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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />tr/etal 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 Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />FINAL ll/4ll,t ?\'61
<br />Notes, Remarks, Etc
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<br />OWNER BUILDER DELCARATION
<br />I hcEby .litrm ufllcr p.Mxy of F.iury ild I m .xcn{,t fDn ih. Conhro* Lt.n$ lls for th. followire Ee$n (Se.7011.5
<br />Blsincis .d Pmfcsion C.d.): An, Cny o. Coutrry {ttt r.qutcs . !€mn ro onntud. ah6, iq,rct' &mlnt or EFn any
<br />srn re. pirr lo ill hs@.. rl$ Equics rhc apDli..nt for slch ,.dlr to fik a ,igEd slalcmnl thrr lE or inc ir lie.sn ljueor
<br />lo llE I,ovisions of llE ConlEclort Licen*d l2w (Cnapb 9. ComeminS wilt Sc.lion ?000 of Division I of lh. Alsin ss .nd
<br />Pmfcsions Codc) or lhar lE or sh. is cxchpr rh.rciom and lhc basis for th€ lll.ged eicmprion. Anyliolarionofsc.rionT0ll.5byaAy
<br />appliclil for ! p.mit slhi*ts thc ipplicant Io.civil pcnlhyofnor mrc thm fivc nudrd dolluB ($500).
<br />-1.
<br />rs oemr ol lhc Imtcny, or my cnrrloyccs wnh wogcs f,c $cir soh smr.nsarion. wiu do tt* mlk lrrl dE sltutlE h ht
<br />intcrd or offcrn ror sk (5(.7044. BusiEss d ttof.ssions Codc: Thc C,nrrlor's Lk n* Li* des mt ,nply ro d o*N, ot
<br />'hc
<br />pabFdy erbt ild! or it+roB rtEmn. ad who des skn eo* hi@ror thNltor dmuSh his tr ncr own cmplorcs.
<br />lr.vidcd rhar such itrqftEftnk m rcl imc.d.d or dtu ftr slc lt ho*B. d* t [ci.g or inlpDEftnr is $ld *hhin om ,t!
<br />ofcoq,hrhr rtE Oprcr AliBd ,ill IEE rlE b'ldcn oflmving rhd hc or shc dA mr t{ d or i,t{mE dE I'oFry f6r itE purpo$ ol
<br />-1.
<br />as owmr of Ihc pmll.ny. !m dchsivcly conrracrin8 *iih liccnscd conrEros ro sn$u.1 rtE portt (Sec 7044. Busincs
<br />ond hotr*sbn Codc: Thc Contm.lols Li.cnsc Low do.s nol amlylo a. oBnc. of prorcny who builds or improvci rhcrcor,
<br />atuj who onlmcrs nr such torc.rs wirh a C.nrdr6(9 liccnscd flnudr rorhc C.nrra.ror'r Liccnsc Lrw).
<br />-l
<br />!mcxcmrl undcr Scct
<br />_ O,E:_
<br />UOaf,EXS:.COMIBIIAIION
<br />Dlst A.8AIM!
<br />I herby offim !nd$ pcehy ol pfijury 6rc ol ft folbeing &dmio.s
<br />-l
<br />tuve aln will miohi, ! Ccdifiorc of Conscnr b Ser.lnsuE for vork6s' otr'If, erhll. os povidcd for b, Serion :]700 6t rhc
<br />Lrbor Codq for rhe F.fomic. ot lh. worl ro' whth thc p6mir i\ ixsu.d.
<br />-l
<br />holcand willD0i.lrin wortcrs c.r,pcnslrion insurrNr. us rcquircd b, Scd tn l?00.f rhc ttrbor Codc. lor lh. IxrfonMrcc of
<br />rlE work r'or sfiichlhh pcnnil is l$ucd My*orkcn conrF.snlion crricr r tx,lilt nu'nbrr,c
<br />N *li.q -l *b, l;L
<br />ol
<br />I c.nity rhar in ih. p.rrnrmftc of lhc wo* ror ehich lhh lErmir k issucd.l sh.ll mr cmploy qny |'cmn in lny Mt,
<br />m N to trcom slbj.rr b lnc *o*dr .ory,cnerion hps ot Califoni!, and a*rcc tur if I sh6uld tx.o@ .ubjd to llr
<br />workcG comFnsolion prcvisioisofS€lion 3?0O of lh. Latbr Codc.l dEll. tonhsilh oq,lr *ilh rho* Pmvi{io.s..
<br />WARNING| Failurc b B!r. sorkes comp$sdrion (,vcn$ is onhwful. and sh0ll subjccl rn cmplolcr lo giminul lrctulrics and
<br />.ivil fincs ut ro om hundr.d rhousand dollrs ($100,000). in ddirion lo thc cosr ol comncnsuliotr. donuAcs a\ providtd for rhc
<br />Serion 1076oarhc libor Codc. intcrcs! ond.ttomy s fes.
<br />,*,-A-1s-tlt? noou^,, W
<br />LIIENIDII.(I}dIIACITIB
<br />IIECIAAAIION
<br />I hcrcbyaltr und$ pcnllty olFrjuly thlt I am lic.trsd undcr prrvkn,n ofchaprcr 9(comftncing sirh sc.rion rffD) olDivisio.l
<br />ot rhc Businc$ lnd PmLsioos Codc. and mylicctrrc is in fulllorc ond crlccr.
<br />$ogzto
<br />G/t-t I tf -,,*,* Ats /Ar
<br />COISIf,I]CtrQNIEtrDIIC.ACENCT
<br />I h.Eby frtrm undcr lcmhy of ,criury th.t rhft i(, on(ocrhn kidin! lgcry to. ihe lErflrlll@c of oE worl for which lhis p.d n
<br />issucd (S.c.309?. Civ. C.).
<br />ArtuljttfDErl, aaIoN
<br />I lrrcty dlinn u ndd ,rtr lry ol l,crlry oN ol rhc nnL,sinr dL\hr ir i,$
<br />I)r mliri,)n Pnnirs A\h.{o\ Norillcrri(r EcJ.fulR.guhri{nN IIirlc t0. P d6)
<br />Rcqun.d IJ(d0l Norii.rron
<br />! adiar rhd Ihc Ldcmlrcglhln,ns rgardinB ostEstosr.mvalnrc not lpllicali.lo rhn F+cr
<br />-l
<br />ccnifrrhar I haE cad rhh appli.srioo r.d arc rhar rhc ah,vc inntrmrion h c.rer. l lgre tl compl! wirh all Cily ond Counl,
<br />odin!.ccs and Srarc Llws rchrins Io huildins consrru.rho. !d hcrcbysurhtri& rcrcsnrativcs olrhn Cilyand Coumy lo ctrr.r ulnn lhe
<br />!bo!c mnr ioned pmNny lor inrtccrion
<br />Meter Release
<br />e.*zbs
<br />*,,4zrh r
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