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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 />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Ducl <br />Fire Damper <br />Openinqs <br />lnslallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Bough Mech. p/Y?f tzlz.al0 .d{/{a)908, . <br />Final Test <br />l/UL/(41 5\{t <br />Notes, Remarks, Etc <br />owNuR utIl-Dl]l{ Dlll,c/\RATI()N <br />I h.rrht nlli'r undrr lr rlry r)l Nriury thil Ix cxcnrfl ho rr C.trti.lor l,i.cNc lrs i{trrh. lnllo*irr! rcr$r (Sc.?031.5 <br />llu\n'c\s n*l Protursi(r C.Jc) Atry Cily or Conrry whi.h r.quir* r |xmir tri r.n{nicr. rlrcr. nnfnJvc. d.niolisll tr rclln rny <br />nJ rhc Dovhlotrs .f rhc C.rlrid{r's l,iccn\ed ln$ lChi!rcr 9. CoNn.ncing qilh Sccrnnr 7{XX) ol Dn(ion I .i rlt tlu!irr.r\ xnd <br />rtllicinr n ! |[nnii suhjr_rr rh. rppl'.airt, rcivilprNlry.l'x nrclh r l,vc hundrcd dollffs(S5U)) <br />l.N.$rcrofrhcnnr|f,ny.ortriycnDloycosLvilhwaxc\n\rhcir$l(.o'pri\rr(r.silldorhc*.*mdlhcslnrlurci\rn <br />inrc lcd.r.illrcdriirsrle(Scc7(!.{-Bdsi',csrndho,.sxn\Cod.'lhcConfudoisLiccnscln*docstr.rlPplyh$oqnrrol <br />rlic ln,|tny who huilds or in!(xrs rhcrrr od who des {ich Mlrl h tr clf or hcr\clt or rhtuu8h hit or hcr owtr cnrPl,,yccl. <br />prt,lidcJ rhxr $'.h i'npolcn*drslcturir.iddlurufardlar{lc.lih.*cvqlhchui ing or iml)lNrnr n v,ld qirhii on( )u r <br />-1, <br />osourcrofrhc proncny, !'ncx.lxsivclycomri.ring wnh lc.nscd.onhmlos ro con(tucl tlE I,mrd (Sec,7044. Btr\i..\3 <br />.nd Protusion Cod.: Thc Conlractols Liccnsc Law docs not aptlylo oowicr olpor.dy who builds or i'nprovcs lhcreon, <br />rnd sho onldcls lor su.h pbiccrs wifi d Conractorts) Iicctrscd ,usuanr to rtc Conlmctois Liftns L2w) <br />-l <br />am.iemfl lnder Sectio B. & P.C. Iorlhis.c6son. <br />]IOAf,E&TCOMIBSATAN <br />PECIdI4trQN <br />I hercby afftrmundcr pcnalry ol pci!ry onc oi rhe ,oltoeinB d(ldarions: <br />I h.vc dNillmrinhirrCenificarcofconscnrloSclilnsurcforNorlt dnnpctrsdnnl.isl,ovidclrirhySccrioilT{rootrh. <br />Lrhor Codc. rorrtu pcrlornmtrccollhc sn lo wnichthc ncnnir is isucd <br />Xl have and will moiiraii worrcn' coopcnsslbn inru,aic.. rs rcquircd by Selion 3700 oarhc Labor C{dc, for rhc lsform0ncc of <br />rhs *ort forehichrhi{cmn ir hscd. Myworkds .o mpc ns.tio n insu rmcc crric r lnd lolicy numncr dl. 9r*rL /olw?eQsA na$ t,p9 fvL,O <br />-II .cniry rhd in rh. pdlorMmc of lhc sork for which lhis trermil t tsucd, I shrll nol cmploy ony Pcnon in any monncr <br />w as ro becom subjsr ro rhc sorkcs' .om!.nsurio. laws of Californi& ud ag@ thol if I should lE om slbjccl to rhc <br />wortes .ompcnetion tmvisions of S<lion 1700 of lhc Lahor Code, I $311, lorthwilh comPly wirh ln s tmvhions.. <br />WARNING: Failurc ro $curc wortcrs compcnsolion mvcm8c n unustul. und shdl subjc.r ,n .n]lloycr to ri,Innd pctro[ts and <br />civil 6n.s up r. onc hu.dr.d thous,nd dollnis ISIOO.OO0). in trddnioi ro lhe co\l 6f cotwn\arion. da.E8cs os Providcd for lhe <br />Sc.riotr :1076 of lhc tibor Codc, itrrcre( lnd allorrcy\ fccs. <br />'1/e'y'r' <br />DI'II=I.BAIION <br />ol rhc Bu\inc$nn'l I'mli\si{trrs (lnld. r !l fl,y li..n\. i\ i', h,llnn.c ,l.fii.r <br />4 conr*cror:!4-- <br />Ihcrchyrtltmundcr pcnolryolpcrjtrryrhatrhcrc il!conitu.ri{,n lc ing a8.my nnrlel)c hrntrmc ollhc work lbrwhi.hrhi\ Fnnir is <br />issucd (Scc.1097. Civ C.). <br />APILTI;ANLII!:SAAAIION <br />I hcrcny iJitm under pcnolry olr.rury onc olrhc rollowin! dccl-arionsl <br />Dcnnilirn,n Pcmic Ash.\roi N.iill.ation Fcdc.al R.gu! ions (litlc 40. Prn6) <br />R.quncd bltcrof Norificdtn <br />-l <br />ccniiyth rhc {ederal reCxlrtions rc8.rding nsb.rlos nftvJl.rc nol opplicublc ro thn protd <br />-l <br />cenify rhar I hare rcad thh lltlicarbn ard srare rhar lhe ablc inlonuion is.oml. t trge losn{lypith aU Cirrnnd Counr, <br />o.dininccs and sldc LjM rchlin8 b 6u ild io8 .o.(ruclion. ald hcrcby lulhori4 rcIrc*nrlrivcs orrhis Ciry..d Coutrlyto cntcr uPon tfic <br />ah.vc nrtrrion.d pmlcdy for insrc.rion <br />Anplicanlor Age l Signutu <br />rVe99d,!4N <br />IOther <br />Meter Release <br />FINAL <br />Dolq_ Oen.r:_,f-------T------ <br />--------T----------+-- <br />I <br />= <br />=