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MECHANICAL-INSPECTOR RECORD <br />OWNER BUILDER DELCAXAITON <br />I h.rcby arrm undcr p.ndly of pcriury thul I m crcmpr 6om rhc Co.racro6 Lhcn* bw f.r lhc followir8 Eretr (St.7011.5 <br />Blsiocss {'d ftofcssion Codrl Any Cty or Counry whih rc!!n$ a Fmh lo 6ns|ru.r. alrci ifl{,rcq d.mlhh or rqan dy <br />smdure. prior ro i|i isqu'N. also ftquies rh€ ,p ham for su.h Frnrn lo fik a siSncd sraltftnr rhar h. or shc ir liensed puBuol <br />ro rhc flllisions oftlE Conttubfs Liccoed Liw (Chaprcr 9. Commcring wnh S.claon 7000 oaDivtion I ofthc Blsincss ond <br />Pofc$i6nr Code) or rhar lE or shc & .r.npl $.b6on and ilE tEsis tor lhc rlLgcd cxctrplior. Any violali.n ofsdrbn 7o31.5 by any <br />alpliclnl lor sF rnn subjds lhc llplicstrt lo acivil pcn.llyofnol mrc thln five lundEd doll4s {S500) <br />_1, !s ower 6f rhc I'6rfdy. or ry.dphye. wnh wagca .r ihcir $lc mn'IEn{rion. will do lhc wlt dn d* st{!r@ i! Dl <br />hr Ld or ofi.rcd f s]. 1Sa.?044. Busircs and Profcisions C{nc Thc Connlc1d i Li(trc Lla doe. ml'pply lo owrcr of <br />rlE polsry wh6 hrildr ft i'4roK thcrstr !d who dd seh m* himscll or lEmlf or thmusi hh or lEr oh cnplor..s, <br />totilcd rhlt Mh itrwo\(*.B@mli.d.ndorcrdforoL.lf.lbsE,rEhil,inSorinpmwmnlis$ld*ntitromy@ <br />ofm,rphtion, tlE Owmr Buil-ls si[ hlw thc hnkn ofprovinS lhlI h. or slr dil m hild o. iqrcw hc pDFry aor tlE Frpos of <br />l. Nownc. ofth. ro!.ny, amrrclusiv.lr.onrrfrine wiln Isnrn conr(toR ro coinrud $c |'o.ied (S( 7044. Bxsms <br />ad Eo6s\bfl Codc: Ttc Conl6croas Li.€nsc Ln* do* nor rylly ro M o]n* ot oroFa, who builds or improEs lficrcon. <br />and sho co.rr.ct fo. $.h pbi{. wirh r Co.rtrrons) liNn.cd pusu ro rhc Conrrsbls Lketrc Lie) <br />-l <br />@ cxeopi !nd.r scctun- B. & P.c. for lhk r.Nn. <br />D.r.: Om.. <br />lllarc8s:couPil6allaN <br />DECLAiATTON <br />I h.rchy rllirn ondcr Fn,hy 6r rdury oft .f lhc tullowinB dNhrarnnN <br />I rhrr (',xlt.larrh.r^-nnnnancr oirhc \rork lnr $lri.h rlr |{nni n tr\u.tl <br />Ihnv.,ndwillm,intaioworkcrCcompctrsarioninsumrEc.NrcqundhySc.rion:1700oflhcl-dh.rCoJc,forlhcrcrlorm0rccof <br />lhc work lbr which thk pcrmit is hscd. MywollcK onDcnsolion insurncc carif und rolicy nunbcr m: <br />-l <br />enilyrhar in rhc I)crformnft ot rhc work aor *hich lhh t).mln h issucd.l stull trol cmploy.try p.rotr in any mnn( <br />s lo hc..nr rxbjcd ro rhc wo*ds .o'ripcnsar ion laws of Calibrntu. ond !8re lhd if I should hccom biccr ro rlE <br />wo da oq$\ario4i.ti.ionsof Sccrion 3?0oofrh. tlhr Codc.l null. ronNirh oq,l, wirh tho$ rFvhions,. <br />WARNINC: Flilurc lo wurc *orkcn d,mrrnsolion s,vcrusc is unliwhil. tr81 firll sxhj..' m cmplorr h siminalp.nuhi6 lnd <br />.i!il fincs up ro om hundrcd lhousa.d doll6 (3,00,0(()). itr 0Cdilion nsarion. danEgcs as [ovidcn for lh. <br />tihr Codc. inrercsr md lnoray s fes. <br />>-<9 <br />DESJ&IIION <br />I hcmhy rflifln undf p.MltyofFqury rhlt I om liantur.l utrdcr pmvision o{Chryrs 9lcommmina *i'h sltrion ?otro) ol Dilhion l <br />of rhc Brsincsr ed Pmrc$ionl Cod.. xl myli.cn* i\ irfuu fur.c.nd cllccr <br />">_o <br />I h.rhy lllirn und.r l.D ry ol p.ljurv thlt nrrc h I coNrrudion h ins lscncy i{tr rhc Frnn'tuncc orrh. sor* ntr which rhn lcrnril is <br />issucd (Sc. .1097. Ci!. C.). <br />l.cnilirhal rhcltdcrrlEsuhrionsr8udins 0\hcsros rcnDvlllrc nor,pplicabL t, rhh pojccr <br />-l <br />ccrrify rh,r I hrvo rcad rhn omlicarion ad nar€ thor rhc alnvc nrfomdbn t cotur I ugire ro .onply wnh r0 Cny and Coutrry <br />ortli'ri(\ rid srrlr Lrs\rLhri'r! ri buildinS rcprcrnlnlivcs.l rhn Ciry!n! G,unrt t, cnt$ upon rhc <br />shovc mnliomd p6Fdy lm <br />Appli.er or AScnr siBmtuE: <br />APPROVALS DATE COMMENTS <br />Appliances <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <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 />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meler Release ,)I <br />,( l,lLtfiFINAL[\-7 hq / <br />Notes, Remarks, Etc. <br />ID/SIG. <br />Metal Fire Place <br />Pre-lnsulation <br />Smoke Detectors lnstalled <br />lnstallation <br />,rppr-tcr t tiixiii niirnn <br />I hRb,nfinru .rlE nllyofpcrjuryoncolrM hTlownr8 dc.lnr iu$l <br />l)cnnii Permns'Ashc(os Noriliurn Fcdc4l Rcrlhrtr\ l'ln[ 4), Bd6) <br />Rcqrircd l.r rd .f Norificarioi <br />7/>,ls <br />tl <br />I