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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.
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