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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER BUILDER DEICARATION
<br />t hcrcby amrm undcr rEnalry of pcrjury thrt I u.rcmpr fmm lh. Conus.tou Lians L!* for lk lollosing r.&en (Sec.7031.5
<br />BBirc$ !d Prclc*ion Codc): Atry City or Counly which EquiG r p.m ro 6r{Mr. ahd. impmve &mlish or EI'!n !nr.
<br />struclu., Fior to hs hslecc. ds rcqlncs lhc applicdr for such ltrmi to lib a siSncd std.m lnal h or slr ( Iic..scd plhu.or
<br />to rhc pbehions of itr Conl'acrol. Lisnsd trN (Cna/.r 9. Comrcing qith Scctiotr IlO0 of Divirioo I of lhc Susincss 8nd
<br />Pmf.ssions Codc) or thrr tr c slE ir cr.qrr rheEliom and rhc b.sis for rh. aU.Bcd cxcnlprior. An, viohrk,n ofsctlirn 7031.5 by a.y
<br />oplli.anr for a pcrmir slbj*rs rhc onplica ro a civit pcBhy of nor mrc lhe lirc hlndrcd dollsrs ($50O).
<br />-1.
<br />ai oencr ol rhc poFny, or my emplorex viln vagcs as th.ir sk conr,Ensl iot. will do lh. wolt 6!n dE srudw is ml
<br />i.l.nd.d tr olI.Ed for sk (Ss.7044. BusinBs &d Ptofcssiom Codc Th€ Coflre'or's Lisn* tlw dm3 nol .pply lo m oqnd ot
<br />rhc Fapcny vho lriBs6! i,{mBrtEeo s who rh.s sh s* hiGeli or ncrElf or lnouSh tis or n rouncmploye.s,
<br />lrovidcd ttut such imlmwNnrs m mr hrc'd.n o oficrcd for s0h. lt, ho*cB. rlr t iui.s or h{ewftn' is sld wnhin om }E
<br />of.onplcriotr rtI oqrcr Btrilld will hlw llE tordcn of p'oiine lhd rE or she dA d build o, i'r{rcw dE P,qny fot th. F!PoF of
<br />-I.
<br />as owmr of rhc pmpcny. rm cr.hsivcly conractins *nh [censn oir&loB ro consrtucr ihe r,rc.id (S(. ]044. Bsincs
<br />ail P,Dtusir Cod.: 'thc Cdnkkror's Li.c.rc tiw do.s ,ol apply ro e ownct of pmpcny who brilds or inptovq th.rcon.
<br />ond who conrmts for Mh ,to,}.rts qifi. Co Gro(s) liccn$n llBu r 16 rhc C.,trn loas Lic.r€ t w)
<br />B
<br />c/o**"x
<br />TECI,ABAIO!
<br />I hcrcby ltlirm undci pcmxy or psjury on. of fic ro[.*irs d(la!lio.s:
<br />I hrrc kl$ill iMirr(_cnillcrrcofcon{cnrroSclllrNurclnrsor[cN conlxnBrn)n. rs pR)ldcd fdbyS.{rim:]70Oolihc
<br />L'htrOxlc- lnrlnc llllornuNcofihc *or* nr *hichrh. pcfl ir
<br />'s
<br />n\ucrl.
<br />Ihrvcandvill@i rin workcB compnsotion iosuronc..0s rcqlircd by Sd ion 1700 of rhc ltrbot Codc, for lhc pc ormnccof
<br />$. work for whkt rni\ Fmi is isMn. My *ort6s conpcns.liotr inslnmc fficr !.d tslicy numb., dc:
<br />l',h) Ntr 'h-
<br />-[\nn.'-l
<br />ccnil'yrhor in lhc Frfornuncc.llhc w.rk tu which rhis tcrdh h issucd.l shall noi.mplo, atry pcAon in uny haMf
<br />s ar ro lt.!m subjdr t! th. *o*.u' ..mp.trsrion l.ws of C0lifonri4 Md !8N lhd ir I should li.om subJ&i lo rh.
<br />qorter conlcn$rionFbvkionsolS.clion lT0oolIhc til$ Codc.l shall. fonhwirh coq)ly wir[ rhos ,rovisions
<br />WARNINC: raiturc to surc $ortcr @hpcnsrion Lolcsse h rnltrwrul. ,nd shnll subj.cl 0n ctrllrlo}tr ro rinitul Fn,Lics a.d
<br />h onc htrndr.d rh.0\rtrJ dnllr{ lSllI).(XD). in trddiri|tr L, rh. .us ol compcnstion. dlnEgcs !1 trovidcd f.r rhc
<br />DII;II.I{IIAN
<br />I hctubyafirrnund.i t.nllr! dlFrjury rhd I 0m liens{ undcr,rmvisior ofCh{prcr 9 (..omtrinB with Ss..tion 7(J00) otDilnion.l
<br />ol rhc lrusincss ud,tofs\on\ Codc, ttrd.ry l{c.s. i\ nr rulln,.c xl criccr
<br />D.r. ( onlro(lor
<br />CA!$f,]]CTAN.LE!DIM.ACIM:I
<br />I hcnby rlitnrnndcr pcmlryofIl.rjur, rhd rhcre i\ ! mn{rucri,n kndnr3 alcn.y li,r rhc ttrrri{n(n.c olrhc worl r.r thi.h 'hilrrnrir s
<br />i\\u.d lS( .1097. Civ C )
<br />IfTLICANLDES/I&IIIAN
<br />I rNydlirnrundcr rcnrlry.l D{riury onc orrhc n,lh*i'r! dNluri,)ns:
<br />Dc nliri,,, Pcnniis Ashl{o\ No!ifi.di, r lr.dcrul RcSularrx (l il]c.l0. P n6)
<br />Rcquncd l.ncr ol Nolilic!lirD
<br />I cMiryrlu rhc fcdcrul E8uhtions rcsorditrE asbcstGrcm\allrc nor lPpli.rbr.lo thn poj..l.
<br />U.eflifrrh l h,vc ud rhi\ nppli.aii.n 0.d i.rdhd rhc0tr\r info.indior iscotr(l I lsre lo NnDly *irh nll Ciry 0ft1 Counry
<br />ordinnnccs rnd Sr.rc h$s rlar ins lo huilding rcby aulhoriru rc[csntulivcs of this C yundCounrylocnt$ upon rhc
<br />!bo!r mnln,ncd propcny for inspccrn,n t ,.,.,,tk/tat?Atplirrtrr or ernr S'Emru
<br />x
<br />Appliances
<br />lvletal 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 />Rough 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 />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release
<br />FINAL tlttlu'lv '$)u6/rt -?)
<br />Notes, Remarks, Etc.
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<br />I onre
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