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MECHANICAL.INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />l\4isc. 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 />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.il {hr/t/w)-7(fi,
<br />Final Test t ttLr
<br />Meter Release
<br />FINAL tu tv fiilANyrD I D.t'
<br />Notes, Remarks, Etc
<br />OWNEN BULDER DELCAXATION
<br />I hcEby ofrn under Fn lry of p.iu.y th.t I m ex.oF tlo 0E C. r&106 Litn* kw for lhe aollowirg E&$, (Sc.,tu], .5
<br />A$in$s lid Prof.ssion Codc): A.y Cil, or Colnry which rcquircs ! pcmn ro otrnrucr, ahd. idll)bv.. &mlhh or rp6ir rny
<br />smcnN. pri, ro itr Llsu.m.. .ho rcquircs ilE .policdr for iuch t'mi lo lilc . sieNd itncm rhar tE o. sh. b liensd l,lNad
<br />ro th€ pmvlsbnr of llE Conrsbrt Lien*d L!* (Ch!pr.r 9. Commrcing wih Sccrion 7000 of Division I of E Bu.inc!, ond
<br />Pefe$ions Code) or lhd ln or she h .rempt lhftion and lh. bosir for rh. ollcg.d er.mlnion. Ao, viohio. olsedonr03l.5 by.ny
<br />l'plicart for a Fmil subjeti rlE rpplicui ro . civil pcalry of mr mrc ln,. fiK hundr.d doltus (t 00).
<br />_1. a. owM ot lhc pottny, or m, cnploys. sirh *rscs 6 rhcir $h @nl'cNdion. eill do tlE *ort od tlE sM@ iq fl,l
<br />n e(k or oficrcd for ek (Se-ro44. BusiBs.nd Asfesiom cod.: Tl'c C.nlmlols Li.cn* L3q &rcs rcl +ply b an o*fr of
<br />rhc piorEny who hoikLs o. itr?sB th.F.. and *ho &6 *h w* hiasclf.r ncMlf or rhFlgi hh or h.r own .mphy..s.
<br />provid.n $d such inv,mwmnls 6 ml hlcdcd or ofr.Ed for sh. n howm, ll* building or iqrMmnl is sld wilhin om Fe
<br />ofonplcriotr dE OwM Buiicr will tlrw llE hrdcn oapbving rld lE o. df, dn d hiild or in{,tus tE poFiy for tt plttD$ of
<br />-1.
<br />aso*rcrof lhc Iml'.ny. !m.rclusivclyco rucling *ilh lic.nsd contudor lo conslrucl thc r,ojsl (Scc.7Or4, Bu\iftr!
<br />lnd Ptuassio, Codq Thc C66rtuioas Liccnm Ldw d6cs nor atply lo troo*ncr orrrot.dy eho builds o. imD.owr
<br />'hrcon,trnd 'ho conhclslbr slch p(+crs {irn a Conrmlo(s) licctrsd rursuont k, rhcCo.rrek, s Lic.trsc L!s).
<br />-l
<br />am crcmpl undcr Scct
<br />SA8rIESC9MfjESAIION
<br />DECITIBAII0N
<br />I hcrc_by lfitrn u.d.. Fnahy of Frrury om of lhe following &.btr rions:
<br />-l
<br />hNc dM qi ll n$intrir . Ccnrficrlc ol Conscnl h Scll lNUrc ,nr workcrr comll.nst( tun. us pmvidcn nr hy S.crnr -lTlxr of rhc
<br />L.$or Codc. for rhc pcrtormorf,c of l hc wod( lirr Nhich thc |)c nrir i\ hsucd
<br />_lhavca qill miinhin worled .o'npcnslrn,n ins!ruocc, qs rcqxirrd bys(ri{ 17(x)ol rh.ltrh.r6dc. for rh.,r:rlorroncc ol
<br />rhc worl forwhicnrhn pcrmn is ifl.n My workcrs comlE.\lrion in\lruncc cdEi.r.fii plicynunb.rml
<br />4
<br />q,c o2l, I C 9o tto 7 ///e
<br />-l
<br />eriify rhol h rh. lcrhrmRc of lh. wort for rhich lhis pcrmil h issucd.l shlll nor cmrhysny,,cson in Bny roner
<br />$ sro trcom subjcd ro thc *o*cn ompcn$rion I!*sofculifomia. lnd.srcc rhar ifl sholu t com subj.ci ro ltr
<br />worlcr'compcnsrliontrovhionsofScclionl?00ofthcL.horCodc.lshal-tunhwirh.omplrqirhlnosctovhions..
<br />WARNINCT Flilur. tu $.um vo*c^ (nnFnsarion svcmtc ic unlrwttl- trnd sh0ll suhjel un c'nplorrr io aiminul leNlries d
<br />civil lincs ut lo om hundrcd lholslnd dollotr ($l00,(xD
<br />Seion 1076 of rh. Labor Crnc. inlcrcsr ond .llomy's res.
<br />ro rhc rosl of coq,€nsorion, dam8€r as Forid.d for thc
<br />Utr/ to
<br />IIECI.ASd.TION
<br />I hcrcby afltm undcr pcnlltyofF,jnrr rhar ! nn lien<n under pmvnion olCharrd 9(.o'nmn.in8 wirh sftrhn 7fiD) ofDivhion:l
<br />ol lhc Businr$ dnd Pnrfc$bn! Codc- dd my liccns is in full fore ud cficct.
<br />t*c LJ6 fttft rq
<br />Z
<br />goll:IA!]g:Irc!'IEDINc.{GElCT
<br />Ih.EbyartrmudcrFtullyof|trjoryth.lrlir.Lrsom.rioiLndiiS.gftyforll*Frfo,r1rlNofth.w[forwhihlhbFdni!
<br />is$ed (Se. 3017, Civ. C-).
<br />-l
<br />ccniti rhar llE fcdcBl Eglldions EBddins ashc(os rcmql &c nor a9tltahk ro rhir pDj.rr
<br />I ccnifyrh.r I hrvc r..d rhis rrpli.dion uld st(c ion h coFsr. I rExr rocomdy wnh ail Cn, Nnd Colnly
<br />orJmrD.c\ rtrJSrrtc l:'r\tuL itrE r) hr,ldin! conn ruFc\cnr ircs olthisCityund Colnryl..niry up.n rhc
<br />Appli.atrt o. ABEnr si8n urc
<br />€
<br />Furnace
<br />Dole: OPm.:
<br />IxRtcr'\ Addrrs:
<br />-
<br />,rrpr rr:,lr.ri nrti an,lirriF
<br />I trRbydlllnnuMurl. !kyol pcrjuryoncof rhc fdloBin8d.\lmlnnN
<br />l)rn)lirior t'crnirs A$.(os Norifi6rion FreJcBl Rcaultriior ('lirlc4r.l'an6r
<br />RL\tutrcd llncr of Norifi calion
<br />dxivc nurn'ncd pml).rr, fir inspcc'ion
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