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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 />Misc. 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
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release I
<br />FINAL lollt fi{ .d 44
<br />Notes, Remarks, Etc.I r
<br />OWNER BUILDER DELCARAIION
<br />I hftby sllirn lndcr p.nrlr, of Fduy lnar I @ .xcopt t$m rhc Co.lnclo^ Licnsc t w for lhe followi4 rc{en 1Se.701 1.5
<br />Businc.r 8n Prolcsion CodcJ: a.y Ciry or C.unry which rcquiEs ! rErmn to mGrtod. all6. i6proE. &rcthh o; rcI,ln y
<br />slrucrurc, prbr lo ns isulne, sko rcquircs rhc appliclnr tor such pclnir lo lilc s .iB*d sr.r.c th.l lE .r shc i\ lien*d puBuanl
<br />$ ilE ,rov\tuns 6I d. Conlmlols Lic.n*d liw (Chlpid 9, Commmin8 *ith Sdlion ?OOO of Divisio. I of thc Susiic$ a.dr
<br />Pmf.sbns Codc) or rhrr hc or sh. is .xcmtr rhcrciion md rh. blsis aor lhc lllcgcd erca,prion. Ai, violirion6lSetb. ?01,1.5 by lny
<br />atDliconr aor a p.mir subr€{ts lhc lpplicaor b ! citil Fmlry ot nor mE rhu nvc huded douae (S50o).
<br />-1.
<br />r. owe. of rh. pmFny. or my enployes wilh vrScs ss lhcn sb comp€trstioi. *ill do th. strt &td rhc snr1m h nor
<br />inlcn&d or oficrcd for $h (Se.704t. Blsifts\ and Ptotcssions Codq Th. Conha.ror'3 Lic..* Lae d{Es ml a,ply to m oqrcr of
<br />rhc lmFfly who blilds o inpmks
<br />'h@n,ond
<br />who dm $ch wolk hinsclfor h$*lforlhmugn his orherown.mpbyccs.
<br />rmvidcd rhlI iu.h impEwmnls @ ml hlold€d oroilcrql for {L.li hoker r,x t{ixina o. i,lomEmnr h$l'lviltitroE Ja$
<br />ofomlhtion. th. Owmr BuitLi s l nat $c hudcn or rmviry ttal hc or shc did Nl hild or inproh ln€ pmFnt for lrE IUIDE ol
<br />-1,
<br />!s o$rcr or rh. rDpcny, on cxcluriv.ly conrtucrnrg wirh li.cnscd conr{.los lo onsl ct thc Imjst (S.c, 7014. Buirs
<br />ard Profssin Cod.r Thc Conlr.crols Liccnrc Llw docs mr lpply ro m own( ollmrcnyaho builds o. impovcs thcrcon,
<br />lnd qho contncrs lor $ch pmjcrs qnh a ContBcro(s) li.cnsed !uR@m ro ih. Conhdols Liccnsc L{w).
<br />I rn ercmDr und.r S.ctio
<br />-,. oq/i: lra
<br />DUCT.AR,\ l]ON
<br />I hm.by nmm und.r Fnrhyoirr(iu
<br />Ihaw{.dwillmi .in r C.nifmr. ofconscnr Io S.lf.Insur. fo. srl€s ofiErsarion. &r prcdi.d for by Setion lr00 oltlE
<br />bbor Cndc. fo lhc FrlollMc€ ol thc aort lor which lh. Fmir i irsu.d
<br />-l
<br />horc and will nri,l.in w{rkc6 compsnsalion insurarcc. as rcqlicd by Sc.rion:1700 ol rhc tibor Codc. for thc l)crfommc of
<br />rhc *ork lor which thir pcnni is hsued My workcs oq)cn$rion insnrue c@tr !d l[lky numh.r ac:
<br />Poli.vNnmh.r: ErDiE!
<br />-l
<br />anifyltal in rlrc r.rformrc of lhc wort fq which lhh pcmn t issmn, I shtll mr cnploy a., Pcson i. lny tuntur
<br />so air. becom subi(r ro rhc work.B .orpcn*rion hes oacalilomia, &d aSEc th8t ifl sholld ficroft sutjd lorrr
<br />wortc^ .on{rcoslri.n 0Dvirions ol Scdio. l T00 of fic Lrk'r Cdh,l siEll. foah'ithconlly * nlhoerroririonr
<br />WARNING: Frilurc lo $curc *orkcd comp.ion cowEsc is lnlarfirl. url lhuU {bier !n cn'plo}r. ro dini..l Fullis and
<br />.ivil finc\ !p b onc hu rcd rhousnd ). in addirion ro thc cost ofomrcnslrion. drruec. ar poridcd fd lhc
<br />"",..
<br />qlz
<br />I hc(bt aii,'nrndcr p(ulryorn rjury rhrr I N I .dn ,,mvtion ol Chrfls 9 (ommmins
<br />ol rh. h'! N\\ i Prol.\ri,rr (itrlc. rnd nD l..n\. i\ i, lnll l,tr.c r .llirr
<br />codn roi
<br />(OIjSIBIJCIIONIINIIINCJJiIM:I
<br />I hcrcby alU undcr lf,nllry ol FrJUry rhi rhcrc i\ r .onnflcrir L dinF aeci.y fitr lhc |Edornnn.c oi rhc rqlt in *hi.h rhis lfrmn i\
<br />issucd (Scc.1097, Civ C.)
<br />l-.n .r\ Nr r:
<br />APPLIC,\N'I DECt IL\ I'ION
<br />lllnhy rliirnurrlcr troalr) olt^-'rlurr_om o, rhc r,) k,{tr,! J..lJJrnnr
<br />l)cni'l'rdr l,rn \ Ashnrs N.rirlc[tr lrcd.r.l Rclul 0]r ( Iirle Jo. I'd6r
<br />-kcqun.(l
<br />Lcrrs oi N.rllicrrk,n
<br />li{cral rcglllri.n\ dgadnr! e\bc\k,\ rm,valarc nor jpplicrblclo lhis pmjccl.
<br />Md rl'is amlictrrion ond nurc rhrr thc rh,vc intbrmatbn iscomcr I lsN k,.omplywirhall Cilyand Counr,
<br />-I are Lrws rclarinB ro huildi.C c.intucrior. atd hcrcby !trrhoriz epr.*ntariv.s olthis ";;r;i;;i;;"-fr t- tp l-,
<br />-ilc F---z-
<br />Above Hard Lid
<br />a. & P.C. torrhh re!\o.
<br />Lh.M chs:-----JieM Ntrt f,
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<br />lt
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