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MECHANICAL.INSPECTOR RECORD <br />APPHOVALS 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 />Openinqs <br />lnstallation <br />F"D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Belease Ir <br />FINAL oi m du,r(ry <br />Notes, Remarks, Etc.I <br />owNrtr Btrll,D!rR DlrLcAlra ll()N <br />lhcrcbyif,tnrtrkl$pcnilryorlriuryth,tlnncrcnUrfn,nr'hc(.l,ncrtr.LiccnscLrwhrrhciollo*ir8Basn(tu.70315. <br />Dusnrc\\ and Px)lcssion Codc) Any Cirt or Counry shich rcquics tr runni n' co ndd, !lr.r. inrrolc. dcfrolhh ur rcFn rn, <br />nd.rurd. trint, ir! nsuatuc, rh. rcqun.\ rlr umli.nir ntr surhplhi h filc, \igncd \ldcrmnr rhd lror shc h liccn*d nuru r ' <br />h rhc pmvi\nnr\ or lnc Conl,ack,\ Liccnscd hs ((h3prcr!). (tmnrcn.i.s wirh scrlion 70(n or Di!i\n,n.l or rhc Businr$ and ' <br />P(na$ ibns c(d.) or rhar tf,orshr i\ cr.mrr rh.rcfru rdrh.hrsisf rhcrlLlcdcxctrrption AnyvidrrionolScclion?0ll.5nyrny . <br />rppli.!.{ n .Fnnn suhjl{a rhc amli.anr ro r.ivilrcn.hturnor nntrcrh!tr irc hundEddolhrs (SsuJ). <br />_1. dr owM of rhc rr.Fnr. or ny .nglolrs wnh u!8cs !s rhcn $t odpe n$rion, will do rrE *6t .,t ir nnxrm is mr <br />inldxH orof,.rcd ror slc (Se.rU44. Businc* rnd Profcssion! Codcr Thc c.nlraclols Liccns t w docF nol amly lo otr owrcr of <br />rhc rroF.ly {ln ldldr or itrsm6ln Mn, !d wh dm sh w* himelf or hctslaor lhDt8n th or h.r own c'r'oloyds. <br />provid.n lh0t slch iqroEmbr* N (n i.rcnd.d or onted f6r .alc. li h.trk( thc buildin8 or irrybv€ftnl h $ld virhin onc }tr <br />ofonl)kriJA rtE Own6 Buitbr *il! hok itr hr&n or prctn8 tlEr hc oi ilE dij @t hild or itt .r lnc pDFny tor llE plrlDe or <br />-l.0sowm!ollhj <br />tm!.ny, anr.xclNivcl, conlrncridS wirh li.cnkd .ontm'.61. onrlrcl lh. rmj(l (Scc 7044, Busrcrs <br />od h.tirsbn Code: Thc Conllrcrofr Liccnsc hw docs nor ![ply ro atr o*.d ofp,opcny*hr' build3 or inpors lh.r.o.. <br />strd vho contBcrs for soch Irojets wirh o ConrBlo(g lienrcd pu6uJnr h rnc ConrB.rols Lictrs Liw]. <br />-l <br />amc*cr.ll undcr Strl B. & P.C. forlhisru$n. <br />YABtrEIUIAUEEIIAIIIA <br />DECLAIAIXO! <br />I ncrcby offirmundn pcn.hy of pcrjury onc oflnc followins delomlionsl <br />-l <br />hrvc lnd * ill minruin ! Ccrr if'carc of Gmcnr r. Scli lnsurc tu worken compcisiriotr. 's pm dcd rrtr by sLrrion r70oor'hc <br />&htr Codc.lor rhc tshirMtrcc oflhc wo for whichrhcr.mi n hsucd. <br />Q/**ond *ill nuintoin *orkcr' comrcN.lion insumrce. .s rcquired hy Sd n,n l7(x) ot lhc Lilx, Cod., tor fic p..aorn!m. uf <br />fn which thh ?c!n l is isscd n insurlncc crdcr !d fni.y !urh., arc <br /><-,1 <br />2-qIr <br />x,.cnify thd in Ihc p.rLflnm.c olnr work for w[i.h rhir p$nrn is nsucd. I shell nor cmfk'yuy pcson n' any nunncr <br />ro t$om subicl lo l,rc uorkcG .r,mpcn$rion laes ofC{lilomi( ud lsrcc rhDr ifl should h.com sub}s ro lt* <br />wortcn .rmp.nsalionpovirionsotSccrion:lT0Ooflhc Llhtr Odc.l shau. ronhwnh.o rdy wirh rh.e provkidn.. <br />IVARNING: Fdiluro ro s.u. workcn mmFnelhn covcng. ir unltrwful. Md shall subFt atr cmrloFr lo aininol IrMllLs and <br />.ivil lincs up t' onc hnMrcd rhousNnd dollaB (Slm.0oo). io dddirion Io lhc cosl olco.pcnsllion. dlMgcs r\ provided for $€ <br />C.d.. int E{ and albmy s a.cs.-*?l <br />UCEMIDJONIAAqIqB <br />DECI,AAA.III]N <br />I htrcbynlflrr utrdc. tE..hyolpcijur] lhal I $r liensn unds pmvnion ot Chaflcr, (condtui.g sirh s..rk n 70m) orDi$ision -1 <br />of lhc BusNrs and PmlcssiorN Codc, 0rt my l[cnsc ir in tull foN &l cfitct. <br />.---- o t4 L.,l l : <br />-1_L <br />q)NEIAIIU!]NIINDIN!.4IiENCI <br />I h.Eby {flinn und.r Fn,hy or p.iury lhal lhdc t r .onddcrbn hndin! !8c!try lor lhc rsfonuncc of lhc sorl lor Bhi.h rhis Frmi' ii <br />hnrd (Scc llr97.Civ C ) <br />i ISIUCAXLIIE$AaAMN <br />I trchy {finn undcr l,j axy .l trrjury .rc of rhc rblbwnrB d(lnrdt ions: <br />Dcfrniti.n Pcrnih Axhcstos Nolificrrion Fcdc,al Rcsulrlions Ont 40, Pan6) <br />R.quircd lrncr of Mnili.ariJn <br />_l dily thal rn fed.ril Egul.rirns rc8arding asb.s.r Emwl dE nol rpplkatrh lo this pmtrt. <br />-l <br />ccnify rhat I haw,cad rhk aptlicarion ald shrc lhar rhe utFvc inforndion ircorel,I agle lo.oqrly wilhlllCilylrd Coutrly <br />ordhon $ atrd Sdc lj,s Ehring ro buildinS conslruclion. od hcrcby allk riz El,c*ntlrivcs of lhic Ciry and County ro cnlcr ulfn lhc <br />aborc mnriorcd pmp.rry for insrrtion flqn*s <br />-htlra <br />II <br />I <br />- <br />m@ <br />U 4 <br />khd.a! Add.$: <br />- <br />----+--- <br />: <br />I