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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAXATION
<br />I h.eby rrrn !.d.r Fnshy of lErjury rhtrl I om cxcnpr rmm rhc C.ntmcros Li.cnsc L{w for rhc followins rcasn (Sft.'7011.5
<br />Brsines* and Pmacssiotr Code)r Any Ciry or Ct'unr, whth EqliEs ! Itm tu .onstocr .116. ir{,row. .hmlih or Ep.n atry
<br />smdue. |rbr ro ns isruam, abo reauitr rhc aprlicor for flch lEmir to tiL r si8md sltrrcEni thd lr or shc is lkensd puru&n
<br />ro rlE provisio.s of rtI Contmloas Licnsd Law (Chaprd 9, ComnEminB eirh Strrion 7000 of Divni.n I ol dE Busin.ss and
<br />Pofc*ions Codc) or rhrr lE or rhc is cxcdpr rhcrchom and rhc hori for lh. ,lkgql cxcmpraon. Any viohtion of Selior ?03 ! .l hy sny
<br />appli.r r.r a pcrmir iubjmk $c aptliclnt lo a civil Fnalty of nol mrc lh fivc hundrcd doua6 (S500).
<br />-1,
<br />!s o*nr of rh. I,0116r. n n, crplor6s wnh wrg.s a rhct $k onFnsrior. wi[ do rlE wort dt lh (u1@ i\ el
<br />intc.d.d or oft rcd for sL (Se 704.a. Busiress and Proa.sions C.dc: Th. Conlrelor's LilnE L{q da tul anply lo a osEr ol
<br />rhc prlFny who hilds or invohs rh6tr a4r who &s tuh hi( hio*lf d hcisclt or thmueh his or hcr own €mploycei
<br />pmvacd rhar such im,rrcrcmnlse ml inlcnd oroateEd for soL,lf, no*q, c hoiBinS or niPlftcni i. $ld withinonc F!
<br />ofmnpL.ioo, tlE Owoo Buildc w h,rc ttE burdcn of pEving $d l! or snc did mt boild or iqmr dr ptuFny lor llr t!trrFs of
<br />L ns owmr ol rh. tep.ny, nm .xclusivcl, .onrldin8 wirh li..n{d .onrmroF lo on(rucl lh. pmjst (Sa 71X4, Bu5ircs\
<br />ad PDnssion Codcr Thc CotrtEctois Liccnse k{ docs nor apply lo otr o*ncr olpn'pcnywh6 buildsor irpmvc\ rh.rcon.
<br />{nd who enrBcrs for su.h prcidq wirh ! Co.rri.o(9 li.!n*d pu^lmr r. rhc Contdor's Lic.np tf,w).
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<br />!h ercmfl ondcr SNr B &PC i,rrhnr.ann'
<br />UOAf,EII:.COMTENIAIIAN
<br />DECLANATION
<br />I h.Ebt afilm und* !.n.lry of Friu.y oR olfic rouowinB ddlnrarlJnq:
<br />Lrhor (inic- tq rhc rurlanmnm of rtu $ork r(n which rhr Ilcnnir i\ $ucd
<br />-, h.vr lnd ,iU minllin qoi{.^ conp.nsllion imuromc. !s rcqutcd by 56tion l70O ot rhc L,hor Corh. for rhc p.rfommc of
<br />lnc krk for which this Fmit is iN.n My *ork6 6h!.ns!lion inrurfte .air 'rxl
<br />polty .umh.r m:
<br />Policy Numhcr:-Expircs:
<br />-l.cnify
<br />lhal in lhc pcrformnce ol rhc wo.k tur which lhis llcrnril h is{ucd.l shlllnor onploy on} IEron in ony monncr
<br />$ ro h.oft slhjrtr kr rhc wodr.s c.npcndion hws of C,lifomin. ,nd ,gN
<br />'h.l
<br />ill should lE om subrc.l tolhc
<br />workc* conpcnerion po{sn,ns.tSdcri.rn l7molrhc ljtnr Cd.,I shtrll,lbnhwirh conuly wirh Iho* provisions
<br />WARNING: F,iluE to sN wrkcn' onrp€nelhn sv.n8e is unhpn l lnd shal slbirr d t"plott. ro oiflnd Follis t.d
<br />civil finca up ro orc hundEd tholslid dollffi ($l00.mo), i. &ldition ro fic.osr of cor{Enstion, .i0@8cs .r providld for lhr
<br />S.cliotr 3016 of lhc Lnbor Codc. inlcrcsl ond altmrcy\ fc.s
<br />UCITNIEnCQMa/ rclj)A
<br />DECIAf,{IION
<br />Ihcnhyrfln rutr cin lrtofrcrjrryrl l rnr lic.Nd und$fovrnrnofchaDlcr0(conrarncing *irhSc.rion7(XX)) ofDivr\i( 3
<br />of rhc h,\inc\s r Pnncs\ins CodL. and mv li.cnsc i\ in lnll nftr ud clf&1
<br />Licnsc Class:-Lienrc Nuib€t
<br />Drr.: Corrhdor
<br />coNliratcuoNt xlil)tN1ifl1i$il.l
<br />is\urd lsrc .1(x)7. ( iv ( )
<br />/Itruta.rtlrr!r lllu]uN
<br />l]t.ht,rlliDufid f.trilr).l n.'jr).n.ol rhclnll,rring(lI.li,xri,rN
<br />D.nnninr Pcfln \ A\l[io\ No.li.rri,n, I;cdcn'l Rrsulxrnnn lT ll 1rr. I)]n6r
<br />II(\LL'trcd L.rrer.l N'iili.iri(i,
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<br />ccnify rhar rhc fcdcrl rcsuLrions rcE&dine a\be sros cmvil rc nor ul hahk ro rhi! pmir'.
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<br />ccn iry rhd I h,v. rcad rhis sppltarion od strrc rhar rhc .tovc inlomrion Lr c.rei I alra ro ory,ly wnh aI Cny lid Co!'tly
<br />ordi.a6.r ,nd Shrc lrw Elaring to buildinS consnudion. rd h.rcby ourhorize EprcsnIsriv€s of rhh Cny ed Counry to entcr upon tlE
<br />above @nlioncd prcp.ny lor inspection purposes.
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled K-B-tr It,lUtA
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Ducl
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release ,.1
<br />FINAL K-tt4K 2r.\+)A
<br />Notes, Remarks, Etc.
<br />Furnace
<br />t nd.lr N3m:
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<br />t n&r! Addls
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