.mir is ks.4 I shatl nor cq,loy ant p.son in any aunrcr
<br />$ ro b€corc subjecr ro thc *.rkcB .rnp.nsdion laws or Cllinrnia. 0nd o8e ttul ia l should bccom subFl ro ln
<br />woltqs. .onF.s.ri,n pmvkions of Sdion l7u) of $c tittr c'od., I sttrll. tonhwirh qnrly wirh thos pmvisiois
<br />WARNINC: Flilurc ro sccuE workc^ .o lp.n\dion.okr+c i\ trnhsful, rtrd shall subjcct u cnployc. ro oininrl l).nrhits ind.
<br />civil nncs up ro onc huodrcd rhousaid dolltr* {$1fi).(x)0). in nddiltD kJ thc.osl ofconD.nsolion. d0nug.\ rl f.viJcd Ibr rhc
<br />Y:s/;;2;_::X,:
<br />ullNsEllloNrMtro&
<br />DECI,AXAITON
<br />I hci.by lird undc. r.6,lry olp.rjury lnd I licnk{ undd prolisn'n ol'Chopls 9 (ormmmin8 sirh Sdion TuxJ)ofDivhion 3
<br />ol lhc Bust$s and l'olcs\n,ns Codc, dn, rylicn{isitullnlr.cltl.lTNr
<br />zo C9Q 44zrd
<br />cox$f,llcfloltrEltrlNc-alirNtr
<br />I hcrcby afiirn undcr lrnaltyofpcrj!ry rhrr rh.6 i\ d.o.srru.rion h.dinB tr8cRt lor rhc pcrforuncc orrh. $krk ror whi.h
<br />'his Frmn n
<br />issu.d(Sc.. l097,Civ. C.)
<br />AITLI$NIIIIjCLrIBAIIAX
<br />I lNrhyrnnmuMcr pcnnlly oltrrjry onc oirhc rnllowinE.lcchrrri,rns:
<br />l)crnnil i,nr Pcmils Ar&\los Nolifi.!r ion lrcdu xl ltc! lrr i,ni\ fI irlc .l0. I']rl(n
<br />RrquncJ l-crrcrof Noiii.dion
<br />-l
<br />coriay thar rhc fcdeBl ,cgularions Egordiog lsbcslos rcmvol uc nol a$licrblc lo lhlr poj.cl.
<br />l..niryrh,r I h,vcrcadrhisstplic(ionandsrorcrnll rhc llirvc inforDrt,n ircoddd I lgre ro.!mpl, wilh ull Cily rnd Counly
<br />ordinakdr and srare tiws rlarin! b buildinS conndction. {Id hcrcnyourhorizc rcprescnrori!* ofrhi\ Cny and
<br />abovc nf,nrtuhcJ ,n,pcny ao. inspccrionI'Urpos g
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<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 Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Fire Damper
<br />Openinos
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release I
<br />FINAL W atlt.t 2/14\/a-la-.'
<br />Notes, Remarks, Etc
<br />Furnace
<br />Grease Duct
<br />lnstallation
<br />I
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