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MECHANICAL-INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUI!,DER DI]I-CARAl'ION
<br />I hcrchy afinr undcr Nnally or pcrjury lh r m crcnu ihr Ihc CotrrocroF l-iccnsc Llw lhr ltc tulbwint rc n (s(?t,:ll5
<br />Bu\inc\\ anl Pdision Cdc): Any Ciry or Coutrry *hich rcqutc\ r rEnir h .on{d.r, drr. inu.!r. Jcnhlirh or kp0n rtry'-
<br />{ru.rur., ritrk, irs Nruan... rho rcquircs rhd rmli.dnr fitr lurh p.mirk"ilc r silr.d {nrcnrnt IhlI h..r itu is liccned pursuunr r
<br />r) rhc pfl,vi\i{r.s ol tlE Conrru.ttr \ l,iccn{d ljw (Chrlrcr 9. Cqnnrcn.i.A *nh Sc.rid 7fi$ .f Division I olrhc Busincs( lnd
<br />l'mlt$ionsCodc).rrharlforsh.Ecmnl,rrh.rclrorMdrh.h!\nlorrhcrllcScdcxcmption.Anrviohln'nolScrirnT0.rlthyrny
<br />apnlicitrr for !pcrnrirsuhjccrs'hc !pplicanl lonciviltctr!klol not nuclhrtr firc hundrcndollm lS5fi)).
<br />-1.
<br />as owmr ol lh. ,DFny, or ny.nplotBs wnh saScs a rlEn $b omp.n$lion, wil do lhc *orl dn ltE slruiN ir n
<br />inrci& or oficrcn for sh (S(.?O14. Busimss and Prcfssions Cod.: Thc Cof,nelo/s Lklns trs &ri ml q,pl, ro u owm. of
<br />lh.lmFdy erb hril& or inqmE dEmn, rd wrD drB sh s& himetl o. h.mlf or lhrcuBh his or h.t own cmplores,
<br />p,ovidcd rhd srch itrqhrftntr@ 6r hratuoro,Icrcd for slc.li to*e. rlr hiiEhgor inqproEft ir Fb wini,om ru
<br />of compLrbtr tlr Osnc. Buitlc. wil hNc dE htrd.i of pnving old lE or slE did mr boild or itrprck rhc phtcn, ror dr purrDs 6f
<br />_1. aa asft, of rhe Fq,.ny. an cx.lBihly co.rmcri.8 sirh liccned .odra.ro6
<br />'o
<br />conshd lhc psjd (Se 7014, B!'ircs
<br />lnd Pi,fLash Codc: Thc Conrrcr.l s Liccnsc ljw docs nol !!tly to owns of nmpcny *ho l,uildi or i povcs rhcrcon.
<br />rnd who c.nturc ror such pm,*h wnh 0 ContBdono li*n*d puEuonr t' rhc Conr6ciols Liscn$ tiw).
<br />-l
<br />ancx.mfl uMcr Sc.riotr . B. & P.C
<br />4
<br />IECI.AIAIION
<br />I hcEby rflirm undcr pcnally of psjury om of lhc l'ollo*inB deleations:
<br />-l
<br />hlvc arn will minr,in ! CcnifEatc of Consflr ro Scl flsurc for worlcn comFnsarion. &\ !rcvided for by S*lion l7m of rhc
<br />Lrhor Gtc. fm thc FnolMcc of rhc work for anicn rh. Ixmil is nsucn.
<br />_l hlr lnd will mlimain wort6 .o6pcBa[o, iBuaaq 4 rquird by Sc.lhn 3700 of rhc tibor Cod.. fo. llE Frforn@. of
<br />rhc *o* for whth rhis pcmn i. ir$cd, My wo*6 ompcnsflion inrurm! Mtr &d poli.y numb.r e:
<br />-l
<br />ccniay rhor in rhe ngformme of lhc *ork for wnth rhis pcmrir h k\kd, I shollnor cn9loy an, lEroo io nny nr.ncr
<br />$ N lo t$otu *!bi* r. th. uork$J omFn3,rion llw\ ol Clliromia. &d agto. th,l if I should h{.om sbj.rl lo ltE
<br />mrk ^ (,Fpcnerionlovhions oaS..rion l70Oofrh. tik,r C(dc,I shrll. fonhwith.omply wirhrh.* pmvisions..
<br />WARNING: Failurc to se m*6'
<br />civil finc. up lo orc hurdi€d {EE.nd
<br />Setion 3076 of rh. tabor Code inr*sl*,,9/ry'tt
<br />enFnsltln .ovcaSc h xrl,*ful. Md shll subrer o emplorr to qimi.rl tf,Mltts and
<br />dollots ($l(x).00)). i. dddirion io rh. c.r ofcom!.nslion. darugcs as pmlidcd for thc^^i#.'\?l
<br />ul;.lNtlD-s]NrtacrcaIr[lLAaAI(ni
<br />I hmhy rflnm undc' Fnahyoft)crJuit thJr I a lic.nsd uidcr tn,vixn,n of Chryrcr 9 r.onnkmin4 sirlrSariotr 7000) ol Divisnnr.l
<br />.r ihc Busiocssand Pntcs\i.rFCodc. !d 'ny liccn\c is lullturcn crlccr
<br />caNuallcr0NrrNltll;-ecENt}
<br />I hrEby llfirn undcr Fnally of pcrjury that lhnc hsconnru.rion Ltrdinso8crcylor rtc I'c.t,nutuc ofthe{. torwhi.hrhi\ pcmn i\
<br />isucd (S0.. :1097. Civ. C ).
<br />-l
<br />ccrl itt thot thc acdcral rcBulations Eguding lstcskx rc'mvol lrc nol a,'plicahlc to lhh !r+cl
<br />-l.cniryrhar
<br />I holr..sd rhis opplicarion ard i0r. rhnr rhc !h,rc int mrion iscod..i.l rE a ro co'nply wnh aI Cil, lnd Colnty
<br />ortli'rrn.rs ud SrJrc l_1*s rclJrin3r rudn,n. nlld h.rcl'y ourh.rizr rcprc\cnr3rir.\ olrhi Cir, Md Coudyt, cnrcr utr,n Ih.
<br />antr! mnriorcd popcny tu in
<br />Aprlicrnl or ABcnl SiSnfltuE ,*, ?y'qy'e
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork Yh stzl-tE-
<br />(
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.b 6/tofD 1A-.
<br />Final Test ( 'r-
<br />Meter Release
<br />FINAL l)"11",ts yrvry
<br />Notes, Remarks, Etc.
<br />Aftl.rcltNfD[llll&ulaN
<br />I lf,'L$yJllirn,trn,l.r J{nrlry .l I)crjrr_ otr. olrhc n,ll(Ni'!g rtoch'rr otr\
<br />l)rntr,liiotr Pci, ii\ ,\\l{{o\ N.l'li.ritrri I.cd.'nl Rrgulxitrtrtr Tlirlc {0. I, n6r
<br />-llcquted
<br />Lclrcrol Norilicl otr
<br />tt
<br />F
<br />-
<br />I
<br />i-
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