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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTYNER NU I LDER D}:I,CARA'TION
<br />I hcrchy alltm uftlcr pcnrlly ol l)crlury rhal I ur u.flpr ion rhc Coitr.ttr\' Lkctr* ljw tur rhe lolh$ire rcrvr lscc Trll 5
<br />Ilr\i',c* rtul ltol!$i,D Cikl.): ry Ciry or Coutry whi.h rdtunc! r turnir t' con\lnrcr, !hcr. impnvc, dc hllsh or icPtir rty
<br />{rucrurc. prnn ri ns iscuance, rl{i rcqutc\ rhe lppli.nd lir su.h t^-nnirt,lilc! \i!trcd {nrc ttrr rh hco! shc n liccnsLn Prunr
<br />r' rhc !,ovisirrN .l dr C.nrn.rn's t.i.cnscd Ll* lChnprcr 9. Connlcncir! wirh Sccrn,n ?(XX) of Diviin,n :l ol thc Ausilrcsr rtrd
<br />Pn,icsions Codc)orlhit hcor\hc i!clcnrDr rhcrcrionJndrhc hri ttr rhcnllcsrd crcnprn,r. Anyvn,hriotrol'ScclionT0ll 5 h, xtry
<br />rprrlicanr lar t p.nrir \uhjc.r\rhc aprli.rnr b,.ivilpcn/lrrornor fttrcrhnn livc hundrcd dol16(S5fl))
<br />Jb)
<br />)ql..h oqkr.'lrltrr,n,ncdy.nrn'ycn'nlorcu\tr r' {is.\ as lhcir r,l. $ ,Fn\rior. will ,lo rh. Bor k and !hc (uru.c i\ nol
<br />i' cndLrl or olhrcd ntr st (sN.70{4. In\ikss ,trd Plo lc$nflr Codc: l hc (tnrrrmroi s l,i.cn\c LN doc\ nor rrtly r. trtr ostrd of
<br />rlt |mrtcny who huilds or impr,rc\ rhcF,n. ud who J,E\ \uch $ort h i'n\clf or h. clforrhtuuthhisorhcto*ncn[loyc.\.
<br />p()! .d rhrr \urh infn^.nrin rfr n r inrc,rul or ott'.d f(tr slc. ll. ho\rcEr. rrs 6ui[ing or inpnM Etrr i\ a,lll sirhi. o c F{
<br />oicon{'ldno. thc OuN, tsuiLl.r $illhrk rlL huRtcn olpn)vi',! rhar h. or \hc dkl Rr hoill or rryrot rhc pmpctly f{n rhc !!rF)t of
<br />-1.
<br />as osncr of rhc propenr. lnr erclusivcly conrrrine shh liccBed conho.roB to snslrud ltr pmjccl (S( 71X4. Bhines
<br />,rid PDftssim Codc: Thc conr"dols Li..nsc tjq dss nol sprly lo M oqnc, of ptoFn, who build! or inprovcs thcr€on.
<br />und who cootach forset rfticli wilta Coohd.(s) lien€d pununl to lhc Conlmtols Ltcns L,D).
<br />.,t9 o"*.,14
<br />DESAAAf:I!,IN
<br />I h..c5, ,fti.fl utu1fi Fn,lly ol0cqu,y orc ofthc loll,,wirs de.-lralk,nt
<br />I hsvc tulwillnuinrainaC..ilrarcoiConrcnll.Selllflsurcforeor*.r'.onp.n$dn,n.a{ ln,vider! ror bySe.-lion 3?(, otrhc
<br />Llh, C.d.. nn rhc lclfommc olrhc work td qhich rh. lxrn i h nsucd.
<br />-l
<br />h.vc rnd willnroinlain workcN conpcnsarion in\!r.n.c- a\ rcquncdbySc.riotrl?00ollhcLsborCodc.lbrlhcl.,lonu'ccot
<br />lhc work iorsnichthis prrmil ir n\ucd. Myworkda @ rncnsa,ioo insurnn.c.anicrudrslicynumbcr ue:
<br />-l
<br />enify rhar in rtc |lcrfortutuc otrhc work ao. shi.h rhi* r.rml is nsucd.l shlll ml cmploy uny pcRon in rny mtnRr
<br />$ .r b b.n)m ubid ro fic wo dl snwnelion lows ofcaliforni0. ud lgtu rhot irI srhtrld tEcom subjccl lo rlE
<br />work.re' omp.nsdior pmlisions of Sdion l?00 ol tlI Ltbor Cod., I dell. a.dh*nh oryl, wilh rho$ tmvhions..
<br />WARNINC: Failurc h se workcB .oopcos,rion ovcng. is unltratul. snd shull subjer M cdplorr lo aiminalJtMhics ond
<br />.ivil linc\ up lo oDc hundrcd rhousn d dolhn (S|(X),01X)), in dd io.. dutuCca es ro?dcd for lh.
<br />Smrion 1076 ofrhc ll}nr Codc inr.6{r.d r omv'
<br />o,,". . 8/-, I n, n,o-^,
<br />UIIXSIDIIINITAEIOB
<br />DECLAAA.IION
<br />I h.toby lnnund$pctrillyolpcrjwythot I om liccnsdutrdcr nF!i\it'n,,rChrnroel.o rmncrn-s\irhScc'i,tr?trn)orDivkion3
<br />ol rh. lr,sinc\s and Pn,r.sqion. codc. ald ny li.cnsc n in tull fom ufrl.iltcr
<br />CONIISIqITONIIDDAG.{GESCI
<br />t lErby sflrm undc, ,.Mlry of F iu.y thsl ilEe is a onslocli,i lediog !9.rcy for llE pdfot]re. of lhc *or{ for whah lhk tBmn is
<br />hsucd (56. 1097. Civ. C.).
<br />AIILICAILD&CLAEATTAN
<br />I My &ninn undcr pcnahy or Frjury oft or rh. follo*inB delnral ioos
<br />Dc x,lirion PcrmiNAsh.sos Nolificoiion t'cdcml Rquhrions (Tnt4). Pan6)
<br />-Rcquncd
<br />krrcr of Norifi .arirr
<br />_l enity rhar rhc f.itcr,l Egulalions rc$rning atrnos rmvd dc ml lpplt.blc to lhis tFi{r.
<br />-t
<br />ccnify rhar I lEvc rcad rhis aDDli.lrion aii iblc rMr thc ahove info@lion G coKl. I osre lo ory)ly unh all Ciry and Counry
<br />onlinumcs Md Srri. Lzws rchlinS ro huilditrB consrrucrn[ und ,uh.rircrcprcsc .liv.sorrhisCiryrndColnry
<br />ot vc m ioncd Impcnyioi inspcclion
<br />\a
<br />, K lHlln t't G Ptlt )
<br />,/t 'oTsueon0E
<br />.//g
<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 />Rouoh Ductwork
<br />Vents
<br />Toilet Room i 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 />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL tll2Jlt?i Wn:vtt+<t a-,2)
<br />Notes, Remarks, Etc.U I
<br />-.'}
<br />L.ftL N!m:
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