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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OlINI]R BTI!LDDT DEI,CARA'IIoN
<br />I hrdby rrrlrn un,t$ ,cidlry (,f pcrj y thd I nnr crcnDr riom rl* Grnra.i{m l-i..isc hw r.tr rhc fdlowin3 rc$on (S.c 70.11 5
<br />&rsnBs xl Prorlssi,'n Cdcr Any Cny or Cotrniy whi.h rrntr,rcs r Nnnr n) .on(d.|. alrcr. imt(nc. d.mli\h nr RlJn rny
<br />nn(furc. prirk, ic i\suxicc. rko r.quncs rhc.pfli.rnr n, su.h lrcni o ljlc a signcd dlrcmnr ihtrr h.Dr shr i( li.rtrscd l[rurnr.
<br />h rhc pnvi\t,nr ol rtE Coniruc(tr\ l-icrn\cd tis (Chrrrcr'r. (innnrn.nr8 sith sc.lion Tlxxr ot Diri\n,n:l ofrhc axsin.rs $d
<br />Prnc\rionsCodc)orrharhcorsh.is.rcnrfrhcrcftnrtlrh.lx\islhrrlNallcrcdcxcfpri{n, Atyvi(nrrionolSNrjot?031.5$yary
<br />rttli.rr r(n r prnnn suhj(Frhc applicanr lo !civilr.nllryoltroi morcrhni 6!c hunlrcd doll.r (9500).
<br />!. !s owmr.r lht Folf,ny. m Dy ctr{,lorss silh wlscs as lhct eL.onpctrdio.. wil do t vmt !d llE slrale ir el
<br />i cftH or ofl.Ed for elc (5*.7044. Busiresr rd Pmacsriom Cods Tfic C.nlmlo* Liens Llw docs nor tpply lo an owmr of
<br />rhc Imllrly qho h{ilds or i,mmB tl.6tr snd who dm Mh w* hims.lf or lEmlf or rl@usl hi. o. h.r om.n9hyc.s.
<br />providcd rhlr such inlProrcmnrs e tur hrc'iH nofiEd fo slc,l[ Left( ttE hrildh8 or nrp'owE.l is $ld snho orc Jor
<br />ofcoqJlahn. ll1. Oqer Buillc. uiI harc 0E hrdc! ol poving tlltrr lE or sh. dll mt build or in{mw &c poFrly for tlE Purpos of
<br />-1.
<br />is owh, 6f rh. lln)Fay. m .x.llsiwly onlr..l inB wilh liensn conEacro6 ro 6trsd ih. pmid (SN. ?044. BBiftre
<br />.nd P,aftssion Codc: 'thc Conm.roas Li.cnrc Lrw der nor aptly ro an owNr of pmFny w,!o l ilds ot inProv4 thetmn.
<br />md who @dkls for such l,oiers rirfi s C.ntmro(s) lie.*n ,!n@t to rhc Cdnlr&lois Li$nrc llw).
<br />I flncrcmd trhdcr Seuon .8.&PC forthirrcaen
<br />IlllBtrEts:g)lttrdsalla!
<br />DECIASAITONIhcrbyrfln undcr p.nnllyoip.rrury onc ollhc tollowir8 dcln,lions:
<br />-lhsvcrid
<br />willnrinr i a Ccd ilralc of Consnl tu Scll-l nrrc for $orteE .ompcns,ridn. r! pmvidcdntrbySccliotr3?(t)ol'thc
<br />libor (-odc, i,r rhc pc {nnur.ofrhc*ork lbr shi.h rhc r.n.il is issucd
<br />xh c,.d *rllruinbi" {"rkc^'. nFnrartr'n trFututuqI ruqutd I'y Sc.liotr l7l$ of I hc btu Coilc, hr rhc lf,.iomrcc oi
<br />( rhc *r,r rir trhNh rhis |c.mrr F i.\d{{ Mr u'.'|fl!.nnB.n\0rn rn\ur0mccJtricro\llnt() numhq nr
<br />o/^D,q2,Btre-h.Fa r /zjrco
<br />I ccnify {h{ in lhc p.raormN of thc work lor ohkh lhis I,crnn is asrucd, I sh"ll
<br />s s to bccom srbjcr ro rhc eo*oC comrc.sdion !rw. of Califomi., lnd l8N ltsl
<br />turk€tr comtensariotr pmli\io s.f S*lion l7(x) of
<br />'hc
<br />Llru Codc. I dBll. lodtsnh
<br />---T-
<br />mr.mploYuyFmn in ey Mrr
<br />ir I rlbuld lrcoE subid ro rlE
<br />6ryly wnh ltbs prcvtk B-.
<br />WARNINC: Foilurc lo KlE @rkcr' conpcosrion d,eBE i3 unhw6l. and sholl suhjcl u mplorr ro dimiml Fdtas .nd
<br />civil fincs rD ro otu tudrcd rhouerd dollrtri (lto0.o00), h lddnion lo lnc cosr oa conlEnerion, dimees as Prcvid.d for tlt
<br />Sd ioo -1U76 oI rhc tih, Codc
<br />,,,,.. t/o /'r-o
<br />iorcr.{ ,nd dlormr's fccs.
<br />ullilsr;ll_(aN1x,l(1oa
<br />IIECIABAIIAN
<br />I h.Eby aflirm undft pcn y of ncrjMy rhd I n lilrrsd undcr rrrlisn'n orChipr$ 9 (conlnEncins wirh Scclion 70m) oroivnn'n.l
<br />oI rhl Blsi8rs rid Prolc$trN cod., a,xl nry lf,cnr is ,n full forcc ntrd effe.r
<br />n€\lo /l7t
<br />coNslf,lJcl]atrllliDllGrll !i(I
<br />i\s&d rS.. r(I.)7. Civ. C )
<br />ATIIIUINLIIECIABAII9N
<br />I rlnl,y riinn u ndcr pcnrlry ot pcrjlry onc olrhc r(nkr*inr dcchrari.n\:
<br />Dcndirbn Pcrnir\ A\tf,dos Norin.ari Fcrl.nl RcBultrri(trr\ (Ttlc 40. Pfi6)
<br />Rcquncd btrcrof No i.oti0r
<br />-l
<br />ccnily th rhc aedcml rcslhtbns Essdnrg $hc{6r r.rDlnl rE mr apFlic!$lc ro rhis Imj*r
<br />l.drify rhd I h'vc rcod this lptli.arn,n aftl \r!r. rhar rh. ibvc inftnhrion ir.orNr.l aSre ro.onv,ly wirh 0U Ciryan'l Counr,
<br />ordinuccs a Srarc lrws rclring ro huildinS con(rudion. mn hcrchylurtrrirc rcrrcsnraliv.\ ofrhis cn, lnd Counl,
<br />ltx,vc mnri0rd potcny for
<br />ES
<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 />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 />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.l-t ?-Lc lba to>
<br />Final Test
<br />Meter Release
<br />FINAL l-2?- 2.Wd to
<br />Notes, Remarks, Etc
<br />DATE
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