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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled
<br />Flou gh Ductwork
<br />Vents
<br />Toilet Room / Clothes D ryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.-t lts ,Ir(1ttfur)
<br />Final Test I
<br />Meler Release
<br />FINAL E t(-r l^lClrMrr,l'2.1)
<br />Notes, Remarks, Etc.II UY
<br />OWNER DUILDER DELO{RATION
<br />I hcrchy lmrn lnder pcMlry 6f perjury lhr I d cxenDr n$m rhc Cono&ror' Liccns. hw for E lolloviig Easn ($c.7031.,
<br />Businss .nd Prof.ssion Cod.) tuy Cily or Courly which rcq rcs 3 Fmn to on(ml.,lI(. inporc, {hmlish or ELir dy
<br />slrucrurc. prior lo its issuatrN, rho rcquncs $c arplic l for scn lcmir ro fic a siBmd stlrem rhar hc or shc ir liccosr! nuFunr
<br />lo ilE p,bririo.s of tlE CoorB.loas Liftlsd tis (Ch,pt.r 9. Conmming wnh sNlioo 70m of Division 3 of llE Blsincss a.d
<br />Pmf.ssions Conc) or lhat lf, or sh. h .xcmnl lhcr.frcm.nd llF hask for tlE allcScd cx.mplion. Any viobfion otS6lhn 7011.5 by uny
<br />spt icrnr for a l,.mil subrc.k lhc rpplicanl lo a.ivil lcMlly of nol mE lh filc hundEd dollm (5500),
<br />-1.
<br />as owncr of lh. pmFny. r my cnrplolNs wnh r.8cs {. th.t sl. .onpMs0tion. wiI do lhc wk !M tlE slrud@ h mr
<br />inrddcd oroflcr{ f6! sk (Sd.7044. Blsimss and PrDfcssk.sCodc: TIE Co ntoasL@reLlwilocseral,plylosowmrof
<br />$o tmFny who hilds tr impmws tlEmn, lrd wh. do6slch wo hinsclforhcr*lforlnmuShnisorhcroencmrloy.es.
<br />pmvid.d rhar suci inpovmft m rcl hrdd.n 6.6!Icrn for el,lt hows. r,r hiiBing6r arSMtu Lieuwilninom){,
<br />olon$lcrbn. dc Owmr Buildcr {ill hlr rhc hdd ofr,oin3 thar lr or shc dit m! t iU or in9n w Ur lopcty for 0E putbs or
<br />-1.
<br />as o,ner ol lnc pmpcrlr. sr exclusilel, contretinS wilh liccnsd .onrrrcros ro @isrrucr ttrc Proirt (Scc. 7014, Butincic
<br />anl Prorcs*ih Cod.: Thc C6nt,.rol s Lien* L,w .locr mr lllply ro e oen6 of rop.ny sho bDil& o. iq,mws lh.Nn,
<br />a.d who conlncls for sNh l,oj(ls with a C,fltr.cto(, li.cns.d !u6Ml ro rhc Contacror's Lie.rc Lis).
<br />I hcrcby amrm und$ ncMl'y of nsjury om of thc lbllouitrs dcchmtions
<br />-l
<br />hlvc sn eill minrain s Ccdifrorc oaconsnr ro S.lf-lnsuE aor mrkc6 coq*nslrbn. ,s Forii.d for b, S6rioo l70O ol rh.
<br />r,bor Codc lor llrc p€nMmmc of tlE tud( ror wnth lhc Frmii h issuen
<br />-l
<br />hrvc rnd *ill @inroin *o,kctr .on{xnsarion insuhnc., f,i ftqut d hy Secrion 3?UO of th. t bor Codc. for th. pcrfomkc 6f
<br />lhc work for *hkh rhh Frn is issucd. My wortca compcnsdion insurancc .mkr ond lblicy nuftbcr Nl
<br />I.caity rh,l in rhc p.rao.mm. ollth vo.k 46, vhich rhi! F mar Ls is$.d.I rh.ll Nl dl oy any p.Mn inlry nMmr
<br />s as lo b.!rm subjd to thc $orkcB comp.nsalion L$ of Californio. ord 088 lhal if I sholld b€toft sbj(r lo dt
<br />*ork6' mmp.B.lion lovhhns ol Sdlhn l?00 of lh. t$or C.d.. I slEll, lbrlt*ilh 6q,ly enh lho* Povhions.
<br />WARNINC: Flihr ro rcue qorl((..rlltn$rnr c-lctusc i\ unlxwful, an{ lhall \ubjer &. cmplor.r lo aimiMl IEMhics oM
<br />civil nnc\ u! ro onc tlodEn thoNr.d doll&s (5100,()l)0), in lddinrn h lh. cosr .l .ofrFnerion, domgs as prcvidcd for ll*
<br />I 1076 of rhc kbor Codc. inldcsl !M ahrrcy s tes
<br />Dl;llnLBAlltul
<br />Ihcrchtrlllrmukl.r pc hr_ot Nrjuy rhar I rm li!.n{n uMcr pr.\r{ion olChtlprcr g (.on,mncinE *irh Scclirn 7(Xi,) of Divi\ion l
<br />of lhc llu\inc\\ rni Pn,fc\\i,n,! Codc. md niyli.c.\r i\ in tull,'nt aNlclLcr
<br />Licc$c Clo$:-Liccnsc Numher:
<br />D.te conlrrclor:
<br />g}IIIAII:IIONIENDINCAGEICI
<br />I hcmby rrtrnurdcr lEorlryolFrjury th3l lhdc is r cotrnMrnrn hnninS orcmy li,r rh. pcrlotrumc olrhc wo* ror whkh rhil Frmir is
<br />i\s!.d (Sc...10)7, Civ. C.)
<br />ATTLIIANLDESdAAIIAN
<br />l,xnb, fiimundcr pctrrhy oipcrjury orc oflhc followirS d(lan(ions:
<br />Ocmolirioo Pcrnrils'Ast{slos Norifi.arion rtdcral Rc8ulat ions (Iirlc tlo. PM6)
<br />R.quncdbrrcrorNodli. tun
<br />-l
<br />.cdify lnfi rhc fcdcml reSukrions ESsdinS $bcsos Enotd m nor npplkobh lo thn poirt.
<br />_l Luify rh, I hdr @d rhi* eplic{rion r.d iarc rhd thc uhovc iotomdion ie.o,d.l a8G ro co.ply with oU Ciry.nd Colnr,
<br />orditutu$ lrd Shre Liwi rbrinS ro blilding 6 dtuciion. !d hcdby aurhori4 rpr.rnr.liws
<br />rh)rc mnrioncd prcpcny n, ir\
<br />At'plicafl or Ase Sisnaurc:-
<br />cny ard Counrr ro cntcr ulntr rhc
<br />tSEt
<br />COMMENTS
<br />lnsulation
<br />lnstallation
<br />"",",otrflz-ltl
<br />,",", OC/rc f l?
<br />tt
<br />tt
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