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MECHANICAL.INSPECTOR RECOBD
<br />-1.
<br />!s owrcr of thc topcrly. or ny cmPloyes {ilh eagcs as lh.ir sh con{E,srion. eiu do thc work ed E $ru.r@ b er
<br />inlenlcd tr oficrcd for Mlc (S€.7O44. auiinc$ @d hofcssions Code Th€ Connadois Liccn€ tiw do.s nor rptly h tr. owm! of
<br />rlE pmFny wtb hildr o. inpoB IEetr .rn wb dfts sh ft.t hini.U or h@lf or lhrougn his m h6 owr .mployecs.
<br />Fmvaed lhll such insmwmnlse ml inlcnd€t oroffcnn for eL l( thMEi tlf hiildin8 or impmEm.l is $ld *ihin onc Je(ofonl'hhn. rlE ol,rcr Build.r will nlE llE hord.n of pDvine tlul lE or sh. dil ml buM or ir{mE rhc tmrdly lor lh. FUqDs of
<br />_1. os ownf of rhc |top.ny, ao er.lu.iwly con[a.rirs sirh lken$d conrErcn rc on(d.t rtE r/o]!r (scc. ?044. Bushrs
<br />ud FDf6si,n Codei Tn Conlre'ol s Liccns. Law doca .or +ply !o e ownd of pmrcny uho bullds or impover lher6'n.
<br />8rd who conlmclsfor suchpofrts wnh a C.nlhclo(I li.cnsd puuwnt torheCo.u&rols Ltc.ic Lrw).
<br />-l
<br />omcxcnrpl utrdcr Scc
<br />Orrei---
<br />U!}Af,D&ISAMIENSAIIOd
<br />IECI.ASAIIQN
<br />I hcrchy rfinn, ondcr rcnrlryofFrj!ryond olrhc f(rk,winS dcrlrrrrn)ns
<br />l hJvr rDd Nill aui' r ! Ccdillcai..lCon\ctrrn, SrlI ln\u.. tu.*o!kcrs $nrr. \rri(,n,r\ lnr idcd 1,, hr Scdion .17{xl ol llr
<br />L6or Gxtc. tur lhc lcnifl.u.c olrh. {.rk lor *hi.h lh. Ennir n i\n,cd
<br />-l
<br />hovc .nd vill mninr0in *orkm compctrsalion insun,c.. !s rcquirn hy Scclion 3?(x) of lhc Lit nr Cod.. for rlE Frforl1me of
<br />rhc work ror which rhh F.rnn is issucr!. M y wortcB omF.saiio. insurdr. fficr ard lElicy number sc:
<br />-l
<br />ccdiry lhor in lhc prfoirmne of thc qork for phth lhis F.m k nsucd- I sh.ll mr enploy any l,cen in uy @*,
<br />s, N to tEd,m slbFr ro rhc woltos onqEn\arion laqs of Californiq ad ,gB rh ifI sthukr b..om subj.rt lo tlr
<br />*ortcrs' mmpctrrr ioo pn vtions of Scrion l70O of rh. L.lnr Codc. I dEll, lonh*irh Nnply wirh rrb* tovkiom..
<br />WARNTNG: Failm ro surc wortcB' L{mpcnsorion svcESc is unhwful. and shall subject an mplorrr ro dmiol FMlies {nd
<br />civil fircs up lo onc hundrcd lhousnd dollu (S100.000), in sddilion lo rh. cosl of danua.r o\ pr,vid.d lar rh.
<br />Scctn,n 10?6 of drc Llhr
<br />DIICI,ISAIIAN
<br />I hcr.hy afirn uM.r Fntrhy olrcrtury rhm l,m lianscJ und.r tmvision ofchrplc! 9 (com'Ercin8 with SLtrion ?(xn) orDili\ion:l
<br />oI rhc Busims\ lnd Pr,r.ss i{i ns C.dc, dd nyli.c.sc h in lullforc uod.fid
<br />grluBlqIlgNLENDlNC-ACrNlI
<br />I hcr.by alfirft und.r Fnrhtolp.iury rh.r rhcrc h r $Nrfldlr LndirE 0ScNr lor
<br />'ic
<br />pcn'ormrcc oithc wxk f(tr shi.h lhis Frtoi n
<br />isslcdls& ]m7. civ c r
<br />A.ELICANLOECLIS{IT9!
<br />I lmb,Jnnnu cr llna[yofpcrjury onc ofthc iollo*ins d.cln0riotrs:
<br />Dcmniri{,n Pcflnirs Ashcsro\ Norifi.ar n hdcral RcsuturnnN ('lnlD40. PM6,
<br />Rcqutcd btr.r of N.iifi cdirn
<br />_l c. ifyrllr rhc lcdcmlrceubln,ns Eq0rdin8 $tr$or 6n$rd,rc nor imli.6lc lo rhh tmici
<br />_l ccnilrrhd I h!!c rcldlhisrmliclr
<br />odinomcs and St0rc t wsEhrinalobui
<br />i,r d (rrr rhrr rh rtxrd i',ntrf ri(,,onpl, wnh al Ciryrnd County
<br />s orrhi\ Cny Lnd C.u.ryr
<br />Btnvc mntioncn pmpcrry for i
<br />?Apflicun or A8cnr signrr
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Com pressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range il"t+"tg
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL It--{t-rx WWy.I
<br />Notes, Remarks, Etc.
<br />Ito
<br />'tl.-,
<br />n
<br />OWNF]R DUII,DT]R I'ELCARATION
<br />I hcrc$y ainnr xnd( |rrn"lr! of rcrltq rhtrt I m .x.'npr lron rhc Conkr.t,s l-i.c \c Lrw ntr rh. fdlotrinS rcnsn rsN.7o.ll :
<br />Busl.css rDrl Prcrc\rnr Codc): Any Cny or Counry trhic[ rcqun.s tr n irnir ro coo(ru.r. okq. irnl)lo{. dt'nri\h or rcFtr rny
<br />\rrudurc. priorro ils nsurncc. aho rcqltc\lhcrpplica li,r chlrmilro fiicr sisncd \rnr8tnr rhar tf,or \hc i\ hc,td puNu0.r .
<br />ro rhc pn,visn,N ul rrr Conh.rn s LiccnsNl kw (Chnpr.r 9. C. nftnciD8 wiih S.crior Tlxx) of Divi\n,n :l ot lhc Busincs rnd
<br />Itolc\\nnNCodc)orlhal hco.shc i\crcnrrr lhcrcri.D d rhc hn\h ltrrhcnllcgcdcrcmpli,n Any viohrionorsc.riotr 7tr1l.5 hyrtry
<br />aptli.r tu ! pcnnir ruhjcch rh. anpli.rtrr t, rcivill.nrlrtolnor nnnrhM nv. hundrcd dollrs (S5(X)).
<br />Policy Numbcr:Jrpncs:
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