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MECHANICAL-INSPECTOH BECORD
<br />APPROVALS DATE COMMENTS OWNDR BtIII,DI,]R DEI,CARAT!ON
<br />I hcrchy ,lhm utucr $nnlry If pcrjfiy rhnr I dn.xcmfl tunr rhc Conticktr\. I-iccn* liw Lr rhc hllowins torvri rs.. ?rrll 5
<br />Itusincss onn Pmt$tD CGlc) Atry ciry or County which rtquncs J Fcrnnr h $nrrucl alrcr' nnPn,vc dc.nnish or rcPlt aiv
<br />(rucrur.. priorro ii\ i$uri.., rho icqutcs th. apdiclnr rnruch lrrnrir tu Iilc I sisncd ndctu r rhd lf,or shc i\ liccn*'l nur\u,trr
<br />r, rhc tiouirnff ol llt Conrftcl$ \ lj.cntd ttrrw (ChrIcr 9. Commc.cin! sirh s..notr ?un of l)ivnbn .r orrh. &rincs 8nd
<br />I,N,!\\tuns coJoorrhri hcor\hr i\cxctrU rhcrcironrrtrd l[c n!\i\ ior rhcullc8cd crcnui,r Any!idtrrionofScclionT0.]l5hv3nv
<br />rppli.rrr lor rFrnrir suhlcck rhc anplic!nr ro aci!ilpcnrlrtofnor 'frmrhatr livc hundrcdJ.lla^lS5lX))
<br />-1.tr\own.rolrtupn,Irny,(,nrycnIil,,yc!\*ilhwrsc\r\rhcnv't.onl'ctrs
<br />ion.*illdorhc$orkddrhcnMlurcisni
<br />inrcnd.\l oroflar.d ld {lc (SLr 7(!1. Ur\inc\\r d P(,i.r\i(,n\ C'trlc lltConrrcttr \ Li.$\c Lrs dncs nor ]Pnly r, ni oqnct .l
<br />rhcrn,Fny who hlil.l\or irlx*ts rhcsnr. ind sho noc\ \uch *ork hin*cllor hcFcll.r rhntugh his or h$ owtr cnrllo)cc\
<br />ur.uDDlcrtr4llr(rsncrBuiltlcrqillhvcrlthuxlctroflmlLngrh.rlE.r\hrdilnorhtriltlorinDn)vcrhepd,Idyfornf,Nitr)\cff
<br />-1.
<br />a. own . of lhc pmFny. !m cxcllsivcly conra.linS wnh lccnEd cont@ros lo @nsru.t llr l,ro,.d {Scc 7044, Busmss
<br />art PrDltssion Code: 'Ihc co.krdol s Lic.nse Lew dms nor applr lo 4 own r of ImI.rry *ho builds or imlJrows lhcrcon,
<br />,nd who mnlmcls for s!.h Dmicrs qi$ r Conimro(, liccnsd pus@nl ro 116 C.nlractoas Li.cns L.w)
<br />I rcxcnrDt unrlcr Sc.ri(,n .ll &lC nrrhi\rcn{
<br />Itol(rls' coMPFNsaTtoN
<br />DECLISAIION
<br />I h.rcby afatrm undq lcnah, of Fiury om of llE folloriq &rkralionsr
<br />I hn\r u,l s ill rMirrri! r (cnitunr. of Cun*nr to Sclf ln\m tu *o.kc.r .o rlt \rrio., 0s 0mridcd lor h, Sc.rtun :1700 oi rhc
<br />Iihor Culd, turrhc PcrLnnaNc . t rhe $or[ fr whkh rhc InY 'ir i( i!$.4
<br />-lhlvcondwill
<br />oinhin wor*c* comFnsarion i.sunncc, as rqoird by Scction 3?0O of lh. L$or Codc. for thc p.rlbrtu(t ol
<br />thc {ort for *fii.h rnir !.rot ir issu.n. My vort.G s"9.ns{riot i.suBN cmicr ud Flty nleb.r E :
<br />Slalz-tnd
<br />,pn",, S.z{o lt
<br />-l
<br />ccnify fiar in rh€ pcrfolruncc ofllt *orl for which lhis p.tnrn is hsued. t shallnot cnploy any Pcrrcn in anv nmnn
<br />$ d b b..om subi.rl lo lh. so*c6'omFnsslion lsws oa Cclifomia, !.d ale rhal if, druld lEom subj.li ro ilE
<br />vortcB'co'npcn$lionpmviionrofSerhn3100oflhctrtbrCodc,lsh!l.ronhwilhcomdywilhlho*pmvhions
<br />WAXNING: F.ilurc lo ssrc wo cE omp.nr.riotr sEmgc h lnlaetul. srd shall subFt atr cmplort, lo omiMl lEtuhi8 od
<br />.ivil tinesupioon hundEd lhousand d.llau {$lm.Om). in addniofl ro thc cost ofconwnsrlion. dlogca.s Providcd ror rh.
<br />Secrion 1076 ofth. L.hor Codc. inlcrc$ a.d stio@y s fes
<br />o.e Ia .t l(,ipptonr Vu
<br />LICTASEDII}NIMCIAB
<br />DIIT.AEAIIAN
<br />I lrruhy rlft'nu.dcr nri yorpcrjuryrhlr I am liccn*irElcr Pn,vi\n,r ol Chl|lcr I (connNc irrE wilhScclion 70(l()) ofDivl(i'tr t
<br />of rhc Busincs rM Protcsnnr Codc. Md nry liccnsc h lull lhre x'xl rfl..r
<br />t0t1e 3 6
<br />q}ISIaUCUAN.LENDINCACTNCI
<br />I hcrcby nrn und.r lEnnhy ol Dcrjlry rhll th.e k o.onstd.lhn hndins alcn , lor thc Pcriomnce oa rhc work for whth lhis Fmn a
<br />isslcd (Scc.1097, Civ. C.)
<br />t.nJr,'. 4,LJ,r$
<br />AfILTCIXLDECI..ABAIIAN
<br />I hcEby !finn und.! I]coulr! orFrlury oN ollhc nnhwinr d$l!r!rionr:
<br />Dctr,lirion P.rnnrAsbc(os Norificllio. Fcd.isl RcBul,rt,rs Il-i'lc.1O. P!n6)
<br />RcquiNd Lcxcr ol Noriticrrin
<br />I ccnilinu rhc lcdcral rclul,rions rc8(dins lshcdos rcfr,vrlr* nor q,/icahlc t' rhi( rtul&r
<br />Li{l Lrn'f! rhJrlhJ\c rciLl rhi\Jnpl'Li,oi.u'd {rrr rh]rrhc$orc idonDrioi is.orcd lrsrehcohplywirhlllCilyandCounrv
<br />o illnccsrtrd Shrc trws i.!!tliE to buildin8 conslddnrn, dd ,urhori^ rcprcscmdivcs of rnk Cit, ond Counry b cmn u,nn
<br />!bo!c mnriomd tmp.ny lor in
<br />ApdicMr or A8cnr Sign urr:
<br />w\baYl C(lut t4
<br />Appliances
<br />I\Ietal 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 />Rouoh 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 />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Bough Mech.6lztl(/,-aMr1a,
<br />Final Test I
<br />Meter Release
<br />FINAL t-t/'Uo //c 'DfiNotes, Remarks, Etc
<br />,"" 5 2t lX-- c-'-,*, AGC
<br />",,. s. zY . K
<br />I
<br />I
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<br />ID/SIG.
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