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MECHANICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Fu rnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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 />I
<br />Rough Mech.fu1'f,,-ta9
<br />Final Test lr I IU
<br />Meter Release
<br />FINAL p \l8 l\?)A
<br />Notes, Remarks, Etc.ul
<br />OWNER BUILIIER DELCARATION
<br />I [crh, amrn ud.r ,cM]ry ol pc,jury lhal I u cxcmd f&n llE C..rrto Lt.nrc L3* for lhc follo*i!8 Etsn (Ss'7oll.5
<br />Busincss ,n{ Pn,lc,rion Codc): Ant Cily or Counly *hich rcqun s d Frdil lo.on{ru.|. !lid. inorow. d.mlish.r Elon an,
<br />strucrurc. ,rior ro irs hsunN, slb rcAuires th. anplicdr lor such Fmjt ro lih { sGmd std.m ln.l lE or sh. ir liencd liedr
<br />io rhc pmvhiom of irE Conhdols Licensd t s (Chlplcr 9, Commcmin8 $ith Sdion 7000 of Davhbn J oflhc Busincs and
<br />Pofcsions Codc) or rhd lf, tr slE n cxcmpr rh.rciiod und rh. basis for rhe allcgcd .xcnption. An, viohtionofsetirn ?031.5 by an,
<br />apdi.anr for d pemit subj{rls rhc .pli.ant m d civil lcnalry of .or rcrc thu fiv. hundrcd doll&s (S500).
<br />-1.
<br />as owM of rlE pmFny, or n, .nploles wilh waScs !s llEn $b @mpcnsdaon, will tu lh. wort and lh. *nIl@ is mr
<br />irrcnd oroftcrcn for $lc (Sc 7044, BuriNrsa.d Prorcisio.s c.dd Thc ConlEctois LiInc L!* &Es.oi dl,I,ly ro owrc.of
<br />rhc pmFny who huilds or iqnovcs tllcotr u{l wlF dts sh e& hiGclt or h.sclf or lhmu8h his n! hct ow..mplores.
<br />Dmlid.n rhlr sucn imFmwr s @ rcl inlurt n o.onbrcd lo. $lc. ll trwcw.llE hiHing o, itrpmkmni i! eh wnnin orc )4!
<br />or coiplcrio.. tlE Owmr Buildd wil hlw d* burdm ot pmvir8 ln l he or shc did Bn boild o. irpmrc lhc pmFyl, fot thc I'!4m of
<br />-1,
<br />as osn.r of rl* prcp.iry. d cr.tusively .onMing wirh lisn*n conlreloF lo connru.l tE Foiil (se 70{4. Buircs
<br />and ftDlc\sb. Cod.: Tnc Conrr{lols Licctrsc ljw d6 ior sorly ro oosn.. o[ prop.ny wio builds or nnDrcrcs 1h.r.6..
<br />and qho conlraft fn ,u.h l'DFc$ with r Conrnclo(i) liensi puruudl lo ttu Contudor's Li.cM Liw).
<br />I lmcrcmo! undcr S.crion . B & PC forlhn r.d\on.
<br />D . ()rn..
<br />EQBf,E8E.CQMTEIAUqN
<br />DECI.AIAIXON
<br />I nceby ,mrn undf Dcnllry of pdjtrry orc of rhc rollowin8 d@lamlions:
<br />-l
<br />harc ard *ill Binlain r Ccdifrar. of CoNfl ro S.lllr$e for wk6 conFNdio!. $ FDvidcd for by SeIjon 1700 of tlr
<br />Llbq q!dc. lo! rlE o.rft|m@ ol rh. sort for whicn ltu ,Ermil k i$cn.
<br />I h0tc ond aillmdint0in workcrl cotr{xnsart,n instrsmc. as rcquirdbyse(rn ]700 oflhe Llbor Codc.lbr r,r nofor@ncc ol
<br />r w.rk for rhih lhk Frmil is issKl. M, wo*c orpen{ation insuratrc c,rif.nd PIi.ynlmbo !rc:
<br />-l
<br />ccnilr rh in rhc p.rtormn.c olfic wolk ior whi.h lhis ltcnnil is hrucd. I shtrll noi.mrloy 0ny p.Hon in any manncr
<br />s ssto bc€onE subjcr ro rhc *od<eB ..qrNdiion hws orcalifornh. Md tr88 thal itl stFuld bcroft {bi(r ro lh.
<br />uorlcc'ompcnerionpolnionsofserirnITLUolrrrLit r Cdc,l shall. ibnhwilt cotrgly *ithlhos ln.vlrb.s.
<br />WARNINCT F lue 16 s@ "6*6 6tr{Ens,rio. ovcBB. t unla*ful. atrd shrll subic.l o crnnlor.r to riminal PcElrics lnd
<br />ciil fines un lo onc hudrcd rhoxsdnd dollrs (!l00,ooo), in rJdnion lo lhe cosl ol hsrn,n. drm8ca as providcd for thc
<br />Cod., inrm$ aod lnorry s fccs.tlL eppu*r >-
<br />Llt[lsul-(aul^c-r!)B
<br />DE(.|BAIION
<br />I hcmby dfrm undo Fnslly oa p.riury lhll I em licenxn !tr&r tmlision of ChaPs 9 (coommin8 *nh Selion 7000) of Dithio, :t
<br />or lnc Busin.ss ed Prof.$ionr Cod.. {d my lk.n* L h tull fom urd clfel.
<br />t\
<br />D.l.: 1 (*,""X=-
<br />tl).Nsral(-uQNll,lllllcJ\rif\1r
<br />I hcEby arftrm under Fnalty of l).rrlry lh.r ft* n 6 .!6mdion lending .8.Ny for lhc pc.fom*e of lh€ sorl for whkh rnis Fmit h
<br />iNitrcd (SN.1097. Civ, C ).
<br />AITIJCANfDECLAAAUON
<br />I lmbyrimnuft.r !.nrll, oI trrjry onc otrnc 61kr*nrr dcchrnrion\
<br />l)cntnirt,i Pclnir A\b.do\ Norili.rrid Fcd.rtrl Roluhrnnrs (l,tlc 40, I!n6)
<br />Rrqutrcd lxrr*orNi ifi.ati)n
<br />-l
<br />ccrrify rhd rhc fcrtc,rl dgxl,iions E8ardin8 asb.slos rcmval arc ml apdicabk ro rhis tmld
<br />-l
<br />cmify rhrr I hav€ ,cad ihn rpplklrio. ,.d arc lhor thc ohov. infondtun is coBl. I r8rc lo .on ly ein el Cny dd Counry
<br />ordinlnccs nal Sx c Laqs rcbrins ro huilding .onshdion. r,rl hcrcby rcprcscnllrivcs olon ciry Md counrylo.nlcr uNn ih€
<br />lbovc nEnliomd pmFrl, lor
<br />Amlicatrr o. As.nl Si8nrlur
<br />r
<br />I
<br />APPROVALS
<br />tlrf,
<br />>r'tufu,
<br />\e-
<br />t ndn'r Addmr:
<br />-
<br />--*" obLtutLe
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