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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNEN BULDER DELCARATION
<br />I h$eby alfirn !..lerycMlry orFrjury rhJl I o exenfl fnid thc Contero l-ic.6!c ljw aor rhc follo{ing ro$n (S(rc.rl.5
<br />Busi.csr !d Pror.s.hn Cod.): Ary Cily or Couniy which rcquiEs ! pqn l lo conndc( !116. nqrcvq d.elkh or qEn atry
<br />srtuclurc. prior ro ns issuafu, slso rcqlncs $e atpli.nir for such lcrmir ro fik ! \ismd lmtcftnt rhd l! or shc ir licctrsd pursulnl
<br />ro rh. pmvhions of tta Conkeioas Liens.d lrw (Ch{prcr 9, CommEi.E Rilh Sdion ,00O of Divkion I ot lhc Busin*s aft!
<br />Pmfcsions Codc) o! lh.l n or shc is cxcmpl tlrcrcftom lnd th. basis for lhc alhScd cxcmrlion. Any{o!!lio.ofsecltun7031.5 by rly
<br />ap!,lica aor o pcmir subjets rne lppli.a ro a cilil Felry oI nor mE $!n firc hui{t&.d dolldr ($slx))
<br />-1.
<br />tri owe. of rhc lrcFdy. or my .nployrs wnh wr8.s N th.n sb .omFnsotion. eill do dc ast ed thc $n l@ ii mr
<br />im.ddl or oficed for elc (Se.?044. 6usi.cs !!d Prcfc$io.s Codc Tnc Co ncrols Liensc Llw docs nor dprrly b s oenc. of
<br />lfic pn,tEny wln' buildr or nrl0mrcs lll.Mn. rd wk &E Mh w* hinqclf or hdelt or lhslsh hh ot hcr ow. .r{'loyces.
<br />foridcd lhdr .uch iolrowftnk aE mi idcd.n oroff.rn for eh Ii lk)s*i rh€ builiin8 o. ir{,owm is sld *ithin w tur
<br />otconplcion. tlr Owtur BuiLLr vin h,r dE hrdcn orl,oing rnd hc or sh. dil mr t ild or in{mlo lhe pmFiy lor rtE tulEs of
<br />-1.
<br />!s o*ncr of rh. !rup€ny, m cxclosivcly contEclins with li.cn$d conrelou to otriiocr rlE uEFr (S& 7044, Busm$
<br />.nd PsrBsa,n Cod.r Th. C,nhcrols Liccnsc Llw doca nor opply lo an owncr ofrop.rlyvho builds or impmlcs rhcron.
<br />and qno onrrcrs for such rhil|r wnh d Conrh.lo(s) licetr*d plnurn lo rhc Coorrdor's Uens t w).
<br />-l
<br />omcrcmfl undcr Scclio
<br />loaatBlt-col4tENsarloN
<br />DEqIAMIIII!
<br />I lErcb, arrn undcr Fndry of Iqjury om of thc folloqiig dGhrdionsl
<br />-l
<br />hJerlnd *illnuinuinr Ccrr in((c ot Coi$nr r{, Scllrln{rc iu $uk6r conll.n\dri(,r,,s trolidcl lor bySccltun3r(rofrhc
<br />Itrtxtr c(xlc. lor rhc tcrt,nun.c ol rhc so fd a[th th,c p.nnir i\ irsucd
<br />-,
<br />h{v€ ,nd will roill.i. *o*.s .onFnsalion iNUEmq ss Eguircd by Selion l7m of lhc LltDr Code, fot rlE Fnolrll!re ol
<br />lhc work for which lhis pcrnil is issrcd. My smlcn .omrc.salion insurorcc caicr dd Plicy nunber @l
<br />Policy Nu,$d:JxpiB:
<br />I ccdily'h,r i.rhc l.rrormmc ol th. vork lor*hthrhis,c.m h issucd.l shlll nor cmployrnypcmn inlnyMtut
<br />m s ro lEom s!$irr ro rhc workers coqEnsdrio. Lws ofcalifomi!. und lsft rhd if I sh,uld b..om subjc.l lo rlrc
<br />erlcrs' cofrpcnsrion povishns of Sdion 1700 of rhc ktnr Codc. I slEll. tonh{irh @nol, wirh rlDs !,rvisions..
<br />WARNING: FliluE lo surc mrlc^' omlcnslion skmg. h unhwtul. !d sh!,| slbtrt an cn{,loycr lo diniBl Febies rnd
<br />civil tif,.s trp
<br />'o
<br />onc hundEd lhousand.lolles (llqJ.ur), in addnion lo lhc cosl ofcoq,cislion. dlm8ci rs Fovilcd fo lhc
<br />Selirn 30?6 of lh. titrr tu., inlcrc( ard rnor*y s fas.
<br />Applio l
<br />Llgirsg)roNr&tclaB
<br />DE!:I,A.BIIION
<br />ol rhc lltr\irr* Md Innt\\i(nr\ CoJc. rtr uylic.i\e i\ in,ill l,{.c kl.l,..l
<br />Lienxcchs: Liccnrc Numbcrl
<br />CaI$IB!&llaNlMlINCrtCIiNlI
<br />I h.toby rffrflrkl.r rf,.rlry orpc+rt rhd thm i\ n cotr{rucri.n LMils a80nc, for rhc p.rri)rnurcc oirhc work rbr $hi.h rhi\ Fnnil n
<br />i\\rd (s.c l(x)?. civ c.)
<br />AITLICANLI'ECI,ITBAIIOB
<br />I ltnby tmrund$ pcnrhy ofpcrjury onc ollhc followint d..l,uhns:
<br />ft mlnion Pcrnrils'Aslxslos Nolili.arion ltdcral Re8ulations Ont 40. PM6)
<br />-R.qund
<br />lxrrcr ol Noriti.dinr
<br />-l
<br />c.rrify lhal rh€ fcd€ral rsulark'ns csndins lsb€rrd rctr$lal are ior anpli.,rn! ro rhi\ !mi.r
<br />-,
<br />cnify thal I haw Etrd lnis lpplclrion ud sral. lh.r thc trbovc inlbrrEtion h oftd. I .Bre ro odply *irh .ll Cny rn<t Counly
<br />odin,m.s.nd sl{c t wrshrilaro ttriMin8 6n!ru.tio., oi he65y alrlbriz rcF.rcnlalivcs oflhk Cnyctrd Coun!,lodlq uI-.llr
<br />.bovc mntio,cd pmpcny fo! insp.clion turposs.
<br /> pflicrnrorAgctrrSiCnxhtrc
<br />Pmile mm (rint):-
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Nilisc. 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 />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 />Rou gh Mech.11/i,r/1,/iL89
<br />Final Test
<br />Meter Release
<br />FINAL v/&/tq M L0-,'
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Hood
<br />I
<br />tt
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