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DATE ID/SIG.COMMENTS <br />Appliances <br />Ir4etal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />l\ilisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood .< <br />Type I Hood h4Jt I <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 DJTLI(,I <br />Note$, Remarks, EtcSlrrlq olt- to w-a.P DD7 <br />5r-5V't, {\-u/}.h+ oK 5't 6-{"1 "twlJc:I <br />tiEEE$il <br />MECHANICAL-INSPECTOR RECORD <br />O}TNER IUTLD6R DELCARATION <br />I hd.by.Itm undd p.nally ofp<ju.y tal I @ .rmpl ftom lh. Conr.doR Li.ate L.v for lhc follo*hs ,eei (Sa.7oll , <br />8Bin6s and Pro&$io. Codc)i Ary cny or co! y wnich rcquiB ! ponil ro .oNruc1 all6, improrc. daolilh or !.pai my <br />sirucru., Fior io irs issnNc, als Equt6 lhc applicot for rlch pennil lo 6l€ a sisncd stolold ifial h. or sh. b liccns.d pcuafl <br />ro lh. prcvi.ioN of $. Conlrlclofs Li..n*d L.w (Ch.fler 9. Coonm.irS w n S(tioo ?000 of Oivbion I olth. B$in.s dd <br />Pr.fcsions Codc) or rhar hs or sh€ i! .rcopr th6clio6 @d tn. t6ie lor lhc dlcg.d cidBio!. Ary violarion ofs.qion'701L5 by dy <br />applica.t for ! panil subjdls lhc rfi,liot lo. ciril p.,ahy ofnol rcr.lh@ fiv. huidt.d dolls (t500). <br />-1. <br />s oMs oflh. ProFly, or dy dplor6 wih erg6 s lltci. $1. orposalio'r, will do tlE wo* sd lh.!ltu.r@ 6 mr <br />inr6d.d or ofd.d fo. sal. (56,704r. BEi.d &d ProlBioN Code Ttc Conlmlor'3 Lic.M Law do6 @l eply lo d oMd ol <br />ll& piopoty wl[ b'ilds m hlplv6 rh@l\ dd wlD do6 Mh wi( hineclf or hoslf or tl"oush hi! or ha oq 6ploy6, <br />provid.drh.r such ampD1E@B d. mt inldd.d or ofd.d tu elc l[ howdE t[. h{iftiiry or inPrMF i!$ld wirin oic td <br />of@npLrion, rh. Oms Builda *iI har $. hrddr ofFovi!8 thd h. or $. did mt hild ot itrprD€ $. ,tlFty for fi. FEPoeof <br />-1, <br />6 oM6 oflnc Fopqtr. m .x.lsivcly cornr..dng wth liccNcd codrrclo6 lo @61tuc1 ltE Fojd (Se. ?044. BEi6 <br />{.d Proft&lbn Cod.: Th. Conlr.crol3 Li.@ Lrw do6 @l +ply lo d oMd ofproFrly who buil& or inpbld lhcon, <br />dd *ho oitn(,3 ao. luct F.jel! with r co 6clo(s) ltd.d plEuer lo lbc con$tclor'! Lic@ taw). <br />-l <br />M cronfl udd Sdlion-. B. & P.C. fot lhb r.@n <br />Dil.: __ ORnd: <br />\{OIT(ljRS' (:OMPENSAIION <br />DECIA8AIIO! <br />I lr@by afUm und6 pdally ofpsju.y oa€ ollh€ aollorvins d$ledions: <br />-l <br />har. md *ill mai.tain a C.nifi.al€ olcored ro S.lfi.sure lor milas' @nvms.tion, s Fmvidql lot by Sdlon 1700 of th. <br />Labo. Codc, lor lh. pqlorlMc€ oalt. wo* lor \ hich lh. lsnit b isued. <br />-l t.!c d vill mainrain *oltea' conpcnsalion iNlranc.. s rdluted by Sdlion l70o oflhc L€bor Codc, for thc pdfomdr. ol <br />rh. work ior s hich lhis p6dir is i$.d My work.R comFsation iasur.occ cano dd polic, numbr m: <br />-l <br />cdiry Od ii lh. pdfolmDc€ of lh. wo* foi vhich lhi! p66it i5 s!.d. I shdll nol dploy sy FBo. in uy hed <br />e s to beom. subjer lo lh. efi6 @mpos.lion laB olcslifomia sd asc ln,l ia l lhould beoh. subjd & rt <br />wort6' comp.elion lDvilioG otsdrio. 1700 oflhc l2hor Code I shsll. fonhsirh @mply wilh lho* povisioE . <br />lrARNlNc: F&l@ ro s@ work6' dnpds.Iion coc.gc h ulhwtuL ed snlx subjdl e @ploF lo aihinol Fulb tld <br />civil lin6 up to oo. hundr.d rto&nd dous (tloo.000). i, .ddnio. b 6c cos of @np.s3rlioI. dtn$6 a pera.d for {!c <br />sedo! 10?6 of lh. Llbor Cod., iDta.d dd atioEr't f6. <br />aDDIot- <br />ttcElsl:Lg)lrlAgaB <br />lrlct a&r.ua! <br />I ho eby amrn undcr pashy ol pdju.y rh l d lic.ns.dunddPovisionoIchapldI(.onnnocin8 sirh Sdio. 7000) .r Diviri.i l <br />oa lhc Bci.Bs md Poasiors Co.lc. od <br />'ny <br />licd* is i lull tbrcc md effdr <br />CONSTf,T]CTION I TIINNG ACFNCY <br />I hd.by alrm @d6 Firlty of pdiury fist rhcc i! a .o8tuclio! Lndiis .Bdcy toi ihc psfo,l@c. of lh. w b. wiiclt rii! pqmn b <br />brucd (sa. 10s7, civ. C.). <br />I cdily that rhc Ldsal rcsulari.nr rcsa.lin! 6b6ros ronolal ec not applicable ro rhG projd <br />I cdilyrhd I h.v. rcad rhis.pplicarion d slare rhar rhe al$vc inionnarion is cord-'t. I igre r. complyrith allCnyandC.u.l, <br />ordinancB dd Srar. h*s Eldin! lo boildioS .oNttuclion. d fis€by outhoiize rcl,Bmtarivg oflhis Cny md Coonlr lo dls upon lhe <br />.bo\ c mo ion€d prcp€ny aor iGrr<rion puqBss <br />Applicdr or Agdt Sirnatur€ <br />APPROVALS <br />1-t5-t1 <br />rr-s <br />rolicy Numbo:-ExPit6r <br />- <br />L.nd.rs Addr*: <br />- <br />appucliiisai^i ii6 <br />- <br />I halby smm und( po.lry oir.dtory orc of thc following d(!trllions: <br />Dotrolirion Pmil9AsbcrG Nolifi.alion f.doal R.sulalioB (Till.40, Pan6) <br />R.quircn ktld of Nolificdion <br />T <br />I