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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<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 />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<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 />Rou gh Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 4lztl fr,-tr @
<br />Notes, Remarks, Etc rt n0 c.-,'
<br />OI{NER BUILDER DELCAR IION
<br />I hcrcby amrm undcr pcElly of Frjury lhal I m .rcr{,l rmm lh. ContrcloR Liccns bw for thc lollt eing Eoson iscc.?Ol L5
<br />Businc$ lnd Profcsion Codc): Any Cily or Counly vhich rcquncs s pcmil lo onsltucl. ahci iry)mw. d.mlnh or EI{n lny
<br />srucruc. rri,r ro ni issuaftc,ds rcquics rh. amlkrnr lor slch,rmit ro filc d sigr.{ sra&rc lh3rhcordEirli.e.$n,uNrDt
<br />ro the pmvtions of E ConlBclG s Liccnscd tiw (Chaprer 9. ColmEing wnh Scclirn 7mo of Divtion 3 ol lhc Busincss !trd
<br />Pmfcsrior. Codc) or rhsr lr ot she is .icq)r rhd.ftom dd rhc basn fot rhe olk8cd ercmtlion, Any violdrion of S(lb. 70.1 I 5 b, any
<br />lpl,licanl for a lsmn subjels tfu applicrnr ro 0 civil pcnrlryofnor mrc tho livc hu.dr.d dollas ($500).
<br />-1.
<br />as o$tur of Inc InIEny, or m, cq)lot€cs wilh *o8cs s ihct solc srycnsal ion. Fill do ltr wort md lh. (tutE B nol
<br />i m.Ld or.rc!.d ror $lc (sr.7044. Busincs e.d Ptnrcssiois Codc: Thc Conracroir Lien* kw d@s er,pplyro oom, ol
<br />rhc rbff,ny *to huikLs or in{'mb rltrn, a.d who dms uh n,* hnnsclf or h.Nlf or rhn'qh hh or lEr orn c'ry,loyccs.
<br />,.oyacd $al such nrl,swmnls @ ml hrcMcn or offcBt f.r sL. ll lswdri rlE huildi.g or inphh@.t is $ll wirhi. om )ra
<br />ofconloLrh.. rhc Ownn Buitl& uill h,w the hrdcn of thni.s fi,r hc or sh€ dA mr build or imprcE 0r nfrrEry fo, itx pqb* ot
<br />l.Nownfiofrhcprcpcny.nrcxclusivcly.onrBcrinswirhliccnscd.o,rracro^ronrnslru.rrtErrorcriscc7or'r.Buiincri
<br />ad hofssion Codc Thc Conr&tol s Liccns. trw docs nor lmly ro s oanm or pbr.ny who builds o. improv.s Ihcrcon.und vho.onrcrforsu.hpnrirrswirhaconrh.brls)ltcnscdrlFuElrorneG,nrEcxysLi.cnscL4).
<br />-l
<br />amcxcmfl undcr Scdion ,B &P.C (trrhiircison
<br />IIAf,EBLCOMfjNSAII!]ts
<br />DECI.AB{UQN
<br />I h.Eb, dli.n u ndf ,.oalr, 6f ,.rjury ore of r he fol los iog dcc hrat ions:
<br />-l
<br />hrlc .nd will @inrdin u ccniriul. olcon*nr k, S.lf lnsurc tu workes coniF.slrion. !i la, dcdforbysccri{!.lT0Oorrhc
<br />Labor Codc, ror rh. pGrotumc of rhc s.rk 16r which rhc rErmit Ls issu.{
<br />_l Mvc and will mrirtlin workcB cotrrtEtrsorion insuBncc. .r rquircd by Selion 3r0o of lh. t t or Codc. for thc p.rfotmrcc of
<br />ih. erk for whth rhis pcdtil ii istucd My wortcB con{Ensd ion insuramc eEar atrd lEli.y number el
<br />P6lkv Numb.r JrDRq
<br />-l
<br />c.nify lh{! i! rh. pcrformmc or lh. *ork tor which rhir rrnl h i*ucd.l3hlll @r copL,y rny p.Mn inony nuncr
<br />$ as ro bc.om subjel lo lic *orkcs comFnsalion lnws of Culiforn in. rnd rgm rhd irl shorld h..omsutjcr to rlf,
<br />sorkcn compcnsrtionpmvisions of Sdiotr 3?00 ofrhc tjbor cod..I shrll, fodhwirn snply wi'h rho$ Dmvisions..
<br />WAXNNG: Faihrc ro ecurc sorlco mmpor
<br />civil nrcl ut ro onc hlndrcd rholrEBl doll8
<br />mlcm8c is unhsful. and shlll slhjcd an cmfbrcr ro di'niMl p.Mlrics lnd
<br />ll)0,0r)0). in addirion ro rhc.osr olcoDrcnsario.. datugcc rs trovidcd ror ft.
<br />v\
<br />Ilti(L 3tlrrur
<br />I hcEby affirh lndcr I'cMIly of pe+ry lhar I m lian*n und.r Fovision of Chlpt r 9 (smEmirS wilh Sc.lbn ?0o0) of Divnion 3
<br />of lhc Ausircri .rd Poacssions Cod.. !,n my [c.ne ir i. tuU lore nd .ffet.
<br />.i.""*N,,.b.. Si ?'7?-L
<br />,}L rn 1,,^, "o! n1l-
<br />I hcEby amrd undcr nculty of Dc.lury
<br />nsucd (Ss.109?. Civ C ).
<br />n ion lcndin8 iscnc, for rhc Erlbrmnce of lhc aork for whirl rhi\ Fnnir is
<br />lItfutiIiLDIicLLBAuaN
<br />I h.R{r! Jninn tr nd$ Ixnrlry ol pcrjury orc ol rhc li)ll,sn,g dcrlffirion\
<br />Dcn(ilnbn Pcnnl\ \bc{o\ Norilicarn FoJcrJl R+uhrn'n\ (Tirl.4u. Prn6)
<br />-R.quircn
<br />Lrncr of Norill.dirn
<br />mrly anh !0 Cnyand Counly
<br />Ciry{nd C{,unry ro.nl.r uF,n llr
<br />Ir
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