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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNM BUILDER DELC]ARAAION
<br />I hcEby amrm undcr Fnahy of l,.qlry rhal I d cxcmfl fron &. Co 6rou Lian* taw lor $c fouoshg t@on (S.c 70l l 5'
<br />Businc$ ad A'nfrision Codc)r Any Cny o. Collry which rquiG . pcmn lo onrtud. tllr. i'npovc d.m[sn or EIan rny
<br />socruq ,rb. ro n! isswe. ulso rquircs thc lptlt l for slch pcmil lo fiL ! sigftd saLmnl th.l lf, or slE k lien*d lumaln
<br />to thc pmvnions of rhc Conrerofs Liccned Llw ((:l'rptc! 9. ComminS wilh Scclior 7000 of Division I of lhc Busift$ and
<br />Professionr Codc) or rhlr ts or shc k crcmpl ihcr.from ed lhc h$h for lhc lllcscd cxcmrlion, A.yviolationofS.di,nT0ll.5byao,
<br />rpplkan ror a pcmn subj{ris rlE lppliconl ro s civil Fialry of mr m.c rMn nv. hu.dEd dollas (5500).
<br />-1.
<br />&i owm, orhc prDFny. or my.mplor4.s wilh w08.s 6 thcir $L oryrcns€r io.. sill do lhc sot drd th. stnItw is rl
<br />n endld oroficrcd for sk (Ss.7044, Busi*s dd Ptolcssions Codr: Thc Cortrcrols t,kcfls Llw dms not atdy ro ti o{nd ol
<br />thc ImrEny wln hoilds o! inlnnB rh.En. ,d wh. d6 trh m,t hims.lf or hcr*lf or lhnrrh his or ho ovn.nPloy.cs.
<br />provid.d rhd such injpmrmnu e mr i .nd.d m orcnd lor sL. ll h.wrci l,E hliuins or inlmEmnr ir 5ld wilhin .nc yt{
<br />olcoqilcri4 rh. Owtu. Btrilc, wil! hlw dE b'nk6 otpmain8 Od lE o. sh. did d build or in{,mw thc p rpcny rot rnc Dntrse or
<br />-1.
<br />ai owE. ol $.IreFny. .m cxclusilcly conlpclirs wilt lienxt co od6c ro coosrruci tlE pmj.ct (SN.7044. BBiB*
<br />ond fttr,Bsnn Codc: "rhc Conlr croir Lkcnre Law des.or apply16,n ownc olp.olEny who blilds or nvrovcs rh.r.on.
<br />rnd *ho onia.k ror such psi{s with ! Conh.ro(, lian*d ,usud ro rhc Conlretois Lic.tr$ kw).
<br />u0xsE[!:coMrlNta.uoN
<br />PES,AAAIIQN
<br />I hcrcby afirm uMd p.nally ol Fdury otu ofrhc lollowing d.tl,nrionr
<br />-lhrvc&nwillmn
<br />ain!CcnificarcolconsflroSclf-lncurclorwork€c.odrp.Nario..ns prcvidcd for byScdion 1700 ofrhc
<br />trb.r C.dc. ror rhc pnronMm. oflhc *ork for whth lnc lEmil is issucd.
<br />-l
<br />htrvc 0nd will m(intlin qorken conpcnrarion inxuEftc. as rcquiEd hy Sccli'n l?00 ol lhc L{lntr G)dc, for rhe Frformncc .f
<br />' co'rllc.\ar io. insur0nc. cMkr and plicy numhcr rc:
<br />n
<br />x""",,,*,
<br />0 7
<br />inrhcprr,onnrn.corrhc\orklorqh(hrhi\ttr,trrrnn{'!Ll l\hrl n r.nll)],)yrn!It'!nrtrrniyor r'.r
<br />s. ,s ro bcs@ subjccl b rh. mltcls' otrqEnsrior la*s of Catifoni!. and agm rhar if I shouh b.com subicr t6 rhc
<br />workcrc's,npcns,rionpmvisionsofSccrionlT00ofrheljE,Gde.lihall.fontwilhonplyeithlt[*rh!i\ion...
<br />WARNIN(;: F ilur. ro surc $orkcr' con{Ensalion coveosc is ulawfxl, and shull subitr fl cn{'loylr 1,, sioinal Ffr,lri.r ind
<br />.ivil ll6rs u! ro oN hundrci llnusand dolloN ($loo-O(l)). in lddnion lo tlD compcnsriotr, dam-qc. ar p.olidcd for 'h.
<br />".,., !l Iitffir1ffi:
<br />IIECI.ASA.IION
<br />I hcrchy uflnBlndcr pcnlxyofp.rjury u I m li(nsd undd prcvnnnrolChatrd 9lom'rumin8 *ihScdion 7r.lo0) ofDiviln,n l
<br />of thc Busincssnnd Prctcssn,nsCodr, u.d nrr lkcnsc h in fu ll nxe drl clIccr.
<br />10t11lk,
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<br />COIEIAICIIAN.LEBpIIG-AOINII
<br />I hcrh, trfltn!ndc. Fnrhyor,,jrjury rhd lturc t a.o.{tu li lcoditrs 0scncr a{n Ihc n rri,nrDne oirh. work nn*hichrhi\Fmir i{
<br />isucd(s(. 1097,civ. c.)
<br />IIIIIIANfI'EII,A&TIJIIN
<br />l lsrby!fiiflnundq Dcmllyof nrijrryoncorrlEr.llo*inedc.lah nnrs:
<br />Ixnr,lirt,n Pfimir\ Ash.{os Norili.arion ljcdcrulRepulations lTirlc.lo. Pdn6)
<br />-Rcquncd
<br />Lcttcr o, Ndiltarbn
<br />yl ccni,r rh,r I h,v. oad rhhipplic0rio. nsarcrhor thc,k,v.lblnErion iscorel l.gm lo.omply $nh trll Cilyand Counly
<br />ordinnncc\ and Shrel.a*s rcliriq b huildinS.onn .i tho,izc Efic$ntarivcs ofrhn Ciynnd Counly ro cnrer upon lhc
<br />rk,vc nE n,ncd pmncnyn,
<br />I ltl
<br />Appliances
<br />l\lletal 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 />Rouqh Ductwork
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL "1,/to /lr -hffJ
<br />Notes, Remarks, Etc
<br />Vents
<br />Hood
<br />Above Hard Lid
<br />-l
<br />.m.xcmfl und.r S6ioo-, B. & P.c for lhh raen,
<br />Drl.
<br />-
<br />om.r
<br />L.n.lar'r NIft:
<br />-
<br />L.ndcr'i Addrcs\:
<br />-l
<br />cn ify rhar rhc fc&dl rclohrions Egailang asbcalor ,.mrd N rol lpplhbL lo lhis toj.\l,
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