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MECHANICAL.INSPECTOR BECORD
<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 />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 Hard Lid
<br />Above T-Bar
<br />Rough Mech.1/Lt/16 ,Lga
<br />Final Test
<br />Meter Release
<br />FINAL Ulr/t<EDKT
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCARATION
<br />I herby af6rm undcr p.n,hy of,Erjlry rhor I !m .xcn l fmm rh. CoflradG Lk.n€ tiw tor rhc iollowinS rc.$. (S.c,t031.5
<br />Burincs a'd Pmfession Code)r Any Cny or Coury which rqlids a Fmir lo onsldcl, 1116. inprow. &mlilh or 4t€ituy
<br />o.rE prior 16 irs ksuec. ds equiEs rlE alJplicul aor !u.h,Emi lo 6lc . si8nd st.tcmil $al tE or slE h liensn tur$el
<br />ro thc pmvisions otrhc ConrEdo s Liened Liq (Chsprcr 9. Commring wnh S.crhr,0o0 of Dilkion I ollhc Buiin€.s and
<br />P,lfcsrhns Codcl or lh hc orsh. h.r.nq thqefromDd rhc brs* for lhc aihg.d cx.mpiio.. Anyvioblionots€clion7011.5byloy
<br />rpplicanl for s n rmil suhjcls lhc allliclnl lo ! civil pcnllly of nol mrc thln lit hundEd dollars (S5m)
<br />-1.
<br />e\ owr ot lnc loltny. o, 6y cnplo]r{. wilh salcs as rhct ola conpcNdion. wiI do tlE *qk atd rlt ilnIr@ ic @t
<br />inrcnlcd or ollcEd aor sk (56.7044. Ausiffis e.l Profcssions Cod.r The Conlocroar Liens Lrw do.s nd .pply lo 3i owM o,
<br />rhc rmpcfly etn hiilds or in!h6 dE@tr ,.d who dG sh @lt hims.lf or h.Mlf or lnmu8n hi or ner oM cmnloycc!.
<br />lrovidcd lhal such inpmwmnls E ml hl.nd.d or offc,Ed fM elc. ll tnerci tlE huildins or itrthwtun n eB ehnin onc Jae
<br />of.onphlioa dE o*M Buih.r wil haE lhc t rda olpr.vi.e ttu h.ddf, dn mr build or impmw thc Fop.ny for rhc purDo€of
<br />l. aio*krofrhc l,mFny. .r cxctsivcly contE€tinB wirh liccnscd contredoa roc.nnBr rlr por.l (S(. ?044. Buiims
<br />!d hDlission Code: The Conrracrols Liccnsc L!, dcr nor lppiyro an6rncr orphFdyvho l,uilds or im'rov.s lhdon,
<br />rnd wh. onlnck lo. such prrjcrls sirn a Conhclo(s) lic.6scd tu*unt to rhc Conrmctor's LieNc tiw).
<br />-t
<br />ancxcnrfl lndcr Sd B. & P C. forihir 6.sn.
<br />l)xrr
<br />u9atrErs:.coMlENtArxl8pEclllSarlo!
<br />I lErcby omrmundcr pctulry of pcrj!ry onc ofrhc lolLwin8 deluhlioNi
<br />-l
<br />n v. !,n *ill minrain s Ccnifrcdc of Con* ro Sela-l.s!rc for so*6 oope${lion.I Fmviled for bySalioi l?m oflhe
<br />Itbo. Co<tc, aor rhc lc.fl]mre of lh. mrt for *hhh lh3 psni is hsucd.
<br />_l h.vc lnd will 'nlinllin *ork.n comnc.sarion insuratuc. * rcquicd by serion 3T00 oflhc tih, Codc, forlhc pctformrftc of
<br />lnc work lor whtn rhis pcrmir i! issrn. My wo ss omp.nsltion inrurake.mir ond rolicy numbcr ec:
<br />2u i
<br />-l
<br />ccniry thll in lhe pc orrumc of lnc *ork lor *hich rhis pcrmir ir h{cd. l shall nor cmploy any pcron in any Mnner
<br />tu ns ro b.$ft $birr ro rh. wo,*cR'oml,.nsrion laws or CrliLnir. !d lBEc lhll if I 3h)uld hecont slbr&t ro ihc
<br />workcfi c\,npensrino povisio.s ols.crion ST0o ofrhc ribor Codc,l sh.ll. fonhwilh coryly wirhlh.s prvi.ions.
<br />W?IRNING: Failxr. ro sm wort(.( $mpcnslion covcr.Sc is unlawtul. ond shnll subicr an .nplot$ ro ri'ni,rllmnllts ntt
<br />civil llncs up to onc hundrcd tholslnd dolla^ (Sl in sndniotr lo thc cosr of con{En$ion. d.m8cs $ provid.d for lhc
<br />SccrnD .1076 of rhc Lnbor C{ c.ir crcnlnd
<br />,*.- <)au
<br />)
<br />r* .
<br />^
<br />lMiLASAllON
<br />I hrftby lmrin uid.r p. dlryorp.rjuryrlurItr li.cMd und$ Brvi\nnr otah0Dtcr I (c.mn*ncin8 eirh Sccrion 7fin) oiDivision l
<br />.l lhc Alxincss rnd Prnt\\ionsCodc. &d nry ltcn{ A i! rullbrcc id.fl..r
<br />lonqlb
<br />0
<br />COIIIBUCIIONIEIPIITG.f,GI'IIIIhc(by,rfimr lcr Fndlrr.lp.{ury rhd thcrc so $nsro.li)n LndirS lgcncr lor lhc p(fortunce olrh. *ork ror whi.h (his Fflnn i
<br />kslcd (Scc.lO9?. Civ C.).
<br />AIILI(:/INL!,.IEI,INIIIO!
<br />I lrrty dtinn und( p.nahyoftf,rjury om orlh.,bllowin8 dccllrlrn,ns
<br />D.n$lition PcnnirsAsbc{os Notificatiotr Ftdcnrl RcEuhtnn ('l'irlc10, Pln6)
<br />-Rcquncd
<br />Lcttcr oI Nolificari,'n
<br />-!
<br />cdifyrhat rhc fedcftlrcsularionsrcs4din8 r\hcdo\ rcnnlalarc n.rrPtrlic$lcfu rhh nmjcd
<br />llr."nlry,t'u, t t ,'".,a,11, q,pli.ariotr nd \rarc rhlr nE (h'ec inl'orrork'n i\..trNr.I aec ro..n[lywirh allcity lnd Counr,
<br />o'di nr.\ tr(l Sr rrl.rrichr ro buildinE consrrucrion. and hcrcl,y ourlDri. rcsrenrariler ot rhh Cnyand Cou.tyl. cnln ulbn ttr
<br />rlxr. nrtrrnN pn)ltnv
<br />0
<br />III
<br />II
<br />Other
<br />I
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