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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS owNEx BULDEL DIILCARATION
<br />I hcrehy rlifln lndcr F-nlhy or Nlory rhd I d crcnl,r fn)m rhc Co &hF l-i(.n\t lrw hr rhc Llk)wil8 rc0cin (Scc 7011.5
<br />llu\ines\ r Pmt si,,n Cqlc) Any Ciry or cDu ry shich r.quncs ! pcnnir l{i con{d.r, ,lr.r. nnfnNt, dcmli\h or rcr0r lny
<br />(tucrulc.I'itr r, i( rsurtr.c,1l$.cquirc\rhc rpfli.ntrr lor {,ch,rn irri lilc r signctl {atc.rnt !h h:or shc h licttrtd plr\uanl
<br />r' rhc pn,vi\nnN olrlr Conrrrctr'\ l-i..isr liw ((harro9. (iDrncmir! trirh Scclbn 7lr(Xr ofDivisn,n I olr[c ausirrss trnd
<br />l,n,Ic$nnrsCodc)orrhar hrnr\hc n.xcn!, rturcli.nrnd rh, hrri\ lnr lhcrllcrcdcrcmpri{ni. Any vn'lari( otScclir?0lll.5 hy!ny
<br />q,plicr ,nr r pcnnn {blccsrhc .DIll.rnl ro icivilJ,cnrIyol nor more rhrn liv. huidcddotld\ (35tx))
<br />-1.
<br />as owrr of rhc reFnr. ol my cnploF.s $irh w.8.s as th.t ok comp€nsotion. *ill d6 tlE edt 3!n lh slrlw is ml
<br />i fixLd o.ofi.rcd lor sl. (Se.?04,1. Susimss $d ProtcssiotrsCodq Th. Comr&lo Lic.n€ LIwdocs nor amlrro doBxtof
<br />rtc IBrEny sno builds or in{o!c. th.mn, dr1 who d.cs Mi md( hims.lf o! hcrclf or lhrolgh his .r hc. o*n .nPloytcs.
<br />prclid.d rhlr such imnmwmrrs 6 tui inrcid.n orofteEd fo, slc.If.lblcw. dE ttrilliu or tqmtmd is sB wnhin ok Fe
<br />ol $nphtion. tlE Owmr Buildcr *ill lEr rhc hrdci of pF,ins i,Er hc oi sh. dil mi ttrild or iqmre thc loltny for d'. lurrss or
<br />l. $ o*n r ol tlE ltupdy, am cxclusivcly onlEclins with licenxcd conr,chr ro onirud ltE pmiNt (S8. ?Ol:l. 8u\ias
<br />!d FDfc.\im Cod., Thc Coitscl6fs Liccn{ trw docs mr 0tplt to an orncr oflmpcny*ho blilds o. ioPmirs lhcton,
<br />lnd who s.lr0crs for such lrolrG {nn u ConrEcto(s) liccnscd rlnuor ro rhc controclo* Licc.sc L!q).
<br />-l
<br />amcichpr lndcr Sccrt,n , B. & P.c. (, this rca$o.
<br />T,8f,EBS:STMfINSAIION
<br />DECI,ABAIOB
<br />I hcrcby lifim !nd.. ,cnalry of rcdury onc oi lhc folo, iog dmlmiionsi
<br />-l
<br />navcod will mi.tlin, CcnifMt ofco.s ro S.rJ.suE for *ork B ohpcNrion. $ pbvi.hd for bySelkr 3700ofthc
<br />Llhor Code. for the Dcrfolffi of rh. wort( fo! shth thc pcrnil is i.sucd-
<br />)ir,* "na
<br />*i,,,",n,,. *"*cr' com!.nssuon irur.kc. r" rcqu'Ed hrsdrio. J?oo or rh. tjbor
<br />rhi e* ror *hkh lhk p.mr s snEd. My u.rt6s. Nnpcr$rhn in{l.N .rlltr .rd porry.umb.r
<br />,*'", Fnt c.s / t!.K€
<br />Cod.. lor th. Frfolrlee of
<br />jrt-iTzsr zar
<br />I enify thot in lhc lErtbrmrcc oflic work for shi.n lhk pcrmil i! is!.d. t shallnol cryloy an, P.^oo io any mdnn.r
<br />$ a\ ro tEcorB slbier ro thc !ork6'6ope nr ion lies oacaliromia. 5'd .8N rhlr if I stould lE om subl{ io llr
<br />*0*6 con!'cnsrion pmehions oaScdion lT00 ofrh. lthorCod.,l shlll. fonhwirhcomply wth tho€ lsvkions.
<br />WARNINC: FailuE lo sw sork F onDcBrion covengc is !nls*6l1. lnd rtau sul,id 6n cnp,6rtr ro {iminll Peirltis and
<br />civil lincs up kr onc honded rholiand doulB additiq ro rhc cosr ofcoq,.ns,riDn, drro8.s os providcn for lhc
<br />S..rion 1r)76 of rhc Ltnr.?/8
<br />L|CFNSED C()Nllt Cftle
<br />DEljlrr.8AIlQN
<br />I hcr.b, nlnnr undc{EnrllyofDrrjury rhrr I !h lieiwlundc. ro\i\tu.olCnrptcr 9 (com,tncins *nh sc.rbn 7un) otDilision 3
<br />or rhc aNincsatul Pn,rcsiorsCodc. ahl nryli.ctr$ is in iull,nr.c and.ltiu
<br />Z aG7753g
<br />IOIEIBUqIIINIENUN(i.A{iENCI
<br />I hcrby affirm unncr Fnally ot Frjuty lhd thcre Lq . onnMiion LndinS !8.my for lhc peraomac of thc sork for qhtn lhis !(mn is
<br />i\\md (Sc. 10S7. Ci! C.).
<br />A.TIUCANLI]EIIA&IIION
<br />I lrtrby lfrnn u Mcr $nolry oi ncrjury onc ol lhc f.lkr{inE d(ldar t,nrl
<br />DunDlirion trcrnill A\hc{o\ Noriliuri(r Fcd$Ll RcSuhrio.s{Tnt 40- l'an6l
<br />Rcquircd t ncrolNolill. ion
<br />I cdif, rhd ihc a.dfial rcsukrions rcsudina arh.sros rcrtuv{l orc nor trpdkablc h lhh pmFr.
<br />-l.drafy
<br />rhrr I hrvc rcld lhis a rion ui slarc nd rh. clD!. itr{omu ion h corot. I ogie lo coryrly anh lll Ciry and Co!trly
<br />ordimtres rnd Srltc La$s rclal n. rld lEEhy,uthotLc qre*dllriws offiis Ciry
<br />abovc mflliorcd popsry for
<br />A,)plicd or Ag.n' SiSutuR:4'
<br />md County ro cnr$ utlon rhc
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh Ductwork
<br />Vents
<br />Toilet Room i Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<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 Rh;'IIK t1/|Vw .1/b)
<br />Notes, Remarks, Etc.I I or \_-7
<br />Metal Fire Place
<br />lnsulation
<br />Grease Duct
<br />g
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