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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />4ppliances
<br />Evaporative Cooler
<br />Furnace
<br />Com ressor
<br />!lisc. 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 Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Dam per
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />anlu*rrfi,R ough Mech.tlzthqn ,4)
<br />Final Test ll at
<br />Meter Release
<br />n,,^atuO')FINAL 2{nlLA tW 1)
<br />Notes, Remarks, Etc.r, L tL
<br />OWNEI BUII,DER DELCANATION
<br />I nercby sffrm unnc. pcnnlty ol lErjury thll I m.ienltl 6om rhc Contra.roF LienE ti* for rhc follo*ins B&a, (Ss.?011.5
<br />Blsituss lnd Pofcsion Codc): Any Ciry or Cdnly whhh Equtc! ! Fmi io .o.rnrci. 0h6. inprcw. rhmliih or m!.r dy
<br />$ .'uE trt r ro nr ilslrrc. alg, Eqlies rhc appli:mr for such pcmi to liL . sigred sllr.mnl rhal tr or sh. h liccnkn pursdl
<br />lo lhc prcvnions of lnc Cofllrlclols Lienscd tlw (Chlprcr 9. Cormncin8 wnh Scdio. T(xlo or Dilision I oflhc au.inc$.nd
<br />PDlcsiions Cod.) or fid lE or shc k cr.qtr rhcEfrom od rhe &rir for ln. rlkg.d .x.mprion. Any viohrion ol S.dhn ?031.t by nny
<br />applicanl fo, { pemn suhjftri rhc amlk8nl ro a civil pcelry of nor mE fian fivc hudEd douds (5500).
<br />-1.
<br />&c oarcr oI ric pn{'cny, or m} cmrloyss Nilh w.Ecs a lh.n $b conp.nsln,n, will ilo llI wo.t ad E sllfu is ml
<br />inrcndci oroficr.d tbr slc (s(.7044. Busin6s dnd ftofeNio.s Codc Th. ContEcror's Liccnsc Lxv drs nor arply rd dnowidof
<br />rhe ,Npcny sho toildr or itr{'mB tlL.Mc !d wls &Es sch wlk hims.lr or h.trclt or
<br />'hmugh
<br />his .r h.r own employc.s,
<br />p,oyidcd lhat such inll,mwmnts N m' i,r.nddl or o,Isrd ro. elc lf. hrwNi 0E t{ilduE or inq,mrcmnt h sld widin om y@
<br />ofcorqhlion. tl.. ot,n$ Bui*rcr will h.w itE br&. 6l pevina th.l hc o. shc dii mr hdild or i,i{,Drc rhc rmpcny fm rhc rrrF * of
<br />l. a ownqofrhe l,6tory, dnciclusivel,co.rrccrins qirh liansd co rmtoB to construc lE prcjccr (SN.7044. Blsinc$
<br />un Aoissiotr Codcr Ttc Conrmlols Liccnsc kw dms nor apnlyto M owncr or piopcny who builds or anpr.vcs fi.rcon.
<br />and who onticrs ror such tmjccr* wnh r Co.trado(, lienscd l,unlunl to rhc Conrrucrols t-ken$ L!q).
<br />I rNcrc$,, uidcr Sc.ln)
<br />I hcrch!nltn oodcr Nn,hynrl.rjury
<br />_l hlr 0,n uilltuinlain aC.triasr.of Cons loSclf'lnsur.f vtrI6 onp.Ndiotr. a lmvilcd for bySdion 3700olthc
<br />Llbor Codc tor lic pcrforomc of lhc rcrI for vhich lhe Fnl n hsncd.
<br />I hnlelid will muinllin sorkerr compc.sltn,n i.surancc. as rcquircd byScclio.37(x) of rtc tihor Codc. r'or rhc ll{rforrorcc of
<br />rl'. turk ror whih rht F..ril i{ ir{cd Mysorkcs coDpcflsri,a insururcc cn cr ud polic, numbcrec:
<br />-l
<br />ccnily lhd in rhc Frfo.mmc of lfu woiL lor elich rhii ncrnl is ir\!cd. I sh.U nor crploy any pcmn in ony nmmr
<br />$ as lo bccom sub.ist k, thc worisl oryrcnslion h* .f C.lifomi.. .nd .gM rhd if I shouk hcsm subjd lo llE
<br />w.llda oqrcretiotr lrDyision! of Selion l?00 of lhc Llbor Codc. I nElL lonhvifi omply wiln lhos pruvisions..
<br />WARNINC: Fuiluru ro *.un workcs .omr.nsar6o.ovcolc is unlnwtul. ,nd shrll suhicr m chplortr io orinnl Fn ics Md
<br />civil rines up k, oru hundN! rhousa.d dolla.s I(tl.(x)or. in dirion h rhc .on of trsrio.! da@gca .s providcn br rhc
<br />Seiion 3076 ol rh. Lih.r Codc. inrcrc{ &d
<br />tll!!"r-u!ua!
<br />I hcEl,y a,rtrn ondtr pcMlry of I'errlry rhll I or lien*d undcr pmyision of Chnptq 9 (mnmming wirh Sdbn 7000) of Dirision l
<br />ol ln Busimss trd Pmf.ssions Codc, .d my lhc.s ir in tull lore {d cft(l.
<br />I hcrcby iffir,n uMcr Fn.hy of lcrjury
<br />issucd (scc.1097, Civ. C.).
<br />a o.slodb. bndinS agcncy for llF |Eno,ll1aa of lh. eod for whkh lhis Fflil b
<br />AITUCANLI'ECLAEAfI!.IN
<br />I )ithy dltm undcr penrhy.fFlju.y om olrhc follosin8 d(lnBlions
<br />Dc'tuIln,nPdrnih A\b.nosNorificarn,nFcdcEl RcsuhrbnsIlirlc.l0_Pon6)
<br />-Rcquncd
<br />hrrs ol Nolilicnlion
<br />rgrclocomplywilh !ll Ciryand Counry
<br />ie$ofrhisCn, d Counly
<br />?lH-
<br />Metal Fire Place
<br />Numb.r
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