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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELC,{B,ATION
<br />I icrby alfim undd pcmly of p.dury Ihar I m .x.q,r fmn rh. ConrrctoB LieM Llw ror d. followinS Eoen (Ss.7011.,
<br />Auinc$ r.d Prcfesion Oodc): Any Cny or C@nry shkh rcquiB s Fmn ro oBtlod. ald. in9rcE. &mlirh o. Eprir My
<br />slocllE. Fhr b ns bsum. rls r.quircs 1n. epltet ro ru.h F.nir to 6h a sigEd .lcft u lE or slE is li.dsd puMl
<br />lo th. povirioN of dE Corralq r Lkc.sd t w (Chaptcr 9. Conmmiry wnh S.crion 7m0 ot Djvti.,n I of $. lusin.*s rrd
<br />Ptufcssions Codc) or lh.l l* or rlt is cr.q fi.Efrom ad $c hAis for th. dL8 d .r.nplior. Any violnlion of Se on ?03 L5 by 3.y
<br />epli.afl for a ,..mt subjets rhc applic{fl ro . cilil p.@hy of rcr mr. rhe 6vc hundr.d dolldri ($500).
<br />-1.
<br />r\ owtrc. oi rlt pmNnr. (tr trry ctrr orcr sirlr qr!.s as rhcir \r. .onrNn![ i(rl qill d. rhc qolk ,kl rhc stnrlurc . Nr
<br />rhcm,N'ly eh. huikl\ or irqn*$ rln.on. md *ho do.r such tror[ hi'n\clfor hrr*]for ihmuEh hn.r hcr osi onlnotcc\.
<br />nfl)vidcd rhnr such nnrrororn( rr nor i' oJL{ or ollircd tur {'L. Ir: howcrr, rh! hu ikling or iaproltnr i\dJ*irhi',onclr,tr
<br />ol ..nrplcri& rhc O*ncr lluiltls sill hrvc rhc bu cnofl(,vingrla( l[orshcr] tr.rhtrilJ.rnurovclhc pn,tdy lnrrlt NrF,{ l
<br />-1,
<br />es owtur ot rlE ,rcpcrry, am crclusirly onrradina wnh lk.nsd o.lE.r.R b mnsftr thc rmrNr (Ss. ,044. Businc$
<br />ard PrDlLsbnCo{k: Th. Co mlol s Liccn* tjw des mr ,Iply.o e own.r of Ibt'.dy who 6uilds or improvd th.mn.
<br />snd sho 6nE&ls for sh ntuirls *nh a Conrturo(, ltcnsd plNunr ro rtc Codturol3 Lie.c tra).
<br />lrncxcnpr uM.rS..rn,n- B & PC ntrihi\r.r$n.
<br />Irlle Orner
<br />l{ORl(EfS C(TMPENSATION
<br />DlcLA.EArlol!
<br />I hercby afirm utrdcr n Mllyof,*riuryonc ofthc followina d..lealnrns:
<br />-!
<br />h.vc 8d *ill miflain ! Ccnifrarc ofconEfl ro Sclf'lNuE for srlct onv.nslrion. !r Foridcd for by Smrion 3700 6t E
<br />L3bor Cod., for ln Fforlfue of ll* *ort for snich ln. rpDiI b issucd.
<br />I hrlc rnd *illnuinirii {orkcrr .o'nr4-neli,,n in\urlmc-.r rcquhd hrSNrn,n l7([olrhc libor (i)dc, ln. rhL lcrii,tuft.of
<br />rhd sorl ror which lhis ri(.nril is i\\ucn My *orkcr' omn€n\0i ion in\urancc cari.r eld rnlicy nlhhcr rc:
<br />c,.t,.. 57+T; Fu*b
<br />Lo s7-6t-2 ot 9
<br />I ccnifr rhnr in rh. pcnbntun.c oflhc *ork lbr *hi.h rhi\ rero,ir G n\ucd.I shall nor .hploy .try pcison h rny uncr
<br />$ s lo hccom subjccr to thc *o*cn'comp€nsd ion laws of Colifornin. lnd !3N lhnl il I should lEoE suhicr to rlt
<br />*orlcr' cory.nsation tmvisions ot Ssrion l7(D of lhc bbor Codc. I shrll. rbnhsiln co'ry,I, wirh rhos Drovisionr..
<br />WARNINC Fdilurc b scurc uoricF compcnsdn,n covcBsc i\ unl,*tu|, end shrll \uhiccr an cnployc, to (itr1iml Fnahics,nd
<br />civil linc\ Dp ro otu hunrlrcd rh,!$nd d.U!h ($l0O,OOl))- n' {ldirion ro rhc.o{ or comri.nqiioo. d,rotcs 0\ Drovdcd r.r rh.
<br />S(ri{m.1076 of rhc l-rhn (ixlc, inicrcn r rrtrmy \ rcrs 4ptrt** t ope/.-, (rn
<br />UCENIEILCONIAACI!}B
<br />IIECLIX6IION
<br />I hcrehylfrtmlndcr penulryolpcrj!,rrhor I am licenaaj lndcr pmlisn'n ol Chlplcr I (conftn.iia wirh Sc.rntn7u ) oioivi\ion l
<br />of rlr Busincs nnd Pmlcsrnnr Cod., n! my lic.nsc ( n, fxll r(xlr ud el fd.
<br />.B
<br />n*,' O c I t c / t I c",.,**.* t'O c Car. t attu CI , ct-
<br />CqlllBucnul{lliNDllcrlliliNcl
<br />IhorcbyamrflxndcrFnalry.fl).rjuryrh0rrhsc,sn{ddi.nLndi.8agcmyntrrh.p.rLrmftcofrhc{orkLr*hichthnFrmili!
<br />issucd (Scc.l@7. Civ. C.).
<br />afg,rcdNfD[(I.^aan]oN
<br />I le-hy rllim lndcr pctrally oir.rjury oR ol rhc followins d.chrxri{trs
<br />Dcmrliri(r1 P.nnir sAsh.n s Norilicari( I;cd$rl RcSuldrion\ lTnlc,10. Pd16)
<br />-Rcqrn
<br />d Lcrler., Nolirj.ilifi
<br />-l
<br />dify lh.r rhc tcdml EBlhrioE EssdinB Bbclros rcmval !e mr rr9lksbh ro rhi IDj(<r.
<br />e(dirytharIhaEEdlnisrpplkdDnr,!d$d.rhddEstEwirlorndioni.cocr.I!88roo,ply*irh!uCnysndcou,
<br />odanam. ard St!r6 Llwr ElarinS ro brilding @rnrcrion. ,od hcrly au*hriz. rcr.r.r,rircs ol lnt Cny &d Counly lo cnl.r upon tlE
<br />2<0t-/te/
<br />+ 0lvr'h/ -T u tLC,r f C(4(
<br />r,!c flrnr( cJ !rcp.nyntr
<br /> pfli.rrr o. Agctrr SiEtrrrurc
<br />Psri,lc Nnc irifr) K
<br />Appliances
<br />Ivletal Fire Place
<br />E vaporative cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Ioilet Room / Clothes Dryer
<br />Residential Range
<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.trh tlF/,5.}/-tL tu*4+
<br />Final Test I
<br />Meter Helease ,
<br />FINAL rlt ll4 a4t|fh./tz
<br />Notes, Flemarks, Etc
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