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MECHANICAL-INSPECTOR RECORD
<br />OWNER BUILDER DELCAT TION
<br />I hcrcby lffim undcrycnahy of pcriury tur I m er.mpl tom ihc Contm.los Liccnsc ti* aor lh. folhwinS Ersn (S€ 7011 5
<br />Busincas ,nd Profcssion c{de)r Any Cny or C.unry whi.h rquier o ltmh ro constdd. {lrci ioI@vc. &mlhh o. rcpoir rny
<br />sltutuE. rior lo ils nsuanc.. ako EqliEs th. opplter lor such Fmit lo fik a si8rcd slalcm lhd hc or rlE G liansl r,onulnl
<br />to th. !,Dvirhns of th. Conrocrcrs Li..r$d tlw (Chlpt r 9. ConmEjng wiih Sccrioo 7000 of Division I ol lhc Busincas and
<br />Pmlcsions Code) or lh8l h. or shc n .rmpl llmarom o th. tssl! lor thc all.Bcn crcmplion. Any tiolalion oasrclbn 703 L5 by lny
<br />unplicafl for a pcmir subjEc rh€ sl,t,li.a lo rcivilI'{Mhyofmr mrcfian fivc hudrcd doudi ($500).
<br />-1.
<br />as owrcr of th. pmFny. or 6y .q,loyEs wirh w.B.s as rhct slc .omp.nsdion. wiu &, rbr sll cnd thc std@ h nor
<br />inrnd.t m o6cred fo, eh 1Sd.7044. Brims. and Pmr.srionr codc Thc Conrr".tols LtcnE ti* dca not apply ro .n o*tur of
<br />th€ rmrEny sho hilds or impmles do6( all *ho d6 skh sll himrclfor lrMuor
<br />'houeh
<br />hir or ncr ow, cr{ oyecs.
<br />lrovidcd rhir such iilmErnk e rcr iircndcd or on6l fnr eh lf. how*,. rlE hrildiiS or inqmwmnr i! $ld wlhin ore ra
<br />of.otrplclhn. llE Owmr Buildn will h,n thc hrd.f, ol !mvj.! th,l h. or dE dn ml bild or iqmt lh. FotEty for tlE pu{ns of
<br />-1.
<br />asosncr.l rhc tml'cnr. amerclusilelronrrdiry with liccnsd codracronro onslft' lhc lftrc{r is(,70,14, Btr\if\r
<br />lnd EDrcsilr Cod.: Thc Comrek, s Licc.sc liw docs nor dpply 16 !n owne. ofpmFny *no huilds or impDlcs lncron.
<br />.nd who conla.ts for ru.h F+crs wirh a (hnrE(lo(s) licctrrd puswr ro rtc Conrrdcrols Lkcnsc L!w),
<br />-l
<br />ad cr.mfl ond( S6t
<br />TOBf,ESI!:OMPIIIAIION
<br />DECT4XAIXA
<br />LErcby rrrn uMo pc&lry oa periur, om of th€ folhshg dc.lnnrio.s:
<br />lhsvc0!rl*illrnlinrlhnCcnificat.fc(nr\cirt,scltln\ur.nr*orkcdc. rt{istrrion,,s rn)vidcd fi, bysNrion lT00 ol'rhc
<br />Llhor Cnlc. rbrlhc ltrionnrncc ollhc wor* for which rhc !.rnrit is hsucn
<br />-l hrLcrnJ willnr"nrr 1 rnrl.1. tu'trf.n.dritn' in\u'nft'c.
<br />'\. s l tn' \hi. h rhi. ncmn '\ trqqi l.ly *, rI.rJ m'nnrn
<br />.-,", Z*et41 ,4-?v/e.
<br />ar Equircd by Selion 3700 ol rhe Llbor Co&, fol lhc p..fo@ of
<br />.lrion in$dh @i.r .td polby nunbc! @:
<br />-rc
<br />I cdifylhar in rh. l*dormkx ofihc wort fo. whkh rhh p.mrn is issn.d. I shallnol cn{,loy any pcson in.ny lMF
<br />so s ro bcro.* sublcd lo lhc wortcr'ompcNal ion lass o, Crlilomi!. atrd !B@ rhr it I shoold i.com subixr ro ltr
<br />q,kcn compcnsarion pmvisiotrF olScclion 1700 oflhc l,tor Codc I shlll. ibnhwnh.omtly wirh rh.$ ptuvisions..
<br />WARNTNG: Fdilu.. ro su.c workctr conFherion .oh.trg. is unlnwtul. Md sna[ subiccl cmplorr lo aimiml pcorltts and
<br />.ivil fin.s un tJ om hundred lhou{nd dolLls (Slm.oq)). i6 addiri.n to th. cos' ofconqErsslion, dunuScs.s provil.n for lhe
<br />inr.n.( rd nnrnrv\ n!\
<br />UIEXSIIX:qNIIACII}B
<br />DECI,AAA.IION
<br />I hcEby imirnur cr pcndlyollcrjurythol l.m,icuscdxrdcr pmvision oi Chtrlls I (conmErcins *ilh Sccli'n7O0O)ol Divi\i.n l
<br />.f rh. Busilc* iM Pr,fcs\i.[\ Codc. nnd hyliccnrc h ii f!]l fore rd rftccr.
<br />t,e c uoT
<br />CIIISIBUCTONJ.ENDAGIGDBCI
<br />I hcEby ,IIun und.r F@lry ot Fcrjury lhrr lhcE ir . onnscdon Lnding r$Fy for tlE perfo,]rw. of the *o* lor whi.h lhis p.mn is
<br />isslcd (Scc. 3097, Civ. C.).
<br />dlrllsaNfolict f,aru!
<br />I trruhy atlinn undcr |rMhyof t^-rjury onc oirhu roln,,irs dccla,urnnN:
<br />Dcflrlirn Prnnirs A\hcnus N.rill.dn'n lr.dcrxl R.Aul.rn'nrtTirl..l0. Pd6)
<br />-Requncd
<br />LcrreroiNorifidio.
<br />_l ccn iry $ar rhc f.dcml rcSulorions Egordin8 .stEsros rcmv.l aE flor applicablc ro rhh pmicr
<br />I .cn ily rhar I hivc rcad rhn aFplharion .nd surc rhd rhc lh,vc inli,rnErn,n is .otr(l I agft b rinDly wirh ,lr City nnd Counr,
<br />ndinoiccs ond Srllc L{ws rchrinB ro n!i6in8 consrd.tion, nnd hcrchy.urhori?. rctrcscnrar ivr\ ofrht Ciiya Counry b cntrr uF,n rr*
<br />ahow Nntiomd pru!.ny aor itrspccrion
<br />A,rt,li.atrl or ASc Si8nrlurc
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Ir4isc. 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 Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Rough Mech.
<br />Meter Release 7\
<br />FINAL l -24'*t1 y.vt-n)
<br />Notes, Remarks, Etc.
<br />Above T-Bar
<br />Final Test
<br />".,.,% /t
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