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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />It/isc. Equipment
<br />Pre-lnsulation lo-lv'tv VJil]hdl
<br />lnsulation /
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Hood
<br />Type lHood y'Ft>Y
<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 />Bouqh Mech.
<br />Final Test
<br />Meter Belease
<br />FINAL
<br />Notes, Remarks, Etc
<br />Hfi-:I til/b cLe I J^"tC IUr;?-zk'tY dhgl dtL,\\ r\ Pni-t^,,\P ld -tr-ty IJdI\
<br />OWNFJR BUtI,DE'I DEI,CARNTIoN
<br />I luub! rfllnn uddcr pnrlry .l pcrlury rh l am cx. rpr liom rhc (btrtddor\' l-i.cnsc lis hr rhc tulkNin-! .cN)n (Scc 70.11.5
<br />Bu\n$s rlxj Pn)lcssnr C&lc) Any Ciry or Coutriy shich r.qutc\ r lrlmir l,i ..n(dcl. rlrcr. i'1l[)n,vc. d.noli\h 'tr rrrrn Jtr)
<br />n'lcrurc- lritrlo ils irsulEc. d{, rc.tuncsrhc utrplic r f{ nE[ p$nrir r{,lilc r \iancd ddcntnr rhrr h.oi sh. i\ li.ctr*d Pur\uanr
<br />t' rhc pmrGn N ol rhc Cont,.ror's Li.ctrscd Law (Chryr.r 9. co,nmcmi.e sith Scdio. Tttxr ol'Division .l ol rhc tlu\incss rnd '
<br />,rrolcsrn,.sCodc)orlhrlh.orshch.xcnrplth.r.iotrrd,rdrh.t^lshlnrrlrolkscdcxcmption AnlvnndionofScdin'70ll5hyrny
<br />amlicr Inr!ncmitsrhjcllslhcrppli.lnrlo!civilDeDullyoinornnrcrhrnfilchuidrcd.llIs(S5u))
<br />-1,
<br />Ns owrcr of fi. pmlrrry. or my cmrloFr wilh wag.s s rlPn $k compcnsthn. will do rlr w6t Md dE stnr@ i{ rcl
<br />i e.dcd or oltcrcd for sl. (Se.?Ol4, Buiiftsi ,!d Profc*ionr C6dc Thc conrEror'3 Licnse L.w &cs nol apDlr ro dn owftr or
<br />lh. tn,Fny sho hoildr or i"pmEs rlEetr ,tn wb &Es slch elt hificlf or h.isclror lhrc!8h hh or hs own chphycei.
<br />proridcd rhd such inV,bw@.l3 m mt i.l.ftk oroficrd for eh.It ho*cw. tlE hoihirg or i,prcEm issld*nhinoe)qr
<br />ofcorthion. rl.. O*rr BuilLr will hlr tlr hllthn of pmlin8 rhd lr or dE dij hr h{ild or inlnnw hc ImFn, tor dE plrpoE ol
<br />s!lcJ
<br />-1.oso*dofrh.Ilopcny..n.xcturi{clycootlclingwirhlien*dcon.clo6tosnslrucllh.prcjel(S*.7(X4,8ulirc$6d PtDtusbn Cod.r Ttc Conlmctol s Liccnsc LN docs mt lPll, ro M owM of Eopcny who buildg or inlovcs lner6..
<br />ard who onrEcrs for such ptu*fis with 3 Conr.cto(, liccr$d psuin lo lhc Co .mlols Lhcn* tiw).
<br />-l
<br />amcre'nnl undcr S6tio
<br />!!l$[45:srMIESlArroN
<br />DECIJAATT]N
<br />I hcrcby 3ffrm und.r rEnaly of D.riury oG of tlE followiry dehElioN
<br />-lhrlc!,illnuin[i.aCcniticflrcorc{'n{nrl(,Scl,:ln\urcf(workcra.onlp.nsnrir)n,nspmvid(lf{trhyScclt,n]7(x)oflncL!6or codc. lor thc pcrtbrnu.cc olrhc Nork for shich lhc Fnnil i\ i\lucd
<br />_l hlre snd I ill d.iotdin wor*c6 comFns.rior insuram.. ai nquind hy Setion :l?00 of th. L3bor Code, for ltc Jdfo,@e of
<br />rhc vork lor Bhich rhis p.ml & is$cd. My w t6 @npcnsation insum ffi.r dd lolicy number @:
<br />I ccnilyrh.r in rh. !.rformmc olrhc qork to. Bhich rhh l)crnrit is nsud.l shlll rer ciploy any p.B)n in rny monmr
<br />s ro txsom sub]cd ro rhc worl6 ca.{4orario. hws of Calif(,mL and ,8M rhar il I 3hould t .o'm suhicl lo rhc
<br />worksl ompcnsarion pmvhion\ ol Serion l70O 6l rhc lnh.r Codc, I {ull ronhwirh co'nply wirn lhos pn'vhbns .
<br />1VARNING lailrc n, *.urc {ork.ri conf.n\ari,tr, r r.rr!.cnlplols nr diminrl lrMhics .nd
<br />ion. daroE* a\ tbvid.d lor rh.cMl fioc\ ut r. of hun<led rhoue.d dolles (ll0(,.000), in .ddn
<br />Sdrb. 1076 ol lhc lltv Codc. inrcE$ {nd 0rbmy 3 fccs
<br />LICEILiEDI;!.INIIACIAB
<br />DECIJAAIPN
<br />I hcrchy rfiirm undd pcnalry of pcrj y th.t I om liccn*n undcr Imvhion of Chrflcr 9 (.ohft.cinr uirh sdi,n 7m0) of Division l
<br />ol rh. Bu\inc* nnd Pro,it.ionq codc. and nyli$ns n in lu0 n,n !.d crL{t.
<br />caNllaiJcrl!)Nrl;NDllic-&clNc}
<br />I hcNhy amrmundcr ltnllryofpcrju,yrtnr rhcrc i\ a Ltnd crionkndi{aa.n.ylordcpdlonmnccoithc*orkior}hichrhirFnnili\
<br />is$cd(Scc 1097. C,v. C )
<br />AITIICITN:LDECIABA:TI!}N
<br />I Ed,, rllnn und.r pc ah y or p.rjfiy om of rhc n,lL,* i'r! dcclmr i.n\:
<br />D.trx,lirtr Pcnnii\ Asb.{o\ Norificdion Fcdcrrl R0BUhidn( lTitlc 4). tun()
<br />Rcqutu\l trlcr of Notilicdirn
<br />-l
<br />.cnify lh0l rhc tidcrd Bgllalions rcSrding &lbcslos rcnErd m mt at pli.lbk lo tht pojd.
<br />l.cniryrhlrlhlkrcadrlr(,tpli.nriotrrtsrat.th,[h.0tnv.infoirDrionGcotrsr I lsxe rocnfrplysnh r[ ciryand Counr,
<br />ordiolnccsondSrarcLiwsEUin!roblildin8.onnru.!bn, d h.(h,Nrhrnzc rcFrcscntarivcs olthh Ciry u.d Co,nry r...rc. ulrtr rh.
<br />abow tunrioncd lmpcn, for
<br />Appli.nnr or AScn' SiSnrrurc W
<br />tglEtil,lru!fi|
<br />I
<br />Duct Work
<br />Vents
<br />Other
<br />/^
<br />\-JLrd)
<br />l, lr ()sn.r
<br />LlnrLr'r Nrm'-
<br />*,. z/zy'a
<br />I
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