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MECHANICAL.INSPECTOR RECORD
<br />OWNI]R IIUILDER DEI,CARA'IION
<br />I hercny rrltnr undcr p.nrily,)i pcriry rl{r I rcxcn n. lhc (inrrrr.nn l.iccn\.l-,w ntrrl[nnhqirtrcrv (Scc.7Bl5
<br />Buntu\\ trd PdaN r (inlc) Art (iry.r Couny qh.h rcqun.\ r tf,nnir k) c.trnrucr. .r. ltr{rove. dcmoli\n.r rcpln My
<br />ntucrur.. priqr. ir\ i\\urn c. rlso rcquncs rh. xppli.$r lor \uch llcnn nr il.r \isncn irrcknn rhd hror\hc I h(urrJ Puhurn;
<br />ro thc nntri\i'nN ol rhc Cotr,rrcrors l-i.cned Lr* {Chrpr.r e. Connncncirs }ilh Sccltr,n ?(xl) .l l)i!ni(f -l or rhc Btrsinc*.rnd
<br />rypli.rtrrturiNnn[suhjc.hrh.pf]ritrrror.i!ilprfulryofiorntrrcrhmfi\chtrndrcdd.llirs(i5(X))
<br />-1.
<br />&s owftr of rhe pmFnr. or my cmoloyrcs wirh waBcs as rheir slc cohFnslrion. will do thc wdl 3!n dE sME ! m!
<br />i.rended o, oFcEd fo. eb (Sd.70.14. BuriBr od Eotctraotu Code: Tnc Coohdols Lhqe &w dc3 fl +ply lo an osnr of
<br />rhc lxorEny *ho trilds or in4m6llEmr and vto &{s sh w,tr hiDsclf or ncmlf o. rhtuugh hi. or rE oen cmt,.t€.s,
<br />provided rh.r such inpmv.nEnll m mr inr. k trofcFd itrsL.ll howEr, ttE huildiry or impmrmir ii $U wirhi. oN )et
<br />ofonq)Lrion. rtr O*nd Boitir will haw rlE hd.n of pmving lhd lE or rh. dil nor briu or inprcw thc pEFoty for lh. pu4rs. ol
<br />-1.
<br />as owrcr ofthc,m!.ny. amcr.hsirclyconrrrcrinB *irh li.cns.n conrraclBloconsm.l rh. pmj€.r lse. 7044, Busincs
<br />Md B.assi,r Codc: Thc contnc'or's Liccns. Lnw docs nor rpplr ro r. owncr of l(,'.ny uno builds or inprcvc! ihcrc.n.
<br />rnd who conrrocrs rbr \!ch pmFcrs wirh s Co mck,( s ) l iccnscd pu^uu ro rhcG,nkd.ktr\ Li.cnsc tnw)
<br />-l
<br />am.xcmfl udc. Secrk,
<br />TOAf,EBa.COIIIENSAITON
<br />DECI,AM:IIqN
<br />I h.rby lmm und.r p.ndry of !6jury onc of th. lolloeim d.ile{rions:
<br />I hr\( xiil*'lltruinrrhtr (..n iii.rrc ol C, urtrr k, Sclf li\urc ntr to'kcN con{rn\rr( . r( prnidci ir 6y Sccrion.l7lx) oirhc
<br />khor(-(xL. nnrk p.rlon ncc of rh. work ktrwhi.hihc |[.rnir \ i\sucd
<br />a/** "* *r,*ao" *.rt rs conrp. ssrior insurm., !s rcqui'.d by sc.rion r?oo orl
<br />rlEq rorwhrhrhB Fmir is i!$cd. V,soAs onlFMion inrutue mmr ad lllt
<br />cm, Fnus 4.Ke
<br />rh. L3bor Corle. lor rhc Frfolr1r.m of
<br />I ccnify rhar in rh. Frlorntrm oflh. wolk for which
<br />'hh
<br />p.rmil h issucd, I sh.ll not crploy any,Econ in any ddm,
<br />$ N to bc.om s!l,j.rr ro llr e*m'sq,ctrsrion laws of Califoni!, !d dEm lhd il t sholld lx<om subirl ro lh.
<br />*orkcrl $mpctrsotion pmvhions ofScclion 37OO ofthc Lohor Codc- I snrll.loahwirhd,6pl, whh rlh* Pmvis
<br />WARNIN(;] F,ilxr tr {rur. work.6 con,,.nsaitun orcmgc iq unlostul. and shall suhir! 0. cmFlorr lo ::r'illrir4,',.ivil finc\ ul, ro on. h!.drcd rhou$nd doll{s (5100,(XlO), in rddir
<br />:::s;#?-& lpprronr,
<br />LII:EAIiEDJONI&ICrcA
<br />DECI.AIAIION
<br />Ihcrcb,alnmunderp..allyoiperjurylh l !d lien*\l undc! provisi(,. ofchnpr.i 9(.omnM.inB wirh sG-rion ?UD) olDivhion I
<br />of rhc Drsincss nnd Pnn'c\sions Conc. urd flry Iiccnsc is ir Iull lnrcc ind cr'rc(l
<br />cz0
<br />re
<br />SIII,IIBUCIIANIEIIINCJ(iINEI
<br />Itunhydrfinnudcr tE.,lltofpcrjuryrh0r Ih$c iracotriru.rirtr hndin8rrcncylorrncpc ormncc ol rhe $o* tor ehich rhi\ peoln n
<br />h\rcn lscc.1007. Civ. C )
<br />AETLUANLIECI,ITBAIIA!
<br />I tlnhy nfiim undd pcnrlry orpcrjoryonc ollhc lolbwnr8 dc.lur nnrs:
<br />Llcmhion PurnirsArttsror Norili.ortnr !.dcrul Rcruhti.ns (Tirlc 40. I'rd6)
<br />Rcquncd hrl.r of NolrRdnn
<br />-l
<br />rcniiyrhd thc ndcrolrcsuhlion\ rcsmdin8 $b.\los rcnnv0l urc mlqrplic$lc lo rhispn,jccr,
<br />I cdiiyrha' I hNc nad rhir 8tlliarkrn aftl sarclh rh.at v. inrorroltun kcord ,o8re
<br />odi.amcs and Shrc tiws rchri4 ro hlildins ons|tut ion. rd hcrcby aurlFrirr en c*.idr irci o
<br />APPROVALS DATE IDiSIG.COMMENTS
<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 Delectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room i Clothes Dryer
<br />Residential Ranoe
<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 />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release l
<br />'1\u5l t g )Wt iq)
<br />Notes, Remarks, Etc
<br />htrc nrfri(itr.i Jirr|{ny
<br />Amli. lur AgctrrSiBhr ***,L
<br />ro enply *hh a[ Cny.nd Cor.ry':""8W;;'-
<br />FINAL
<br />baTq<s
<br />*9
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