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MECHANICAL.INSPECTOR RECORD
<br />APPHOVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />lnsulation
<br />Rough Ductwork
<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 T-Bar
<br />Rough Mech.
<br />Meter Release Ir
<br />FINAL \7-lLr t9 t9)
<br />Notes, Remarks, Etc.
<br />( )WNllR Btll!-Dl.lR DELCARAll()N
<br />I hcrciy rinn tr.,lcr ,rcrrlr) rn pcqury rhir I in cx.nrfr lioDr rh. Conrr(tA l-iccrrc l-iw lnr rhc li,ll{nving r({n, (scc?r)ll 5
<br />Bu\ii,rs !'rl Prdt\rn,n C,{.r Any Ciry.r Coudy qhich rcqtrircs r n nnir io con(dd. ulrcr. irnn,rc. cndNh .r rqrn aiy
<br />iru.ntrc, r.orb ( '\s,u(. rl\o (tutc\ ihc rppli.rtrr ftr \u.[ Fnnir [, rilca \i! cd {xrc rtr rh hcor shc N lien\L\l puiiurtt
<br />h rhc nmvi\t'ns ol rhc (i)nrr{tff \ l,iccn\cd l,aw ((hnprcr 9. (nfDn in! *irh Sc.xon 7(xX) of Divni{,n .l otrltr Bu\ihc\\ r d
<br />!mlic I(tr ! N,nrir{'bJcur\ lh. ntplicunrt,r.rvilncnrlryolnolNtrcrhMlnchtrndrcidolhrslS5(D)
<br />-1,
<br />a. ownd oflh. pmp.ny, or my cmploy..s si$ w!e$ &c rh.t $lc co'q.nsali.,.. willd. tlE wo* en dE strEle il ml
<br />inldn { or offcrcn tor slc (56.7044. Busincss &d Prcfcssions Cod.: Tnc Conllaelor\ Ljcctr€ L4 .LE ml .pply lo M owmr ol
<br />lh€ pEpcnt wtb builds or iqmrcs lhcmn. ad who dss such mrt himscla or h.rslf or thoush hii or h.r osn cnployccs,
<br />phvidcd rhsr s!.h irlrolmnli e nn iinendcd oroltcEd ft,rslc.lt lnn4w, rtE huildin! or iryrowmnl is sld *nhin orc }ta
<br />of cotr{,lclion, tlE Owmr Built r wil hrrc tlE hmkn of Foving $,1 h. or shc dn d hild o! itrpmw ,rc pmlEly for lt* porlD$ of
<br />_1. &sowturof rhc,mrn]. am.icllsirlyco rlclitrs sirh liccnscd contncloB ro con(tucr rh. phj.cr lS(.7044. Burinc*
<br />,,xl Profcsrbn cod.: Tnc Conrm.b.\ Liccns. Law dmc nor lpplyro oown r oipmF.y wno builds or improvcs thcran,
<br />und *no snlm.rs for such prcJcrr. lilh ! Conh.ro(s) li...scd lu^unr ro lnc ConrEctols Lian* l:w).
<br />-l
<br />dncxcmnl uDdcr Sd
<br />WOlI(EILS' COMPFNSATIoN
<br />DICI.AAAIION
<br />I hcrcby omm !ndc! I,cnalry of rcrjury onc oflhc folbwnr8 dccl0nlions:
<br />I hryc rril sill'ni'rrrinrCcdificrr.olCon\.nrii S.lf ln\urc n)r $o*c'r .otr,trtr\rri()n. a\ p()vntd f.r hy Sc.ri( 17(Dofrh.
<br />l-xlxn Codc.li,rrhc |Enonnincc ol rhc work rhrwhichlhc Itnnir ir i{\ucd
<br />-l h,vc a.d witl naiotlin workc$ c6qrcnslrion insuBncc, $ rauircd by S6rion l7u) of ihc L,bor Code. for lh. pcrfor@ of
<br />llE vo* for shich |his pemit Lr hsucd. My vork ( @mlcnrnlion ioslruncc @kr !d Flky nunbd a.l
<br />Policy Nuhba'JipiEt
<br />I c.nifrrhar inrhc p.rfdmn.. of rhc *ork fttr qhich rhh Ii.rnir k ii*ucd.lshrll nor crpkry iny pcnon in {try mrtrrcr
<br />so N to l$om suhlcd h lhc wo*cs co'q,cnel iotr hws.f Califon rnd lsrthlr ilI \h,rld bccoft sub.,c.r lo rh.
<br />knkcrl u,nrpcnsar ion povisn,ns or S6-rion 3700 ol
<br />'h€
<br />L!h, Gic- I $all, a.n h*irh L$mply *irh rho* tmvhions..
<br />ApEll@t-
<br />IICENIiIDJONISAIJA&
<br />DICI,IEAIII}N
<br />I hcEby amrmundcr FnallrorprrFry lhll I am lie!{rd undcr pmrision olChuplcr 9 (cohnrrint wirh SNrion 7fixJ) orDivkion l
<br />of
<br />'hc
<br />Busincisand Pmf.ssions Codc,.nd nry lrcn* is h rulltorcc nd cfcrr
<br />Cont6clo._
<br />SANiIBIJCUI,N.LENI'INJj.&CINI.I
<br />I hcEht amnnundcr Fn,lr,otp.rjory rhm rh.B h a conq di6n Lndine r8.ry n, th. lcrfonmn.c oi rhc *ork for whi.h rht rE,rtril ir
<br />isru.d{s( lll}7. civ c )
<br />AITUCAII"I]EII.IIEAIII}N
<br />I lIEhy rfim und.r F.akt olFrjury onc ollhc ri,lk,*nrg d..l8,rnnrr
<br />D.nnlition Pcmit$Ashcstos Norificllion Fcdcrcl Rceulorions ( I ilc 4{}. Plni)
<br />Rcquncd lrtr.rof Norii.a on
<br />l.caifyihd rhc l!dc.!l rcguhiion\ rcE{ding a\hcsros rcmovll rc mr qdkahlc ro rhis projccr.
<br />-l
<br />.cnify rh,r I hrrc r.od rhb rFplic ion {n slsl. lhlt thc atrvc inaomulion is .mdr. I [8re ro con?ly eith lll Cir, r.d Counly
<br />ordiMnes ed Si!r. Lrw3 cLin8 to buildi.g .oEcucriotr !.d lEEbyoulhori& nF*nrarircs of rhis Cit, and C.! yro..t6 utDn r,r
<br />abow mmioncd po!.dy for ins,arion l)urr$cs.
<br />TtltU,l
<br />I
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled
<br />Above Hard Lid
<br />Final Test
<br />WARNING: Flilurc to RUrc *orlcrt compcnsolion ovcm8! is unlawtuL and shlll subjcct !n cmploy.r to aidiml !.mbics.nd
<br />civil nrcs up to orc hundr.d lhrusa.d dolles ($100.(x)0). in trddilior ro thc.osl of cohp.Mlion. darEsca as Uovncd for rh.
<br />S.crion 1076 of lhc tahor Codc. irr.Est &d 0rL.my'3 fccs.
<br />trnd6 c Addr.sl
<br />Alllianlor AE. SiEnJrurc:
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