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MECHANICAL.INSPECTOR RECORD <br />ID/SIG,COMMENTS OWNER BUILDER DEt'ARAIION <br />I h6.ty arrD u.d{ podry of pdrury rhr! I @ qopt tm [E coftn.ron LieN. Lrw for$.lollowi.s r@d (sd.?0]1.5 <br />Buin6! ard Profsion Codc): Ary Ciry or Coul, which requtB. FEil ro @tr(rud. rhd. inprolc, danolLh ot l1?6n dv <br />slftcluq pdor ro ns isoec., .Lo equnB th. tpplicdl lor such pdon ro frlc I si8ncd slddal lhar t or s\. i! licas.d p@el <br />io ln. prcvBioc oa thc Conr.cld! Li*nsd t w (ClBPl6 9. Comhdcilg * iltl Setion 7000 of Dilisio. I of thc Acio6s ed <br />PDI*io6 Cod.) or 0'ar lE or sh. i! ddpt lhqlfom sd lhc basi! fo.ll8 sll.8.d ddFion. Ary viottlion of Sdion 7031.5 bv ov <br />applicer lor a ponn lobjels lh. applicdr ro 6 civil p.!.lry of lot moE rfid livc hund..d dollrB ($500). <br />-1, <br />s oms of rlE Fopdtn o.oy 6plor€ wirh wag6 c rhct eL @oraEdim. *ill& tlE qdt ed tt sud@ b ml <br />ifldd.d or ofiir.d fo. slc (Sd.?044. BBi!B md P&t3!b4 Codq Th. Co ocrqt Lkqe Law d.6 et agrlv lo e oMa of <br />&.potaty who hild! or i,nprcv6 $@n, od who doG Mh w't hnnslf or n4.llor lhdu8lt his or l'n oM dplor6. <br />provid.d thal .ucn nrprDffir9 e el intad.d ootrqld 6r $b. l( bowM.lhc btil&tS or i,IlmEnan is eld *inb on. tE <br />ofonplrio! rlE o\rn6 Builda si[ l'rc tlt htdd ofFovilg $t h. or .l'. dA t6l htild or itr'FDE lt! tBFtv lbr th. Frpo* of <br />-1. <br />son@ of ilE FDp<ty. 6 d.l@ivdy@inadin& vith lica!.d.ooha.1oR lo @!$o.1 1t. Fojdl (Sd 7044 EEiE <br />.nd PDftsbr Codc: Thc Conl.!.loar Lic@ t w dB nol opply lo e @Dq of FePsiy who b.il& or ihpo6 lho@!. <br />@d who onlnds ror such F.j61s with ! co,!hcro(, lica..d pdum lo th. co ncror's Lhce t&) <br />I m.rad rd, sdion . B. & P.C. fo, thB l!&n <br />llaB6!8ii:ca[rulsAroa <br />DEC!ABAr.&! <br />I 6deby aIttrn und6 Fnalty of pajury on. ofth. follosing dcla.rioc: <br />-l <br />h8c dd *ill maiDtain ! C.nincalc oaco.ffil io Sclf-lNrr. lor @rl€r' onlposarioi, 6 providcd aor by Selion 1700 o f the <br />L.bor code, fo. $e psfomec. ollhc *ort for sbi.h rh. p6nil ir isu.n. <br />Imaintainworken cort Naltuo imuranc.. a bySelio,l70O oflhe Labr Codc, tor lh. pqlomec€ ot <br />D.fltrn is i!.udl M, workdr mnpaE l cnier &d rFlicy numbo ,c: <br />-l <br />.qtit $!, h rn P6fomne of thc eort for wti.h this Pdn i! i$ucd. I shrll .ol dploy ey pq$! ir lny btud <br />s s Io b@m 3lbjet lo tlE woi(@'@DPdldio! Ias of Ctlifomit ed.sre rhd if I 3horld be6e $bjdt to {E <br />wtt6 @npalstion p,!wi6 of sedon 3?oo of tt. rdor tu!, I 3lulL fonhnh @Dply wnn tho& prcwioB.. <br />WARNINGT Fdtu.lo 6@ sott6' @ep.t!dio. @v6sg. it unbwtul, ed shdl eubic.l & @plors to oisiDd Frxb.!d <br />civil 6!6 up lo oe hun<h.d OoBlrd &lls (llOO.0oO). b .d.lition io rlE @r or 6dp.'6.rio!. d@g6 !. F.vid.d for lh. <br />Cod., i,ra6r dd.lr@y s lG <br />llct asED-coxla^claa <br />IIDCIASAIION <br />I hs.by amm undd pdalry o apajuy rhal I m licmsed undd p(vbion ofchsplq 9 (comndcin! $ilh Sdlion 7000) ofDivision 3 <br />ol rh. BNins md Pioa6sios Codc, ard my licd* is ifl tull forcc ard .iler <br />ta 42- <br />lplirBucrxlNrEdDlNcic&lcr <br />I hdlbf ammunds penahyolpdlurythatlh6cbaconshrcrio! lendins agcncy aorthe psfomd.e oarhe (ort lor shich this l.tnir ir <br />isued 15c 109?, civ. c.) <br />AIILICANIDIiCI,AMIIA! <br />I horby aIIm urdd pa ry of p.rjury orc of thc follou in! d(ldarioN] <br />Dcmolilio. P.rmirs-Asberos Norilication F.dd.l Rcgul.tions (1 itlc 10. Pan6) <br />-R.quir€d <br />lnlaoaNoriFcaion <br />-l <br />cdtiry rhat lne fdlsd rcEulalio6 r.sddjns Ahalos rmo\.1 sc nol 0ppli.abL lo rhis prol.cl. <br />I cslily rhat I have red rhis arplicario. 6d sl.tc thal thc above rntomalion is cordl. I a3.E to conplysirh dll ciry aod cour, <br />ordj.anc6 dd srai. tlws elrlim ro ildinr coBrrudion. od n.rcq aolhonzcreIr6dlaril6 olthB City aod Couryto.ntd upotr tnc <br />lbovc mdrio.e, propdly for <br />Applicer or 4.nr straruc:tt/ ,/r{ <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 />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <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. <br />Final Test <br />Meter Release /1, <br />FINAL 9-/il/lb x4t <br />Notes, Remarks, Etc <br />APPROVALS <br />Other <br />I oare <br />=