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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Appliances
<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 />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<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.7,1<rl,t 5D6q
<br />Final Test
<br />Meter Release
<br />FINAL ?/tZ/rtt 5h6k
<br />Notes, Remarks, Etc.
<br />()WNER ALrll-Dr,lR DrlLCAL]\ l!()N
<br />I hcrchy rrliln undcr Nr.hy oi nrrjwy lhll I n cxctrrt, rioh thc (i rrcur l-iccn\c Lrs l()r rhc dlo!'i.r rcrvr lsJ.70.115
<br />Ilu\inc\\ inn Pda\\i.tr C,\ac) Any Ciry or Counr, shi.h rcqntc\ r Fnni! ti .on(rucr. rlrcr. im|mv.. ddr,li\t' ,tr q r Jn)
<br />n'acrurc. pri{n n, iis i\\unncc, xlso rc+nr( rhr rppli.rni lnr \d.hpciinit h lilr r si!tud {xrcntrnr drrr h. or \hc ir li.cn\.d prrsuntrr r
<br />Pf,Icsnni\ Codc)orrhrr huor \hc n crcnDrrhrrclrnnrxfd rhc hnsir ltr rhcrllclcdrtct,pri,n, Ait\nnrri{ ofSc.rni 7(r11 5 hi rty
<br />rtfli.rfrntrrF-.nnii\ulicrrrh.rmli.rrrrrcivilt,rnJlrtninolnnr.rhriliv.huid'cdd.llnnl$5(l))
<br />-1.
<br />!s owner of
<br />'h.
<br />pmlEny. or my .trll,loFs silh wag.s as lh.n $h con{'.nsuliotr. *ill do thc wlt and lhc sln.lm h hr
<br />ini..dcd or olr*d fo, $k (Se.?Ol4. Bnriocrs sd Prcfessions Codq l]lc Contracrof s LtccoF Llw does nor !npl, ro an o*n$ of
<br />lhc pmEny wln builds or imI,DEs lttm( !d who do.s skh mlk hinsclr or h.r*lt or lhFugh his or ncr own cmtloyccs.
<br />pmvid.d rhdi sx.h idrhrm s@ Dt hrcnd.d oro,Icrcd ib. sle.lt io*crl rh€ tDiHin8 or iry,oEft is$ts*irhinorcF
<br />of @'qrlerion, iE Owm, BuitL, eill ler $c hrdcn of !rcvin8 thd tE or shc dA mr hild or i,iqmrc llrc Fot'cn, ,or fi. luqrF of
<br />-1,
<br />asowncrofrhc !rcpc.r,. an cxclusilcly cortr&rins *irh liccnxt conradoF l. on{rud rlE loidl (S.! 7044.8$in6s
<br />and PiDfclsbn C.dc: Thc Conrturo. r Licen.c Lja d@r rcr !tply to an osn6 of prop.ay sh. buildl o. inpbtcs rhcron.
<br />and $no onrEcts for su.fi pr.irts wnh a Contr&rorls) li:cn€d puBunr ro thc ConlEclols Liccn$ LIw).
<br />I Bnrcx.rrlr un cr Sccl A, & P,C. fu rhis rc4{'n.
<br />l)!rr
<br />IOAf,E8S:COMIEIIAIII}B
<br />DECIAAAIION
<br />I nercby d,firn undcr prnalry of tdjury oN of rh. follo ns dc.ldri.'N:
<br />_l har ond sill m.inraii ! ccnificarc olcon*nr ro sclf'lnsurc fm workcs conp.nsltioo. es Fovidcd t6r by Seclioi 3?m ofthc
<br />Labor Codc. for lnc p.rformre of th. *or[ for qhkh $c Fmi ir nsd.
<br />l h.vc dnd *illnunndin qorkcrs ..n.ns ion insurrk.. a! rcqut d bySNrion lTtX)oflh. tibor C.dc. forlhc
<br />t Ufi
<br />2
<br />-l
<br />ccnni lnd in lh. p.rformncc ofllr *o!k for which lhis p.rnir is issucd.l shall rcl cmployany pcrson in any manncr
<br />$ ds ro b6om subjccr to rhc *orkss' .omocnsrion laus of C.lifomia, !fld 03@ rhar i{ I should lE<om subF(l ro ih.
<br />soltc6.oqrcnslionpmvisbnsofs(liotr1700oflheLatDrCodc.Ish ronhwirh connly wil,!l,F$ nmvi*ioos..
<br />WARNTN(;: FnilnE ro $cuc wo*eu omp.nerion 6v.ng. i! nnldwful. md shall subicl m ."l,lorr to sin el IEDllts and
<br />cilil 6ncs uD ro on. hundEd thousrnd dollaB ($10o.o00). in addnion lo rhc cosl ol cotrrpctrslion. d!roEca I t iovil.d ,6r lhc
<br />Scclion 3076 ol lhc Lator Cnde, inlmn and attomyt fcrs.
<br />Dale: ]\pplicanl:
<br />V)
<br />-.r.*- S
<br />(;ONEIf,UCUI.}NIENI'INCAGENI.T
<br />I h.rby dffird und( Fnnlryorp.rjuryrhdrrhee i d.o.rrocrion lendin! lccn.y fn rh.,Lrfolfln( ofrhc {ort ibr *hkh thh It itis
<br />h$cd (Sc :1097.Ci!. C )
<br />ATTIICINI.DICLAETII!}N
<br />I l.d,y
<br />"fllnn
<br />und.r !.naXy ofFlury onc olrhc lolk,ving dNlmxridnl
<br />D.nbl ion PcnniB- rb..los Norificrrion Fcdcral RcEUIarions {Tirlcltr. P.n6)
<br />-Rcqutcd
<br />lxlrcr of r,rorifi calion
<br />l.cnifyrhar rhclid.r lr.$hrion\ r.lrrdiDg nsh.{os rcnmvrl rrc nor lntlicnhl. rrrln\ pt,jc.r
<br />-l
<br />eniry rhd I haE Ead rhh qiplkdion dd rhr. rhar c atovc infomrion h corcil. I 0g,e ro coq,ly wilh aU City and Counly
<br />ordimnas md Sr0lc hws rcldin8 to buildinS ad hcmbr rulhoftc rcprc\cnrativcs olrth Ciryand Couryk! cnr& up.n rh.
<br />ahovc mnrk n d pmFny for
<br />ApDlic,fl or As.ot SisErurc:
<br />I
<br />I
<br />Metal Fire Place
<br />Vents
<br />Hood
<br />L.ndE's Addss:
<br />-
<br />ut[NtlllcoMaacruB
<br />DDI;LAf,AIION
<br />I hc,chy afinn undcr lrntrllyofncrjlrr lnrr I !n lienvn undcr !o!isi.n ofChaprcr9 (comtun.ii8 wirh sc.rir,n 70uJ) oioivision 3
<br />ol thc Busim$ind PmfcssiotrsCodc. I mr ltcnsc i{ in tullforcc !trd cItNI
<br />".," alzdl\{
<br />:
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