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ME iANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.colutrlt ENTS
<br />Appliances
<br />l/etal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<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 />Bough Mech.4j*Do
<br />Final Test
<br />Meter Release ,,|
<br />FINAL -</c/ 7,o .htlt )
<br />Notes, Remarks, Etc.
<br />->
<br />OWNER BI'ILDER DEI.CARATION
<br />I hcrcby rifrm und.r F@lryol perjury rhfl I M dcdfl finm rh. Conmclo6 Lie.e rjw forlh folb*in8 Ea$n (Se.7031.J
<br />Businc$ d PDfession Code): Any Cily or C.unly whkh rcquircs o Fmil lo snslrocl. shs. imllor. .!.mlish or Epsn 8ny
<br />srEcturc, prior to ils issumc, aho r.q!n s lh. applic.fll for sah lEmir ro 6k r sigftd srarcftnr $!r lE or shc b lk.n$d lNaln
<br />ro rhc pmvisionr of rtE Conrmlois Lic.nsd Lis (Chrpter 9, ConmEinS with Saiion 70m of Divkion 3 of llE Busincs lnd
<br />Pmfe$ions Cod.) or thar h. or sh. n cxcn{,I th.r.frem ad th. b{ck for lh. alh8cd cxrmplion. A,y violllion of S.dbn ?011,5 by ao,
<br />{,plha.r for ! pcmit subjers Ihc a,rpli.a.r ro ! civil p.Mlry of mr mE rhd fivc huidr.d doll, ($500).
<br />-1.
<br />os owncr ot lhc pmFcny. or f,y cryloyes *ilt w.8cs as thet mlc compcnsation. sill & llt sdk dd lh. {Nr@ i! rcr
<br />inrcnrkd o, o,fered for sle (sr.7044. B!.inc* dnd Pmf.ssions corlc: Th. contudoa. Lk re Law der nor qlply lo an owmr oa
<br />rh. p,ollny who hil& 6r in{ E dEmn, &:d who dm trh wrt hinsclf or hcRlf orlnmudnis orhroM cmrloyccs.
<br />pn,eidcd rhrr sr.h in{mkftnE e ret i odcn dtu tu elc, li hoeki rrE hrildine 6r inqrorcm.r is $ld wirhin om Fs
<br />ofcotrplctbr rhc O*rcr Auittcr vill hNc lL bordo of Imvin8 rh,r lrc or stc dil mr triu or inler ,r |loFny f6r ilE purtD$ ol
<br />-!.
<br />es owm, of thc Forcny, am .xcluiiv.l, conmditrs enh liccn*d .onr&hn ro odrud th. pmlr' (sec. 7044. Buvms
<br />md EorLsrbn Codc The Contrrctols Liccnsc Llw does nol lpply h an oqner of t)n)Fn y $ho builds o. inln)wr rh.rcon,
<br />dnd sho.onrtu.arorsuchpmFclswirhrC.nhcro(9lkcnsdpunuonrrorhlConrrldolsLiccns&w).
<br />I inr.xcnu undcr S.criotr . B. & P.C. lo hh rcoson
<br />Del?'
<br />laltrE8E:lJ)MtElSAI1a!
<br />DEAIASAIION
<br />I hnby amm undcr p.nalry of Fjury om of lh. folk!{ine d..lradoB:
<br />-l
<br />havc !n will mintain a C.nifrlrc nlconcfl ro Self'Itr\ur tor srtcB snFneiion. I pmva.n for by S..lion 3700 of llE
<br />t ar tuc. ftrthc p.rfoM. of rhc sok lor *hich lhc pcm n issocrl.
<br />I h,vcmd willn,inrain w.lk6 comlEns0rion insuram.. s mquncd bySccrion 3?sJ of lhc til'or Codc. for rh. I,crfomke of
<br />iq pfnil is G$cd. My wortcrs compc.sarion insuroncc ca cr ud policy numbcr e:
<br />l.cnifyihnr in r,E p.rfomnft olrh. *ork a6. ehth rhk Frnir is iriu.i.l sholl ml cmploysny Fmn in any muErs s ro bc.om subj..r ro rh. *o*6s' con{Ensd ion &ws of Califoni., ud lsE rtal if I {tbnu beom 3ubjer to rrE
<br />wor{c6.ooocnsrionpDtisionrofsrtionl7motrhcLiborCodc.IslBll.lonhwhhsqr,wnhrb$tmvisions.
<br />WARNINC Flilurc ro wurc worlcs .ompcnsario covemBc ir unhqful. lnd shall sobifl u.mplorcr o dihinnl FMhid rd
<br />ciil tines up ro onc hlndEn thousand dolhG (3100,0(x)). itr rdd ion to fic .o\l 6l conpenlar ion. dunDg.s as,,rovid.d for lnc
<br />!E!I.dBAIIQN
<br />I hcruhy xlfilnondcr pcmlrtolr.rjury rhd I n liknwl ondcr provni( ofChrprcr 9(co.nmncitrE wilh SL\ri). ?Uxr) ol Dirisiq,l l
<br />ol lhc &'\inc$.trd Pofc$ionsConc. ul nrylic.n\c ir ir inll lnrcc fll.lTc.r
<br />. cx! c.3hili/ia '
<br />I!,IIEIAIJI:IIANIINDIIIi{iENCI
<br />I hcohy lnnnxn'lcr acmxyorlrrlury rhdt lhsc is{.otriruc'ir Ltrdir8 ucncy lorlhc pcra.rnutc ofrhc work ft* shi.hrhh pcnnir i{
<br />i$ucd (S( 109?. Civ C )
<br />d.TILIEANfII,TIAf,AIIAN
<br />I lrrLty llilnn undcr pcnalr, oftclury.rc olihc tulk,win8 J..hr rn,n\:
<br />D. xrirx Pcirnir* sbcsos Notlli.rrii lcdcrnl Rc8uldion\ (lirlc.l0. Pin6)
<br />-Rcquncd
<br />Lrtrcr oI Nolilicirion
<br />-l
<br />ccnilyth lhc icdcmlrcrlllrions rcsa.dins Nh.\ ros .cnbva I lrc nor lttlicrblc h rh^ pbj.cr
<br />-l
<br />ccnify rhd I hnvc R.d rhis lrpli.ltion ltd srorc rhot rhc nvc infomriofl is otrKr, I as6 ro onply wirh all Ciry lnd Counly
<br />oilinMc.s .rd sr,rc Llws EkinS ro blildir8 .onnddn,h, dri h.r.by surhoriz rcprc.cnrarives of rhis Cny and Counry t, cmo utb. llE
<br />.ho!c mmn,rd tmpcny lor inspccrion
<br />'t/t4^ o
<br />Furnace
<br />Smoke Detectors lnstalled
<br />Above Hard Lid
<br />1/ tq3'7
<br />V-Er,"a t h'i
<br />I
<br />I
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