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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lvlisc uipment
<br />Duct Work
<br />Pre-lnsulation
<br />Ro ugh Ductwork
<br />Venls
<br />Toilet Room / Clothes D ryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Jype 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 />Rou gh Mech.to/u.ltt ,*X\'l)
<br />Final Test
<br />Meter Release I
<br />FINAL ///of/ttr ,,)
<br />Notes, Remarks , Etc./ --1,,/
<br />-+
<br />O\,VNER BUILDER DEL&RATION
<br />I hmby a,Ifm uMcl pcMlry of ncrrury rtar I m €xcnpr tnm th. Conmcros Lh.m tlw ror llF fouowing ffin (56.7011 ,5
<br />Blii*ss ad Pmfcsion Codc): A.y Cily or Counry vhi.h EquiB , Fmn ro on{e[ allci itrrpor., dcmli.h or E on my
<br />iren@. prbr ro ir. hsu!ft.. rho rquircs rh. q,plicet fo. su.h ,Emir ro fiL a iigied *rdcmnr ltr lE or sh. ir lic.n$i puM,tl
<br />lo lhc pmvisioN of hc Conir(ioi! Liccncd trq (c}q,tcr 9. C.mftftitr8 wnh Sc.lion 1100 of Divnion I of rlE Blsincs and
<br />PDfcssions Codc) or lh lE d dE i! .rcmF lhftlion ard ft. bssi\ for rhc .lkg.d qcrlflion. Any viobion of Serion ?011.5 by sny
<br />rmlka for ! lcmir subials rhc appliclnr ro r civil pcMly of not me lhan lie huodrd doll6 (t500)
<br />-l-
<br />as o*mr of ltc pmpcny. or my .riploFca wirh w,gcr .r rhcn src c.npcn$tion. will do tlt wst {d rL srnd@ i\ hr
<br />inlcn&d or or.r.d ror elc (Se.7044. Busine$ {nd Pmfcssions Codc: Thc Co mcrols Liccnr. kw {hcs nor amly to n ouBr of
<br />rhc tat!.ny {l'o hlilds or iqmts rlEDn. md who dG sucn md hims.lf or h.Rlf or fibugh hh or h.r owr rdploycca.
<br />pmlidcd thar such inrylkmnk m mi inrc cd or ofiald ror eLr. It tu,wcs. rh. bnilding or iqmwmor h s.h anhin orc Fs
<br />ofconphliotr th. Ownr Buillo sill hale rh€ burden oipmlin8 rhd hc or shc dil nor blild or imprer! dE Impcny tor rlE p!4DB of
<br />-1.
<br />!s owrcr of lnc !mpc,ly. am crlNihly .onr&rios wirh lic€nrcd coirra.ton k, snsrdcr llE roj.Er (Sa. 7044, Bunncs
<br />and ADtlcrix C.dc: fic Conlmclr's Liccnsc l-3w dG ml sprly Lo ,n o*nf ol proFn, who buildr or in!reks $crcoo.lnd who .onlmcls fo, such F)i{ri eirh r C..rBclo(s) liI.rd pu^Mt to rtr Conlrldols Lk€r* ljw).
<br />-l.n.xcryl
<br />u.dcr ser B & P C.for$h rcMtr.
<br />lLOStrEXSll;OMtENliArrA!
<br />DEI;Id3A:IION
<br />I hcrcby.ntmundcr p.nrlryorl)crjury unc.rrhc rolLwins declulion\:
<br />-l
<br />huvc nnd will nuinrtrir dCcnill.d.orconscnrbsclt lnslrc,or sorkera con{Ensntion. as pmvided lnrhrSccrionlT0Oolrhc
<br />l-$or Codc. lnr thc Frronn,rc .r rhc work (or shich rhc pclnril n issucn.
<br />I hrvc ndwillnoiorainqortcr'cor.pcns.riotrinsur.ncc.asrLttun.d6yS. i,ril?(n.frlrlihorCodc.forrhcrclfornrmcol
<br />th. sork for which rhi\ pcnni is is\ucd. My sorkcn cotrux.sd ion insurlndc cdnhr ud l)oli.y nu,nh.r ml
<br />Cl (C\ce
<br />.o 2_b - q.z9.2p 19
<br />I.cniry rh.r io rhc pdfo,tutc oarh. *ork rbr *hth lhis p.rnrn is nsu.d.l shall nor onpbyanyp.tron i! my m.mr
<br />$ as lo beom subje o rh. worlcN .or{E6r!io. la*s of Califomi!. and asm thd ir I should tEom subrct ro tlr
<br />*orlss cou,xnsrionpmvisb.s ofsdion 1700orirr khor Codc,I shall.lo henh &r{,ly wnh t,Ds pmyisions..
<br />WARNINC: Failurc b $.urc w.rkc( Lr,npens ion covcasc n !n
<br />civil fmc. up lo onc hundRd lhou$nd dolld ($100.000). in
<br />Sccrion 30?6 oftnc kbq Cod.. irrer.$,nd nromy s i*s.
<br />p",", -9e?.L6.18 nor,,-,,
<br />uMltt -rax
<br />I }EEby ar6rn undcr Fnalry of lcrJury thll I m lienscd udcr pr.vision of Cn picr 9 (conDrmin8 wilh Setbn ?000) ol Divisior 3
<br />ot llE Busirc$ and Prcfcsiotrs Codc. ud my liccns is in tuU lom r.d .tlor
<br />Cn-c).3-oq\t
<br />llo
<br />I hcNby dtnm u rr Fn,lry or pcrlory rhar rhcrc n ! enslrucrion tndir8 rrcncy tu rhc l{rrbrnun$ of lhc
<br />issucd(s( lm7_ civ. c.)
<br />AITUCANIDLCI/&IIION
<br />I hr.by rrinn u cr,.nany orlxrlury on or rhc r(rb{ina dlrbruriotr\:
<br />D.mol n,n Pcrnlil\ A\hc\los Nolil_r(.lion ltd.rll RcAUlrrions (TnL{0, Prn6)
<br />-Rcquircd
<br />t ($ol Norifi.nron
<br />-l
<br />cenify lhd I hnvc Md lhh lpplhd io. ,rl sdc rhd rhcah,rc I .3dlo.omplywnhall Citylid Counly
<br />onlin!tucs.nd Sirrc bw\ Nb( ing k,
<br />uhovc mnr ioncd [.pcny r.r inslrcr
<br />s ofrhG Citt and Counryh ctrrcr ut,n'r.
<br />Ap/icmr.r AE.nt sisn r0rc ,,,", -S€.zra.lB
<br />nc I
<br />a4r,
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Lxnd.f sMm:
<br />-
<br />-l
<br />ccnify rhd lhc lcdeElrcElllrions ESordin8 asbcstos rcmval aE nor fplicrbk io rhh pmj.{r.
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