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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal 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 />Rouqh 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 I
<br />4nl, I [\n ,
<br />FINAL Il//L/t y 4fu\Al
<br />Notes, Bemarks, Etc /'t i
<br />OTVNER AUII-DER DELCARA ION
<br />I lrcrhy ollirD undcr lcnrlry ,,1IdrJUry rhd I nn cxcnnr lion rh. (hMrckm l,i.ci\c Ljw fd rhc folli,qiry rcusoi (Ss ?lr:ll 5
<br />Bu\inc\s a'xj ,\or.s\n,i codc) ny Ciry or Coutrly shich .cquirc\ r Fm n, .on{rucr, alrcr, irnt'rnvc. dc hli\h o! q'rtr ttry
<br />\ .rur.. pri(rro ir\ irsurtr.c. ulv, rcquircsrhc {pliclnr li'. \u.h pc'.rir nr ilc. risrcd slllcNnl rhtrr hcor shc is licctr$d Plsuanl
<br />lo rhc E.visiinN olrhc Conkn ttr \ Lnrnscd L'N lcnlprq 9. ConrnrNilg wirh scc'ion ?(xD ol Dirision.] orrhc au\inc\s lnd
<br />Phrcsn,n\ Cudc) or th,r hc or sh. is cxcnrrlrhcrcirinnnnd rh.1'!\i\ ror rhd ullcgcn cxcnr|nion ny !n'hrinnorsc.tion?0115 hy ntry
<br />rrplicid lon p.xnn suhj(Isrhc rpplicr h icivilpcnahJ-ornor nrrcrhon lirc hundred dolhs (S5m)
<br />-1,IosMntrh.poFn,ormy.n{,lortsqt*sgcsasfiennbcomFB0tion.sildollE*dk&drl.tdnrrmismla endcn trof.r.d for sh (S€.1X4. Ausires ed ProteiioB Cod.r TlE Conttrlols Lien$ t& dra.or trpply lo anowMof
<br />rh. lnlp.ny *no hril(l3 6, hlproB tFM.. .d who do6 tuh w* timrcll.r h.elf or rhmugh his tr tut oM eryiotlca.
<br />providcd rlur such invmrmnl. @ mr im.nd.d ddlT.E{ for $L. lL t$w.w,lh. hilding or uriEEc ii sB qnhin.r J4r
<br />ofcolrphrion. thc Owrcr Slifthr will haE rlE hrd.n of pmvirg $ar lE or sh. dil nol t H or it{mr rhc p6ldy lor itE pu{n* of
<br />L 0s owmr .f ihc pmlEny. !h cxclusivrly .onr&lirg wnh licc.srl conlncloF lo mnrlel llt p,$id {S(. ?044. Br:imrs
<br />ard Pro,tision Codc: Thc Confuroas Liccnsc L.w docs not apply lo 0n ownci ol pmFdy who builds or irymwr lhcmn.
<br />and who conlacc for su(h I'ojccis wilh r Co.r&to(.) li..nkd pusuanl lo rhc C.tu&roi. Liccne hw)
<br />I rmcxcnrpr undcr Sccr
<br />_ Orn.r_
<br />lo8trE8[gl}ll[ENlAtrOX
<br />DECI.AEAI!}!
<br />I hcrcbyaffi rmundcr Fn.hrof li.rjuryonc of rhc lollowing dc.Lntions
<br />lrhtr(i .,ntrilrltrfonhr.flrhc{ork,n.}hic[rh.n!,n,ir i\ n\urd
<br />-l
<br />hNc and will nminraifl qortc( comp.r$rk n i. rarcc,as equimd by Serion ]TOOofrhc Libor Codc.lor lhc,dfor@cc of
<br />lhc qort for wnich lhn pcmir ir i,rucd. My wortdt .omFnsarion insumrc€ cdtt un Flhy numb.r @:
<br />-l
<br />.eniry rhrr in lhc pcrlbrnEme of rhc work tor phich rhk perml ia LBu.d, I snal not cn loy 4., Fr$n in my 'nrnNr$ as ro bcmln subicct ro rhc $o 6'oop.ndion lnws ofcolifomia. $d rsE lhtr ir I should tr.om su$icl lo llE
<br />wortos conp.nslion tmvhionr of S(liln :l7lx) ol fic btxtr Colc,I shall, fonhwnh conply eirh lhoE prcvision5..
<br />WAnNlN(;: F.,ilum ro surc
<br />civil fincs up
<br />'o
<br />orc hundEd t
<br />.ovci.8c k unlawlul. ond snall \uhrc{r M .ntn,Fr lo sin nd t.Mlrics ond
<br />Im.o00), in addnior ro lnt .osr or.omp.nstion. d,m8.s !s ltovil.d fot .h.
<br />o,tt,,vdB
<br />ult(r,itiaugr
<br />I lEEby,ftrm nod6 Fn y ofp.rjuty thlr I am lieBcd lrd€ proviibn ofclEl,ls 9 (comnca.g *nh sclior ?000) ofDivision l
<br />or thc Rusinc\srid Pturc\\n,r\ codc, od nryliccnrc is in llu
<br />$Jo3o v
<br />F,
<br />I hmby.,Im undc, IEolly of F+ry lhll t
<br />isrucd (Ss. 1097. Ci!. C,).
<br />n Lnding d8ctrcy fu thc ll(rfintullT.lrhc sork for $hich thh Fnrir i!
<br />APPLiCANT Ni'CTIRATI(IN
<br />I nddry !trrn undc, !.rulry oa p.riury orc of lhc followin8 deldarions:
<br />Dcmlirio. Pc.rnik-Asbcslos Noritic,lion Fedcrul Rc8ulrlioN (Tillc 40. Pan6)
<br />rcxrdins alh.nn\ rc'tu,vrl r. nnr,pltli.uhh h rhis pnrjcr
<br />n ald srot th.r rhc 0tnvc inromrio. L\.orer.I {gN lo coq,lysnh rU Cary {nd Counry
<br />trurhorizc rctrc{nrdiv.r orrhk Cnyard Counrr ro cnro uF,n rh.
<br />^,, b/z'l/tW'{:v
<br />Meter Release
<br />Polky N!mbe.: E,'I!ncs:
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