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MECHANICAL.INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.OWNER BUILDEN DELCANANON
<br />I herby !fli.d undc. pcnalry of l)criury rhal I m.reh fmm rlE Conrturon Lkctre Lns tor thc fuuowing ENn (Se.7oll.5
<br />Busincss a.d Pblc.sio. Codc): Any Cny o. County vhth rcquhr a Fmii ro snirucl. ah(. inprct.. &mlnh or EFan ut
<br />sldctuc, prior ro ils irNwe. lho rcquircs rtc sprlkanr for such lEmit ro fih a ,i8ncd slar.ftnr thd nc or shc is liceied l,uNdnr
<br />to tho povisions ol lh. Conlrrlols Li.cnsd liw (Ch,prcr I, Comcfti.8 wilh S.ction ?000 oaDivision 3 oflhc Busioess lnd
<br />Prolcssions Codc) or lhal tE or shc is cicmpl ltcrcfiom lnd lhc h€sis for $c alLig€d.rcm,,lion. Any liohrion of Sdbo 7031.5 b, .ry
<br />applnai' fo. . Fmi' slbjer rhc applio lo a civil p.nalry of hr mr rhd fiv. hundEd .lolla ($5m),
<br />-1.
<br />as owrcr oarh. pmtErly, or my emplort{s witn w,g.* a lh.ir sh onp..siion. wi[ .lo dr m* ond llE ntur@ ir hl
<br />inlcfthd or ofc.cd for sL (38.7044. Busin.ss md hlfcssi.ns Cod.: Thc Conrhcrols Li..ic Lrw dfts rcl ag,ly ro .n o{M of
<br />rh. rrqEny qho b.ild. or inpmE. ihcmtr .nd wh. d@\ sEh mr* hins.lf or hcrsll or lhmu8h his or lEr own cmlloy.cr.
<br />provided rhlt snch inFDrft,ni m mr im.oiLd o, oFecd for sh. l( h6ftwr, rhc btrildjng or hgrcE4ni k bt wnhin om ,!u
<br />ofcotrDlerior llE O*kr AliBcr will haw rlr blrd.n ofrrcvirS lh lE or shc dil ml huit oi in{,ow dE ttDtEly ror 0E puqnsof
<br />-1.
<br />Ds o*rcr of rhc F!r,cny. .n.xcllsiwly conrBcring *nh [ccnsed enrBdoh b ..n(M! rlE poi{t (Se 7(x4. Amr,N
<br />0nd Pioa*sim Codc: Thc C.nlrulols Lic.ns. Law dfts no' aplly ro sn o*ncr of tmrEny who builds or impmt. lh.aon.
<br />and who ontmcrs lor such poj$rs qirh r Conr@ro(s) liccne.d l1ucoa ro rlE Conr6.roa. Limnr hw)
<br />-lam.knfl
<br />lndcr Srction- A. & P.C. for rhis E.sn,
<br />Irarr (nrn..
<br />lrlxtr Co,t. ntr rh. p!nni,rtr,.. ol rfu so![ ntr shi.h rhr ]rdnn I is i$ucd<-r'
<br />rhc$orklnr$hichrhntrrmiri\n\udN1!\ortr\.onfctr\rri, Ln\lrrn.r {incr 3ri] ,r'lry nuDk\r irc('/Peess
<br />VZvoZZo o
<br />-l
<br />ccnilrlhat itr rhc l}.dnrnurcc ol lhc wo ( lor which rhis p.rnril n issucd.l shlllnor cnnloy any pcron inaoyfr.nmr
<br />$ aslo b.conr ruhjsr ro rhr Mtrkc( codpcnslrion lavs or(:!lifomia. snd rr. thd il I should b..om slbrcd to lhc
<br />wor(s\'d'mlE.\!rn'ntn,visbniofSccrk,nllloofthcLjt C{ntc,I \hall. fonhwnh .onl,ly wirh rhos Imvisntns
<br />WARNINC: Fli,ure ro sure $o cs mnpcnsarion corc,asc is lnla*iul, !"d shall {ubitr d .iplorr ro ri'nin.l Fmllts and
<br />citl li.cs up ro om hundcd rhooslnd dolloE lSl00,00i0). in lddirion ro rhc con of con,.nqtnn drnE8cs {s [ovidcn for fic
<br />a Z/
<br />UCIiNSIJLCANBAIIAl)!:c!ra .IoN
<br />I hctoby dlfinn r d$ p.Mlry of p$jury rhd I m Ii(tnild undcr ttulisn of Chr|nd 9 (cunrncins qilh Scclion 7(Ixr) of Dili\i,tr, .1
<br />ol rhc,lusinc\\ rnd lton$nnr\ (inl.- u lnry liccn\c i\ in lir ll rnr$ ul cic.r
<br />z-o o
<br />q)NEIA.UCII}NIDNIIINCIGIIII
<br />I h.ehy fir und$ Fnalry of pcdury rh llErc k , .onio.lion lcndin8 agcncy rbr rhc Frlbmncc of ltc hrk for whi.h rhis Fnnir ir
<br />ixsued(Scc. l0'r7.Ci!, C ).
<br />_l .dify thar I h,vc ead lhn .pplicalion and slst thd lhc abovc inlomlion
<br />onlinrnes !trd Slatc bes BlaritrB ro huildinBconntoclior a h.rcbyrlrhorit
<br />is comcr. I oSre ro comply Birh allCiryand Coutrry
<br />xm n,cnri,,ncd pnFdy trin\T-crn,n purlxxc\.
<br />Annlicdr or A*m SilnrtuE
<br />/*=
<br />Ciry .nd Counry ro clE unon d.
<br />e/-r // I
<br />Appliances
<br />Ir/elal Fire Place
<br />Evaporative Cooler lr
<br />Furnace rx UmanvDr (D
<br />Compressor ilhU it €dk{a,-'iJ
<br />Misc. Equipment r ['tl"
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh Ductwork lr tllA tk -E lAtfrfr, -tsl./
<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 />Bough Mech.I iu-otYTv-t)-'
<br />I
<br />Meter Release I
<br />FINAL I UctY, I t?/
<br />Notes, Remarks, Etc.{
<br />COMMENTS
<br />lnstallation
<br />Above T-Bar
<br />Final Test
<br />]IIIBf,EIS:COMPTIIAIIAN
<br />DECIJEAIIO!
<br />I heicby 6mrE @dcr p.@lty otFriury om or rhc rolkreinS d(lrrdriors:
<br />)-coir..crc /--
<br />L.ndcls Addrcss:
<br />-
<br />apprrciiiiiiil iii
<br />I hd{by drm undc, Dcnalr, of p.r.iury om of lnc following d..htr tio.s
<br />Dcmlition Pcflnik'Ashestos Noriaicdion Fcdml Rcsuloliotrs (Tnb 40. Pan6)
<br />-Rcquidl
<br />L.u* or N.liicalion
<br />-l
<br />ce^ify 6a! rl* f€n nl rcgril,rionr E$rding 4\l!sr.s rcnheDl de mr dl)plic$lc ro lhir pr.ir.r.
<br />P.rnircn,m (pri )
<br />I
<br />II
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