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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrby omd undc, pcnalry of Fdu.y fial I m ck'i! fsm rhc ConlftcloG Lien* Llw fo. tta lolloving Elsn (5(.7011.5
<br />BBin ss nnd Phfersio. Codc): Any Cily or Counly thih rcnuiEs a Fmn lo onslrucr. .lts. in{,ot, dcmlhh or rlan My
<br />sltuctm, lrh! to irs Gsumc. d$ EquiEs rhc sFrlicant for ruch Itrhn ro nb a sisncd srsrcft.t thor lr or rlE ir liccns.d puNqt
<br />to llE prcvisions .l rh. Conlelols Lk.n*d tlw (Cltaptct 9. ConmcminS wilh S.ction ?000 of Division 3 of thc Blsines o
<br />Prot ssions C.dc) or lnlt lr tr sh. is er.mpt tlErcfion rnd llE hasis for lnc rlhScd crcq)lkrn. Aiy li.'hlior of Selb. 70:11.5 b, an,
<br />.pplicmr fo! o l.rmil subjcds thc lplliclnt lo a civil pcnllty of ml mrc lhd fivc hlndtd dollm ($500).
<br />-1.
<br />.s opNr of rhc OnFny, or ny cmplor.cs with wdees as fict sh ompcnsarion. will do llF wo* . tlE slrLt{@ i\ nol
<br />intmtu or oficEd aor eh (SN.7OI4, Busiftss dd Profcssions Code: Th. Conlraclm s L*cne Liw d.ti ml a$ly ro m ownd ol
<br />rhcth,,eny wh6 build{ or inipEKr oE@tr arld sho des skh e* hiorlf or hcrcti or lhmu8h hh .r lEr own.mplo}rcs.
<br />prcidcd thlr sEt impmmnls @ mr intsd.d orotu aor st. It lDws.lh. ttrildirs G iqlmBnr is sld *ithin om ,ed
<br />of on{,htt tr lh. OwEr Buitlfi will hrE ttF burd.n of povia8 tld fu or sh. dil mt hoild or inlmw lhc pollcny for tu lnrlbe 6f
<br />-1.
<br />asowrcr otrhc pmpcny. !meiclusilclrconhcrins {irh ticcn*d conradoB lo co.srrud rhc phjd (Ss 7044, Busres
<br />rnd hd6si,n Codc: Thc Contdor'3 Liccnsc ks der no! aptly ro an ownd of l,ropcrty sno builds or imFrcrcs lhcrcoo.
<br />nnd who conra.ts for such [ojccls wirh 0 Conrrlcro(, licen$d p!r!a ro rhe Contricrols Lken* Llw).
<br />-l
<br />!n crcmpl undcr Scdion-. B. & P.C. for lhh taron.
<br />IAATEf,S:.COMPINSAIAN
<br />DEII.AIAIII]N
<br />I ncNby uirtrm undcr ncntrlly of Dciury one ofthc folloains dcclarutions:
<br />Ihrvculdwrllntrir rinaCcnificrrcofC!trs.nrtoScllltr{rclnrlorkcc coml.n\lrion. N pn,ridcdtrhys..rbnl7mofrhc
<br />Irtxtr C(xh, r.' rhr,.rfff ,tutuc of rhc $.rk fd which rhc n rnri i\ nsuL{
<br />I hnvc snd will m.inlain *orkcN .orycnsolion insuramc, as Eiuncd by Serirn 3?00 of lhc Lbor Cqlc. fo, rrE Frfo,rl1mc of
<br />l\1 comr.nsdion inslr.mc carict ud poli., nlmhq e.:
<br />0,/d
<br />-l
<br />mrrify rh.l h rhc ncrlormrc of rh. wort fo, whi.n $h rJcmit is irsu.d. I !h.U mr cnploy any p.rsn in uy MmI
<br />$ 6 to b.com .lhjccl ro ln. wo*qc onp.nerion b$ oa Calif6mia, and a8rcc lhlt if I should b.{oft sobjel lo rhc
<br />mik s' coopcneiion pDvisions of Sd on S?m of rh. t$or Codc. l nE[. fonnwifi orply wnh lb* pmeisio8..
<br />WARNING: hjlurc lo wurc s{trkcs conFnglion cohrusr is lnlowluL &d shall subjer &.nplorr ro aiminol I'cMllics and
<br />civil fin$ uI lo om hundrcd lnousnd dollus ($100,0m). in rddirion lo I "il;,Sa&ion l!076-r!h.ldnr Cod. i.r.E{ snd
<br />,."), Q/zlt t& a*,\l--Se-on'
<br />LICEdIEDIONIBASIAB
<br />IIECI/MIIAU
<br />I h.ftby rllinnundcr FndlryolFrjurt rhd I n liccnsd undcr lmvhiotr of Chaflcr 9 (conurcrciry *ilh Sccli{,n 7In0) or Divinon .l
<br />.f rh. Busi'r$ and Proris\nrrCod.. mJ nrv lic.rsc i\ i'r tulltur.rdrdcllt.r
<br />CZO v? vBgY
<br />caauBticllllNr[NDlNtilli[Nrr
<br />I h.rb, x8irm undcr J.nrlly oi pcrjury rh rh.rchr.o.$flction lcndi,rB ng.ncy for th€ l]crformrc oflhc mnk f.r whth rhis Fmn i\
<br />hsucd (Scc 1097. Ci!. C.)
<br />AIELICANLDECI,IE{IION
<br />I tltby ammr undcr pcnah, of pcrjury om otthc nnb*irs d.clorali{nr\
<br />l).m,liri, Pcrnit Ashc{os Norificrrnnr F.dcral Rctuhri.i\ ('rirlc40, PdO
<br />-Rcquncd
<br />knd or Norific i,n
<br />I cdr iay rhar rh. fcncd rcgllarions EgordinS ,st{slos rcnbvll sc nol a,rpltrblc ro rhis Imre.r
<br />I cnirvr&r I l8u mxd tfiis ion ad sr0lc rhrt rtc above informrion h Lnmn. I dgrd rosmplywnh ollCily!trd Counly
<br />0,1 rxn(.\ r (Lsrrl.lN!\ion. dxl h.rcbysurhorizc rc,'rcscnloliles ofrhi\ Cn,
<br />ohovc motioftd pmp.ny for in
<br />Appli.anr or Ag.trr Si8ndurc
<br />P"tr')r,{
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Com pressor
<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 />Rouqh Mech.
<br />Final Test
<br />Meter Release I I I
<br />FINAL \\c \14 I )11,',{ (
<br />Notes, Remarks, Etc.
<br />Metal Fire Place
<br />L.ndo r Addrcs.
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