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MECHANICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTSAPPROVALSDATE <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 />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <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.il l{/t4 <br />Final Test <br />Meter Belease I <br />FINAL z/?4 n4/'/ze <br />Notes, Remarks, Etc.t <br />()WNI,lR AtilI,DUR DEI-CARA'f lON <br />I h.r.hy olllrnr un(ls |Eflrlr, of lr.rjuy rhar I rm crcflfl hnn Ih. (i)nira.tE l.ic.n{ l.ns ntrrhc lolloBir8 r.r$n lscc70315 <br />Ilusir${ 0Dd Pi{,lc\\i,n, (1 c). Aiy Ciry ur Cou ry whi.h rcqunc\ r tb rir ro con{ru.r. !l(cr. inr[o!c, d.trk,lNh or rctrn y <br />ntu.rurc, prior ro irs h(uarcc. rho r.quir$rhc arpli.lnr lbrsuch pemrir i,lil.r \i8ncd i cok rhd hcor slt i\ li.oi\.d Nr{ur <br />l,)rhcpn ision\ frtf, C.nki.ror-i Li..n\cd Law lchrod 9. Comnr.ncing *irh Sccri,,n TlxX) or Di!,!k :l ., lh. Atnnclr rtr,l <br />l'mfr\\i,'n\CodcrorrhJr h.orshc i\crcnU rhcrchnnrnd rh.ba\i\ rtr rhcrllctcdcrc.r!rion Anyvidrrn,i.lSsri({11}.ll5hyrir_ <br />itpli.lN tu aNnnr suhjc.r rlr rptlcr tu.cililpcnrlryoinorEtrcrhmfi\.huidrcddollr\(3500r <br />-1. <br />&c owrer ol rh. poFnr. or m, enlloyes with wagca ca lhct $k onDcntalion. wiu do lh. wo* od tlE sttutE b mt <br />inlcfth or of,crcd for eL (SN.?044. Blsimss sd PrDfe$ionr Cods Thc Crnlr{toas Lien* Lre does mi +Ply to d oser ol <br />rh. For.ny *no hilds or itrieB dEptr od wlb dB Mh w)rk him*lf or lb*lror ltu u8h hb ot h€r oM.nor.,@s, <br />Dmvilcd lnd such inDtoEmds m ml imo&d orotrctrd for sl€. lt hosq. tlE t ildins d trllmEm n $b ri6in om Fs <br />ofsrptxioi. tlE or"Er Buitlr will haE 0E hr&i of FovinS li.l tE or shc dil mr bild or inprorc lh. poFry for tlr Frpos of <br />-1. <br />as owrcr of lh. In,rcny, !m cx.lusivcly onl@tins wilh liccnscd conmdsn lo sontod lh. pFlrl (Se ,o44 Blrre* <br />,flt Pint s\im Codc:1hc C6.kkror's Li.cnsc Lrw d6cs.or al,ply lo anowrcr of prop.dy vho builds or improvcs lhctmn. <br />.nd who onrBls ror such lmlclr {iri a Conrrcro(t liccnEd lu(@r ro rlE conlr&lois Ltc.s llw). <br />I &tcxemn' undtr Se o. . I & P C for lht rosn <br />!!]8.[EIN:I;AUPJNSAIITN <br />D[CIAf,AII9Ii <br />I hcrcby allirm undcr I'cNI'y or rdjury onc ofihc rollowin8 dcclamtions <br />-l <br />hsvc ud $ill rMinrdin , ccnil^_0rc oi Consnr k, Sclll n\ur nx work.* c.mpcns ion.is ProlidcdaohyS.crbnl?(x)orrhc <br />bhor Gnq lb, rhc pcrtomffc .r rhc wd* for shi.h rh. |xnni i hsucd <br />Vhrlr rnd sill nrinbin workcn .ompcn\arion insuruh.'., r\ rcqond hy sdrmn 3700 or thc lihor codc. kt rh. t)clfoirmNc ol <br />rhc wolk for whi.h rhh pcnnit i\ ksucd My *orlc6 conFn\arbn iosnrjRt cnFkr dd Inlky nlnhcr e.: <br />bo G<m44> <br />-t <br />ccnily rhat in rhc t). formme ofrhe wor* ror whi.h rhir lcrmn k issud. I sholl nor.nPloy {hy Pcd,n in.ny murcr <br />$ sr ro trc$m $bjcd ro thc work.u'compctrsltiotr lows ol Colifomia. s.d ugM rhd if I should t8om slbrc{ ro fi. <br />worksl comE.sarbn tn)vhions of Slclion l70O of lhe Lolnr Code, I xhnll. fonhwith .ondy with lhos lDvirnrns.. <br />WARNING Failurc lo surc Ml}cr' oipcng{i.n .ovcfl8c is unlawtul. and rhau subi.r an .mPlo}tr ro sininal Fn lrk lnd <br />civil 6n$ uI, ro om hunded rholsnd dou4 (SIOO,mo). i. additioo lo $c cosr of con.nstion. damScs aq lrcvidcd for rlE <br />sorion 1(r?6.f rhc Intnr Ir(1lt1 <br />U(}:ISITLrcNIIII-IUB <br />DECI,INAIIAN <br />I hctohy nrfii,n ud.r l..rlryoflErjry rhl( I !o lianrd und.. pr.vi{on otChnplcr I (la'mnrmins ailh sNri'n 7([0) oiDivi\ion:] <br />or ric ltuiNss rll t'snd\sions(ndc. rM ryliccns is ir lull nn.c aBl cffocr <br />Or. 7 <br />coNsl llucl I(rN I INDIN(l a(iENCI <br />i\{'cd lS( l(D7. Civ ( lt .&r.t Nm: <br />- <br />l.ctr.lr'. \ld,c$ <br />a.t[u! i[DItcL x^lll)N <br />I h.R.nt ritr x id.r tcfulry.flc.juy onc ol rhr n)l[NiDE d.clrrrri(,n\] <br />Dcnn,lniin Pclnir( Ashc(o\ Noriturri( lr.d$Jl Rcgul.ri(D\ (Iirlc 4r. I'xn6) <br />Rcquncd hncr.l Norificrriof, <br />l.cnityrh$ rhclcdcrulresuhrioo\ rclddins ashsos rcnnrvrl arc ml rrPlic,bk ro Ihi! lfl)i.l <br />-l <br />c.niry rhnr I havc ftad lhis lpplicarion and \rdrc lhar rhc fltsvc inrormriotr h corccl. Llxrt lo .omPly anh sll Cil, lnd Co!.ry <br />otdinorc€s unl Sr{t Llws rhlinBlo builditrE connocrion. and h.rcby auhrB rcprcFnlativcs oflhir Ciry ond Countyro€ilet ol'on dE <br />rhlc mnrn,ncd piol).n, ntr irstcd nr n purFxc\ <br />^,-z/ n f v <br />,MA <br />Vents <br />Hood <br />Amlicont or AEEfl Si8narui. <br />--------T------ <br />I <br />=