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MECHANICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER DT'ILDER DELCATAION
<br />I hcEby amrm udd lcelly oa p.rjury rtut I u.xcrq froo lhc Connldm Li.cnsc Llw for lhc followin8 rcosn (Sa.?031.5
<br />Busi..$ ad Prolcssion Code): Any Cny or Co! y *hi.h Equies r Fnir lo co[(tucl, oltd. in{mE. .hmli3h or Epln ey
<br />smcnft. tritr ro irs i*urc. al$ rcqun.s lhc atplhsl lor such Fmil to ,ilc ! sigftd sltr.ftnt th.r tE or shc it li..nrcd plrs@l
<br />to thc Imvkions of rlt Conrrdcro, r Li..ncd L{s (Ch.ptcr 9. Co@ncing *ilh Sklion 7000 of Divisio. I of l}E BBincss and
<br />Pefc.sioni Co.!e) or thar h. or stc is cr.npl thcElionsd lh. blih lor th€.llcg.t cremolion. Any violdion oas.dhn ?011.5 by .ny
<br />rpplha.r for s p.mit subj.!l3 lh. q,pucol ro , civil peMhy of mr mrc rhm fitc hundrcd dolus (5500).
<br />-1,
<br />ss owmr or rhc tiopcny, or ny cmplorr.s wirh wae.s N thei sh sm|'ensa on. will & llE "ut old 0E irlw i\ ml
<br />anl.nlcd or ofcrd for elc (Ss.ro44. Busincs lnd Pmfcssiotrs Cods Thr Conri.lois Li..nr tiw do.s nol rpply b an owtu! ol
<br />rhc tmp.ny whot ildr or iftpmB rhc@n. ard eho des sh F* hiNclf 6r h.elf or rhouSn his m hcr o*n cn{)by..s.
<br />pn,vid.d rh,r su.h inqr.Emils N ml inrcnd{d or otu for sh. li h,ltw. rtr tnilding or inqmEmnr ig sn wnhin .m re
<br />or.onVibrb[ ihc OeB Buih.r uill hlw lhc blrdcn ol pmving lhd hc or sh€ dA rc| hikl or it{Ew 0f, nmp.ny rot 1,f, !uqn$ o,
<br />-1.
<br />ds owncr .f rhc poFny. sn.xclusiwly contr.litrg wnh lien*d conlracloF lo ensmd llE poj..l (Se. ,044. Busirc$
<br />and E ftssi,n Co.h: Thc ContrErols Lkcnsc Liw der nor rpply ro u own.r of prcpcny who builds or inphvcs lh.rcon.
<br />a.d who onracr tor $.h ,,oicd. wiln r Coitaclo(s) licnscd puslol lo rh. Cont r.loas Licn* t w).
<br />-l
<br />mcx.npl ord.r S6rion- B. & P.C. lor lhb rc{en
<br />.wa8[ESglouriNsArrox
<br />DECI,If,A.IIQN
<br />I hcrcby uffirm lndd pculry ofFrjury om ofln fouowhe dclmlions:
<br />I rhor li c. itr rl,c l)o,krn r. ol rlr $, lnr \lri.lr rlr l{rnnr ^'\{,.(l
<br />-l Mvc nnd will roinldn wolkcB .onucnsd ion inslramc. as rcquncd by Ssrion 37m of thc L€hor Code. for lhc poto.m@ of
<br />rhc work lor whkh lhis lErmir is hsd. My wortm con{Ensdl ion insorMc cai.r a,t lDlicy nun$er rc:
<br />4coe\
<br />sKo9tllt lL 1 5-l-)ol
<br />_l ccdily lhar in rlE Fraormncc of Oc adk for shich Ihh pcmir is i3sucd.l shrll not cmlloy !n, pcrson in lny ouNr
<br />s N ro h..om subid ro rhc wo*si mmFnsarion ldvi ol Califorli.. dd e8N lhrl if I Fholld b.6m lubrdt !o thc
<br />wottcB mmpcnslrion pmlisionr of Sdrion 1700 of $e trb6, Code. I 3nrll, fonhqilh oq'ly onh rho* lovisions..
<br />WARNINCT Failurc lo sur. workcrj .omrcnsalion mvcmgc h uni!*lirl. and shtll sxbier m cmlloltr io qimindl |tdti.s and
<br />.ivil fincs up ro orc hundnd thousand dolks (SI0o.00o)0ddirn'n 16 rh. coqr .r.om!.nslion. &nu8cs !s proridcd to. rhc
<br />s..rn,n $74, oa rh. I itnr C.dc inrcE{ rnd ,i
<br />/r8
<br />lJll$IrD-L])Nlnilgl93
<br />Dlclrl&UtaN
<br />.l rhe lnr\i'rc$ rn,lPrni\\iu,sC,'J.. mJ n,y li.rhc,\ n, hrllturrt rnL.lR.!
<br />c-7 ZAOL
<br />'1/tl /tb
<br />IONSIBICIX}I{IEIDINIi.ASENCI
<br />I hcEhy llItrm urdcr Etulry of nerjlry rhar rhcrc h a q'.nd.rion kndinS a8.rcy for lh. PcrlolrMc ol llE mrt for *hth lht Fmil ic
<br />(surd (Sc. :lur7. Civ. C )
<br />AfILICANI.DECI,AS.EIIQN
<br />I ffily dim under Dcndlly of Dc,h.y om.1ln. fo owin8 dc.,u.lions:
<br />D.tufiioo Pqmirs.Asb.stos NolifEarion FcdcBl RcBllarions ( l irlc.l0, Pin6)
<br />-RcquiEd
<br />Lclrcr of Norifdrion
<br />-l
<br />ediry rfiar rhc fedcral rcgul.rionr Egr(ti.8 a\bcslos E mval !E ml ar,lliclnh lo rhir pDFcr.
<br />-l..rrifr
<br />rhar I lurc Md lhh opplic.rion dd srarc $ar rhc sbvc i.tumrion iscorel.l agN tooorlysilh r[ Cny nnd Counly
<br />odinatud,nd Sr,i. ljws Nl,rin8 lo conslrucrior lnd h.rcby aurhrn rcDrccnkriv.s ollhis Cily and Co.nlyb enrd upon rhc
<br />atx,rc nEnrt'ncd thpcny roi /+Aprlicanl or Agcnt StEr!
<br />BP,5cc
<br />\ti| /tt
<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 />Rouqh Ductwork I-l-,v l)c,llia(-\rl)
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Flange
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />IAbove Hard Lid 7-l -tg_Dc{ch gx)
<br />Above T-Bar I D.,Jr>l>44
<br />Rough Mech.
<br />Meter Release
<br />FINAL Detata 'Yr)
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />QlL.IB,
<br />Final Test
<br />t3-7.-te,
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<br />ffi
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