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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Melal 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 D ryer
<br />Residential Ranqe
<br />Other ll4^n-L ?.*<'"ZUrc,u
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Ducl
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test r
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.t\\\\?/,1/ tfrT/5,'."Vo co 4-, \v* pfih v^tts
<br />Final Test !^t gPt4,
<br />-/,
<br />FINAL 7-zr-tB /-/?n-2 )
<br />Notes, Bemarks, Etc
<br />r
<br />OWNER NUII,DET DELC RAToN
<br />I herchy iflnm unrlcr !.ntlly oi n rjury rh l !m cxcr. riom Ihc Ltndor\' l,ilcnsc l-!w Ior Ihc tulbwinr rcawn (scc 70ll 5
<br />Businc\s and Pmrc\\ion C,rlc): iy Cir, or Court shi.h ..quirc\ x risni' tu .on{tud, rcr, imIfl,v., Ltnr,lnh ur rctDir uny
<br />*rucrulc. prid k' n\ i\su.ncc, uho rcqunc\ rhc.mli.rnr for su.h Frnrir t, nh r \iancd {nrcnE rhrl lEor shu is liccr\cd pu^urnl
<br />ro rh. f,visi('n! ol IlI Conhd.tn \ l-icctrscd ti* (ChitJIcr 9. (tnnnrrnr! $nh Sccrior 7Ux).1Oivi(ion I olrhc ltu\inc$ rnd
<br />l'ml$snrns Codc)o.rhrr hcorihc n $c DlrhLrctomond rh.basir lnr rhctrllctglcxcmptnrn. Any!i.l ionorsccrionToll5byrny
<br />rpplicrnr lor alr.rnrir sul,jc.r\rhc rpplicrnr bx.ivilpcnulrlotnot nmrc rh& 6vc huidrcddolla*l$5tx)).
<br />-1.
<br />!s owns of th. I,mFny. or ny cmpnryes whh *ag.s s lhcn $t 6mt enslhn. will &r fic *ork and tu slnxrm is mr
<br />i edLd oroltted for slc (Se.704.{, Bnlimss,nd PrcfcasionsCodq Thc C! ractoir Uens Lr{.ios nor +pl,lo an owrcr of
<br />rtc pmFny wtb hrilds m inrpDB tlEor 8rn who &E sEh mrt hiNll or lEi.claor lhmu8h his or lFr own.mrby6.
<br />poviiLd thar such imnm\€fuds @ bl i.rc*Ld oro,M for sk. li hoscrs. tlE hiilditrs or impmrftnl ir eE *nhr m ,u,
<br />ofconphton. r,E Owrcr BuitLi will lDr ltE hurd6 of prcvin8 th,r ,E or dE dU mr toild n inrmw 0E pEpsty aor rL p!4Es of
<br />-1,
<br />!sowmrof thc nspcny, mqclusirlyco racrins uith licensd conr,cror r. o.srocr rlE poFr (Se. I)44, 8usift$
<br />ard Prohrsirn Cod.r Th. conhdols Liccnsc tjw doci ror orply r. u owncr ofrropcrl, who builds or impmlcs lfi€rcon,
<br />lnd *fto co.rE rsfor suchrftixk wirh rConttub(s) lten*d psu.r rorbc Conkrrbf. Len* tiw).
<br />-l
<br />m .rennr undc. S.crion- 8. & P.c, fo! rhh Eason.
<br />Drl.: O{n.r
<br />IOAf,EEE..IOI4PJNIAIION
<br />D[.CI.A8AII(A
<br />I lErcb, a,rfo und6 ,cnrlty of Frjury oG of rhc fotlowing d6l@tions:
<br />Ihrv.r'nlrillnui' linr Ccnifi.rrcolCon{nrt, Sclf ln\urc tnr $ork.^ co,Fn\Jri(6.r\ I'n)vidl{ n, bySc.rion.lT(Xr.lrh.
<br />lntxn ('t'dc.,or rhc F-n.n.rnc. ofrhc sork nr*hich rtu pcnnir i\ i$ucd
<br />_l havc d will m!i.lli. *orkcu compcnsaliotr inslBNc, os rcqun d hy Sdlion l?00 of lh€ Llbor Code. for lhc l.rtdr,@c of
<br />hn nermir k hsucd Mywortcn conFnsllion insuroncc caFicr.nd lolicy nlmtcr uc:
<br />, CO,,tgo1 H./\1 449n/.c
<br />-l
<br />ccrlify rhll i,llrc ncrlormre of rh€ eolk aor whih rhis Dc,nit is irilcd. I shnll mr cmphyey p.r$n in 8ny mnrcr
<br />$ {1 (, bcoft sutF.r ro rhc m*nc conrEnsarbn hws of Cdlirornia. and 08ft rhal il I should txrom subjccl lo rlt
<br />woikcs oinn ns,rion pbvisions of Selion lTuJ of rh. bb.r Codc. I $rll. fonhsilh str{,ly wirh lhos ,novlsions..
<br />WARNINC: t:lilurc t, {ctrc {o*cri.o ,tcn\rri,in co!rrr!. i\ udhttu|\uhj.ct ,n employcr to aitrnllal Fnshics Bnd
<br />cifil linr\ up h oh- hundrcJ rhou{nd doll \ (SI(I).ofl)). in oi.onpcnslion. drnu8cs ss pmvid.rl tor lte
<br />Sc.rion:1076 ofrhc lrtrr Codc. nn*c{ Md on.y s fcc\
<br />X*"6 G
<br />LICENSD!)!1}IUAASr!!B
<br />DEII/BAIION
<br />I hcruby riltn undrr p.mlly ol Eljury lhd I am licctrrn undcr pmlision oiChaprcr 9(..nrnrncint wnh setion luD) olDivhion 3
<br />o, rh. Busimsrmd Pr.rcsions Codc. nid mylicctrE n intull forcc md cltirr.
<br />7 ?6 LK
<br />\-"L/ ///-1--l l
<br />qQN,tlBlcullNl.ENualiir;INlt
<br />I hc(by f,lrm undd Nnnlryolp.rjury lhJl llrrc is r coNtrucrio. Lndins €cncy ntr lhc nc,lortuncc orrht wo* nx whici fih Pcnnit is
<br />issu.d (scc 1097.ci! c )
<br />I ccnift lhd $c f.d.rJ Egulalions reB,rding ashcstos rcmvol sc no! u,rpli.ablc to lhir pDirr.
<br />I ccniryrhrr I hrvcr.xdrhn rrfl'.r onurion n corc.t I l8re to otrq,ly wirh !U Cny and CoDnry
<br />ruh,rir repr*nlarivci ofthiq Ciry o.d C.unly lo cnl6 utrtr thcordi..rcrs d Slar. tiws Eltlins ro hlildina
<br />/'vc nrnriotrcd pn,ren, for insD.clion 1//// r e
<br />)rnm*r*ee"n
<br />Meter Release
<br />ru^*,, tuz O)bfL so4o ^,*., a/ | I lA
<br />%'tl tLl
<br />L
<br />Lr.d.i3Nrft
<br />-
<br />tri.lci\ Addrr\\:
<br />,rr+r (:,rnr rxt r"lnrrroll
<br />I lR.by dtjmr undci r--trllly of Frjuly onc ofrh. folloviDs dcclar0rions:
<br />Ir.trblirion,r.i,ni( A\hc{o\ Norific rn,n f{duml R.guhrn,n\ rTirl. i0, Prd6)
<br />Rcqunclk .rof Norifi..rirr
<br />t--
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