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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation -3 ktuld EklttDlt $ueY w4J( <br />lnsulation <br />Smoke Detectors lnstalled .A\ <br />Rouqh Ductwork N,lu1a'Ptgwl <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />frtytr-ttllttyTv 7DAbove T-Bar ll UI <br />Rouqh Mech. <br />Final Test <br />.x-ytcqtl/.FINAL ttb/h'n 1., ) <br />Notes, Remarks, Etc.UI <br />f hz- Ufnto ,L- o-t 0 oJ ,, <br />{\ <br />I-I)IaR DIiL(,\R.tl',l(,1 <br />I hcrcby rr"n undd p.@lry of pcriury rh,l I m crcq liDm E ConFlcron Lkctr$ tw lor thc fotbwing lNi (Se.r0Jl.5 <br />Blsincss lnd Prcfcssbn Codc): A.y Chy or Counry whkh rcqubcs a rxrnn lo 6nsroct. alls. imprcrc. .lcmtkh or Elui. dy <br />sm(e, Fi'r to ir! hrur@. d$ r.qunar llE eprli.lnl tbr $ch Frnil lo lih a .i8Ed rlslemnl lhlt lE or shc ir li.cned pu^!t r <br />ro rhc Imlnions ol rlr G)nrEtoa. Lkcnsd (,w (Chapro 9, Collmmins *ilh Scctio. Tq)o of Division 3 of In Businc$ and <br />Prolcssions Codc) or ln lE orslE is cxchpl lhcaaonaid ft. hqris ror rht allcScd cxcnptiotr. Anyviolarionolse'ion1031.5byony <br />aprlic.nr for a ponir slbjccN rhc rrtlicot lo s civil lcnally of nol mrc lhtu fivc hundcd dollrs (3500). <br />-1. <br />as o,rer of rh€ l,lFny. or my cnplorr.s wilh waScs I lh.n sb compen$rion, wall do th. wort 8rd l,E nrtlft ir er <br />inr.nd.rt or ollced lor s& (Sa.?O14. Blsincss ed Prsfcssions Code Thc Conlrclol s Lic.n* ljq docs nol aruly (o e owmr of <br />fic pmpqry who trilds or inphh tliren dn wb dB s.h mlt himself or hcelf or fiNlgh hh q her os. rnplottc!. <br />torit d rhll skh irp$wm s @ ml inl.dH oroffcEn for sh. lf.lEslq. rtE h'iiuinS d inpoErd t eB sithin om JEr <br />oforpLrbn. ttr O*F Buillr wiu haw dE hsd.r otFovin8 thd lE or slrc dil ml t ild or inllme 0E tmFiy for lh. Frlns ol <br />x as o*ncr of rh. rmpdy, amcx.lxivclyconkaclinS wilh li.cnsd contr lorlo oni'd.i irE ImrNt (Ss.7044. Bu\imss <br />hofssir Conci Thc Contruclort Liccnsc L€w docs not arply lo !no*mr oitror.rly who huilds or imrtovB rhcrmn, <br />lnd who contncrs l'or \{ch porek *irh a Co mdo(s) li.cnsd pursonl lo lhe Contracrff s Lrccnse l:w). <br />DECI,A8AIIOtr <br />I hcrcby.mrmundcr pcnalry oa pe.j!ry 6e of th. louovin8 ddlr ions: <br />I hntc {lsillnBinrair rCcnili.rrcolconsc h s.lllinrc n sor lcr' cunpln"dnn,. a\ Ir'ovidd fd by Sccr i{nr :lr(x) o f rh. <br />ljhtrCodc. for rhc pcrlr).in0nccotlhc *tr[ I(n whi.hrhc trnii '\ ^\ucd. <br />Ihsvcandwillmainr0inworkrlcomp.nsalionanslrancc.{slcqdrcdbySeiion371{orthcklhtCodc,lorlh!pcorm.ccof <br />thc vorl ior *nich $is p.rmir is iss.t, My work6 compcns,rnrn in$.mcc oricr md lolicy nun$c, rc: <br />-l.cnifyfill <br />in rhc pcrforrotue of rh. {ork ror whhh rhil Fmir h issucd. I shlll nol cdploy rny p.mn in lny nwftr <br />$!srob€sftiubjerrorhc*o.6.omF.solionlawsofcolifomir.andaeBrharilIrhouldbc.omslbjcdlorh. <br />sort6 @opcns ion povisio of Setion 3?0O of lhc L{Er Codc. l shall, lodhwilh comply wirt lln$ Imvliio.r" <br />IVARNIN(;: r_dilurc !) $.urc workc^ comPcnsulior covcrrar is unhstul. rDd {rall suhiccr ur cnlnoycr ro dimirrl Pcmlrics rnd <br />civil fin.s np lo onc hundrcd lhousand doll$ (Sl conrpcnsrio.. ds.De.s 0s Drovidcd for rhc <br />Codc. inlcrcsl lnd dttrruy srLI(]jNIDD-II)IIXAIIIIBDli(lt8/lltu\ <br />- <br />ContBlor: <br />QNSIX!!.UAtLLIiJDLlllrI{ili:CL <br />I hcrcb, artrm und.r Fmlry or pcrjury lhd thcrc k a .on(ruction lcndins ng.ncy ro. rhc ,Erfonmmc of I hc wor* r(tr whf,h rhis rrmir i! <br />hsucd (Scc 3097,Civ. C ) <br />A.TILICANI.!&EIIBAUA! <br />I tu$y aninn uRlcr pcnlht oft*rjurt o.c orthc rollowirS dcclitdn,trs: <br />Dcnx,lirion PcrmnrAsh.{osNorificalion Ederul Reg!brn,n\(Tirl.40, Pd6) <br />Rcquircd t ncrofllolifi. i.o <br />-l <br />ccnify rhar rhc fcdc,al rcgubrions c80dinS osh.nos rcmvd sc nor q]plictrhL l. rhis tmj..l <br />-, <br />ccn ify rhor I lElc rcld rhl dnpli.nrion Md $.rc rhar lhc |k,vc informlion is c6ftd LEm ro cohply sirh lll Ciry ond Counry <br />.rdihlkcs md Strtc Llws rcllln'E <br />8k,vc mntiomd ,mpcny lor <br />Applicanl or AEc Sisnalure:_ <br />D <br />hcrcby,urhorizc rctrcscnlolivcs "'":":"'a;l;',;'" <br />Meter Release <br />Poli.y N!mbc.-xpiEs: <br />I hcrcl,yalftmundcr pc.alryolpcrjuryrhnr I n li.dtrwl uid.r pturi{nr oiclupr.r 9 l$ nk cin8wnhscclion7000)orDivi\n,n.1 <br />of rhc ausnrs rnd Pdt$iux (inlc. and my li.di\t i\ irr fulliar.c tclltcr. <br />Lcndcl3N.m:- <br />I <br />I <br />I