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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE tDistG.,COMMENTS OIVNER B(III,DI]R OELCARATION
<br />I hcrchy iilirr urdcr lcnrlly ,,r Nrlury rhar I nm cxctrrtr frurr lhc (i)nir(rtrr l-i.cNc lrw ld lhc lbllowin8 rca{,n (Sc.7011.5
<br />Ilu\inc\\ lnd Pmf.\!t,n C,xlcr Atry City or Cotrrry rici rcquirc\ r Fnnir ro .on(n'cr. ollcr- ifrInrlc- d. nni\h ,{ r.f.,ir Jtry
<br />ntuctur. prin tr [\ i*urtrcc. r'li, rcqunr\rhc lppli.rnr tur $rh N"nirb l]lc a \l3.cd {itnrnr rhar l[tr \hc
<br />^
<br />licenti Durulnr
<br />ro rhc pn)vni,n,\ olrlf, Co tr.r,'\ l-i.cn\L\l llq (ChrDr.rt). Comnrnciis \irh sc.rirr ?rDo ol l)iri\i(n .l .r rhc Bunmr\ rnd
<br />Prncsin\ Cod.) or rhrr lr r\hc i\ $cnrpr rlrcrclromind rhr hr\h f(trrtf, i lc!cd crcnll)rion Antvidnriiro{Sc.rionTl).ll5ryrny
<br />itpli.rnilor.I'cnnirsuhjcchrhcrp!li.r brcivilpcnrlry.lr( nnxrhu livc lrndrcd dollt^ ($5ft)
<br />l.r\oqnrrofrhcl)n,liny.rtrnrycmployr\sirh{rgc!r\rhrirqnc.onDcnurion.$illdorh.soltuxlrF.{ro1uc\rn
<br />rnc crl .rolttrcd nn {I.(SN 7l!.1, tsu\in.s\ tutPhfcr\oi\adlc:1hcO,nrack,-rl-icci\cLtr$dQ\nolJIPI,t,snnsndol
<br />rhc|x)|rny slx,hiiu\ori'n .ks rlrNn- !trd wM des su.h *. him\cllorhc^clforrhniulhhi\o'hcro*n.nlplolcc(.
<br />t,n'vi,lcd rh(t su.h irnmvcn.nr\ cnori cd n.fLtd nt \tlc lf hot cv.r. rhr huildinS or i'll|, orcnrf
<br />^
<br />{rkl wirhin.nc )tr
<br />of$mplcri(nr. rh- OsNr Auillcr w!lh!rcihchu'd. of prolin! rlhr h:.r {t did nor huiu or nryx)vc rhc F)Nny ir rh. NrP{ ol
<br />-1.
<br />n\ownerotrhl rft,rdy. rrcxclulirlycoolri.lins wirh licutr{d c.ntrrk,\ n) co.srud rhc pniccr (scc 7([4.Btr.i"ls
<br />rnd Pn,ll\si,,nCod.:'l hc Coirnrtt s Lrc.n\c l,iwrlo$ Dor0!Plyro !nowmr ofln,Fdywho buil or i'nln,vc\ rhcrcon
<br />rdJ {ho co rr.N Lr such tnoi.l{ wirh r Ax Bcron \) licc'r{d Nr\uanl h lhc Contrr.rr'\ Li.cisc liw )
<br />I mcrc6.r und.r S.dbn , B. & P.C. lor ths ersn
<br />UOBf,ESILCqMISNSAIION
<br />0EcllllAroN
<br />I hcrby .mrn u.dc, !.nrly olpciury orc ot lh. tolloaing del@lio.s:
<br />lnhtr(i c. li'rrlr p.rloirrutr.c olrhc qork lor *hichric rt ir i\i$u.J
<br />-l
<br />havc and sill @inrain sorkcs coml,cNdion insuhtc. !. Equiad by Seliofl 1700 of rhc L2bor Co{h, for llE pdtolffi of
<br />rhc work r.r ehhn Uir p.mir is iss!.n. M,$i lcr!,omFFutr'r Numrc uricr Jd F,lny nunh.r nIV\A€Tafi--' -+-^{o- 6t -lqbo
<br />-l
<br />c.rlify thnl inlhcp.raormnccofthc work LrNhkhrhisl.rnil h nslcn.l shtrll nor emiloy.nyFrsotr ii rnymns,
<br />s !s ro he.om s!bJ.{r ro rh. m&6 o,qEnslion lEf,s of Catifomia, and !8tc rnal if I sholll bctom subjccr b ttr
<br />mrlcs' onp.nsorion lovirion. oascclion 3100 of lhc L3hor Cdo I duu. fonhwilh omlly wilh lhoe 0bviiions..
<br />WAI{NING: Flilurc ro scurc workcri contF.r\rrbn cov.tnSc is trDh{tu|. 3nd \l[ll lubr.rr ilr .nr!L)er lo nini al ,.nrhi$ !n<l
<br />civrl fincr up h oN hundrcd lhoosrnd dolln^ ($l(X).001). nr:ddirn,n l{) lhc colI of.onDcnsnlion. dlnlgcs * pnvi.lrl riri rh.
<br />Sr{ri( 1076ol rhc lih.r Gxlc- inicrcdxtr rronrcy s fcc\
<br />?t--(E epprloor ?A I /JOrr"r l\
<br />UCEN$ITSJNIAA!.:IIB
<br />I]ECI,AXAIION
<br />I tuEh!lmrmu cr Ii.oahrotFrrury rtur I am lien*rd uMcr F,visbn ofChdptcr 9 (commncin8 *ilh Ssrbt 7o0o) oaD'vi\ion l
<br />or rhc Busift$dn,l Pmfcssion\ Codc.,ri nryltcnr k h rull ror.c andeaiccl.
<br />&e56C^9q
<br />CONEISIJI:III}NIINPINIi.&CDXCI,
<br />I hcrchy atfirn undclEnrll, of pcdury rhar rh.r is,.onid.rbn lcndinE qcn., fd rh. l.rfornEm. oilhc ruk for *hkh rhh lEnil n
<br />isrtrcd (S.. 1097.Civ C ).
<br />Ic.diarrharrhc,tdcralrcFllnii,nsrs lin!r{rno\rc xrallrc tr.r rpttlicrbtr b rhh In,l..r.
<br />!4rrdilrrlrrIhrL'c,'tlrhL{Jnnl(irior,ndn u thar ihc rh)k inrinrr i('n is cor.cr. I rsre h ..nrfly wnh .ll Crry ind Connly
<br />onlirtrncc(rndSrorcliw\relarinsi,buildinS.on(ru.rnru hcrcb, rullatrizc rdPrc*nhrnc\ {)lthh Cily dCoxnryroc tcrulFnlltr
<br />abovc mmioncd polcny for insF.|ion purtoss.
<br />eppri"m * eg"m sa*r..X -Il Vd,,tJ -2d .t3
<br />Appliances
<br />Ivletal 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 />Rouoh 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 Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.r/6ln TL rrwctf;?b)
<br />Final Test ur\
<br />Meter Release
<br />FINAL Ht4lu 1 lvr[wtaL *)
<br />Notes, Remarks, Etc.t I t'UI
<br />coroo-,rllra.
<br />Llndcas Adrlrc\s:
<br />-
<br />lppr tcar,ri oriilr,rii
<br />I h.dry amm undcr pemhrotp.ijlryonc of'hc lolhwing dNldolions:
<br />Dcmliion Pcnnirs Asb.sos Norifi.alion rrdcml Rcsularions (firL40. Pd6)
<br />_R.qun.d bllcr ol Noliff,alion
<br />n .tr)
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