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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<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 />Residenlial 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 />Rouqh Mech.tzl5/t{l O.-xt$z "*2-> )
<br />Final Test U
<br />Meter Release /w$&FINAL U.tlt4 \v ?E
<br />Notes, Remarks, Etc.
<br />-+
<br />oWNFJR BtIII,DER DE!-CARATION
<br />I herchy u,lnD un crycnrlry ,,a !.rJury rhar I c\cnu i om rhc Conn.nn\' Ltrn\c tnu ri,r rhc tnlb*in! ft"v,n (sc. 70.1 1 5 ,-
<br />Bu\ioc\! and lrroicsri,,n Gnlc) Any Cn, or Courry $hict rcquirls a ri.flnir r, .on{flcr. alrs, in!nov.. d.ftnnh or rc|,'ir . ry .
<br />iru.ru... n'i,nn, irs i\\uricc, rl$ Bqunr\rlr rflrli.a r lnr \u.h rrnnir b filcr rigncd {.rc f,trr rh0r hcor shc h liccned prunnl
<br />k) rhc povirions ol lhc Con'ra.ro r l,icn\cd lj* (Ch:'prcr 9. (nnrnrcncins wilh Scclbn 7l)($ ol Divi\ion .l or rhc Btr\incs tt
<br />Pn,fcsnnl\ CDdc)orrh,r lkorshu i{crc.rrr rhcnfinnmd thc br\is Lr rlrcdlc!.'lcr.npr$n nyvi(nrrionofSccrionT0ll.56yrny
<br />trptliclN lnr i,cirnil sutlccts lhc anpli.nnl k) a(ivrlpc llyol nor ucrhnn fivc hunnrcn dollff (S5@)
<br />-1,
<br />!s ownr of rhc I,DFny. or f,y cn9loy@s sirh sascs as rhcn bb .orp.erion. *i! do tlE wort ard llE srruclw is mt
<br />inlcnd.d or ofrcrcd for sL (Se.r01.4. Busimss $d PrDlcssioB Codcr Th. Conhctoas Liccn* L.q docs nol arply lo e oqftr of
<br />$. pbFn, wth brildr or itntuB dEstr dd wh6 dds tuh sd< himrclf 6, he&I, or $rcngh hi. or hc own cmrloyccs.
<br />Foridcd lhar su.h imomvcmnls E ml intcndcd or olf.Rd lor eh IL tbe.w, llE hiildinB or id{,mEmnl is $ld virhin orc ,.u
<br />of onFhlbn. |,f, Owncr Build.r will hat l,E l[d.n of FDvinE lhd lE or sh. dn ml ttrild or irymw lhc FlrEly lnr llE pu.rne ol
<br />-1.
<br />ar owncr of rhc lmpcrrr. om ciclusilcly contro.ring *nh liccflEd €onrr.do6 ro onsrtud tlE |,oiu (Sft, 7044. Bucic*
<br />{d ho&si.! Cod!: Thc Co 6crol s Lic.!* Law de. hr r,,pl, ro o ownc. of prop.ny ah6 builds or impmvcs th.Nn,
<br />and who $ntn k for .ucfi pmjels with . ContEdorls) li*ned puBMr ro rh. Conrracrols Ltcrse kq).
<br />-l
<br />!mcxc.rpl undcr Sd B. & P.C. for thn rcason
<br />-)
<br />/ra-!1 Ca**rrv/-O l1 u*^",, <'rru.tfu.tr-cl.Att:tl!$lruM
<br />L&g.J0$ruN - -
<br />I hcrchyalnflnunddrcn0lryoln riuryoncofthcrbllowir!dcclurtr'ions
<br />-l
<br />hare si will dinrain a Cc.rifEatc of Cotrsflr ro Sclf- lnsuE aor *o.km Nn Ensarion. as lmlidcd for by Secraon ]700 ol lhe
<br />bbor Codc. for llE pcrfom oflhc wrk for wti.h lhc p.rmit is issued.
<br />_l hrlc oidwillnuinrain$orkcrs conpcnsarion inslrancc. as rcqoircd hy S(rn,n lTuJ orrh. llb.r Codc. fo. rlE,rsformna of
<br />rhc qork for whi.hrhhFlmir is isu.d M,vort$ @mr..iatb. in{ldcc.ei.r at Fli.y numhd m:
<br />-l
<br />ccn ify lhol in lhc F ormflccoftbc qolk aor enkh this pcrmil is nslcd- I shlllnor emiloyanylcrsn in rnymmmr
<br />$ 3\ ro b.a!m sutj$r ro rhc Bo*cn conqE.erio. hws ol Califomia, od a!rec rhor ir I stnlld b.snm subj(rl lo ll*
<br />worlcF compen$rnm pmtsionsofSerion 3700 ofrfic L3tnr cldc.l strll, todh*nh s'Ipl, sirhlhos tmvkions..
<br />WARNING: Failurc ro scurc wortcB conr.nsari.n cotcm8c h unlawful. ord shrll subjcl an cmplorr lo siminal Fulli:r and
<br />civil lin.s np to.n. huEdred
<br />'housand
<br />dollm (Sloo.mo), in addnion lo lhc.osl ofcoq,ensolion. dlmgcs as rovdcd for rhc
<br />Sccri.n 1076 of lh. tabo. Oi., inlcrcsr md
<br />2 7t*
<br />I tur.h! lrfinn und., I.nrlrl ot p.rjurt rhnl I rn,ltunscd utrds pnvi\ion or( hrpic.9 (.omrmnci.! wrh sccri(). r(xx, ol Division.l
<br />ol ihc lrurnEs!M P&lcssiorsCodc. rnd nyliccn\c h ir lull t)Ec andcijccl
<br />IOXSIAIJCII0 lliNl2INCrtCINCI
<br />I hrrhynmonondcr F rhyoll.rjrrrrhrr rh*. isr.od{flcihn L in!,!cK."r,irrhcp.rlbnn,n.co,lh-}uktur\hichrhnpcnnil i\
<br />isu.d lscc 3097-Cir. C )
<br />iUILll NLDIsldtrAIIlJIi
<br />llf,nlrr" rllnrrntur potrrlrt oftcrjur! ntu ol nr r,,ll,,strig lc.Irrrrntr:
<br />l).Nninr l,.nn[$Asicslo\ Norilic!ri, licilcrrlRe!uhri.ns ( Iirlc.lo. P!d6l
<br />Rc!ricd I crr.r ol Nolificrri(m
<br />-l
<br />.crrify rhdr rhc rcd.rd Eguhrbns Eg&di.8 nsb. os rcfr,!.l ,rc n.r lrpli.nhlc lo rh pmrcr
<br />-l
<br />ccnifyrhdr I h!!ercdrhirsn icarion d! arerhar rhc rtblc infomlnr is codc.l I nF( ro coryly wirh all Cily Bnd Counly
<br />odinlncrs orn Srltc l,ss rclarinE ro l,lild ine cdn{rucrl,n. lltl hcrcby rcprcscir3rivds ofrhh Ciry rnd Cou.tyro cmcr llJ)on rtE
<br />1k,vc Nrrioncd prop.ny lor inrpcdin .-3/"/8
<br />Lic.!* Clrsr Lice Nu[te
<br />-
<br />D3le
<br />t nds ! AddE*:
<br />-
<br />I
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