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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Ivletal 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 />Rouqh Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 1w 1!&r)
<br />Notes, Remarks, Etc.
<br />OWNEN BUILDER DELCARATION
<br />I hdcb, affirn udcr p.nahy ot p.dory rbar I !m crcmfl from rh€ Cdnhdo^ Licc.s Lrw for rhc lollosing r.asn (Scc.7031.,
<br />Busi.css 3d Pror.ision Codc)r Any Cny or Counry whkh icqui.s . Frnn lo snsNl, alrs, inpow. d.ftlish or r.Fn lny
<br />srruchrc. rir ro ns i$u!re. sl$ rcqlircs rhc epltanr aor soch !,cmir ro filc a sigftn n.rcmfl rhar lE or sh. i lk nsd ,w8nr
<br />ro rhc Inovhiors of rL Co.r&loli Licenscd Liw (Chaprc, 9. Crmncine wilh S.crion 7000 of Divi*ion 3 of lhc Blsinc$ od
<br />Pofesiois Code) or rhar lE or.hc ii cr.npl rher.Iion rnd rhc b{sk fo.lh. alhg.d cx.mplion. Afly viololio. otSdion 7011.5 by ao,
<br />lp,licanl for ! pcmir subjets lhc amlicanl lo,civilp.Mnyofnol mR lhan fiy. hondE<l dollEs (5500).
<br />_1. ,s oercr of lh. prcFdy. o. my coplorrci sirh w.E s &c lhcir srlc {mp.nslion. wil do llf, wmt 8nd tlE dmnc ir ml
<br />inr.nd.il or otr Ed for elc (Se.?044. Ausircs lnd Pt$fcssi,m Cdc TIE Codmtoas Lietrc ti* <lEs mr amly to .n owm, of
<br />rhc lolEny who tdide 6r ir{@rr h.ren. dd who d@s ikh slk himsclf or hcrcll or rheu8l his or ho osn cnq,loy.s.
<br />phvi.lcd llul sch imrrsErnls @ ml htdtu or ofcr.d lor slc. lt lnscq. llE toiuins .r iqnmmnl is $ld *ilnin orc F&
<br />ofonplclhn. llE O*nr BuitL, *ill hat llE tldo ofprorinE lh, lE tr slrc dit Dl tlild or iqrcw tl& t ,DFr, for tlr pupo$ of
<br />-1.*owncrolrhcrn0cny,afrcxch\ivclyconrra.rinswnhli.cnscdconrado^rodrndfl.rih.pioF.t(s€c704.4,Bu)incs\nril Eonssion Codc ThcConroctoisLiccnscLowdocsmrrrplyli,anowncrofprotcdyuhohlild\orimFovcsrhc'con,
<br />and who conrEck for \u.h Imi*rs wirh a C.niracbns) ltcn$d flr\u.r t,rhc QJntr.rr\ Liccns L1*I
<br />-l
<br />mcx.ftfl un&r Ssr
<br />W0RXT'(S' C(IMPFNSATION
<br />DICI.ASAIION
<br />I h.rcby,tirnund.r Fn,hyof pdjuryoncof rh. folk,winS d..L16tions:
<br />29 n*" -, * r, ,",rt , a"n irE,,c ur cun\cn, rn sclr- lnsu,c ror worlcr\' conp.nsdion. di roridod ro, b, sccr ion l?00 or rhc
<br />' tjbur cMc, lor rh. Idlonrorc .r rhc tr o f.r u'hirh rhc Frm h h\ucd
<br />.onp.isarion in$ran.c, !\ rcqoircd lry S..rnrn 1700 of rh. tjhor Codc. for lhc pctlonEncc ot
<br />io. itrswc. ffkr ard rblicy numbd m:
<br />q
<br />-l
<br />cenifyrhal inlhc perfortuncc oi rhc *o n{ which lhis Ilcrnir ir \$ed. I rhsll nor cq)loy ,ny o.Mn in any m ncr
<br />h $ ro t 6m subjryr fu rhc sork * .omF.erion hwr of C{liromio. ond iBN lnd if I should hcsm subicr lo llE
<br />wortcN oq!.ne'ionpbvhions ofSetion l?0o ofthr tiho. Codc.I shall. fonhpnn omply wilh lho$ ptuvhiod\,
<br />WARNINC: Frilurc to $curc erlc6' com!.nsarion ovcm8c is unla!tu|, und shall xubjd n. dplorcr lo o'ninal Fmhhs lnd
<br />cnil fincs u0 lo orc hundrcd rhousaod dolhs (Sl 6f.ompe.srior. &@9.. as providcd lor llE
<br />Sccrior.l076 ofrhc l.!horCodc- itrrcrc{ md
<br />LtcErl}:Lcax1Bdlla.a
<br />DICIAMIIQN
<br />I hcd)ydfllrmundcrr.nrlryofp.rluryrh.r I inr li.cn{rl undcrlii,vi\i of Clrprcig (.omDrnc inA rilh S$rion ?(Xn) .r O i!isn,n .l
<br />ol rhc 8t\inc\\ trfriPrnc$i,nN (i,dc, tr,xl nrylicrn{ i\ ir tullt)r.c i cffer
<br />.,**. .".-.- d-)o (- 3V q
<br />caNirf,ucraNuiNlulc-&arNcr
<br />Ihcrcbyirtrnund.rDcrlryol|Erjryrhxrrhc.ci\!connn'di,n[nn'nsrs.nctf(trrhcl,.rrur.rmcolrhcwo.klor*hichIhhpcmin
<br />is{uLt (Sc. :10i)7, Civ C )
<br />APPI I(IAN'I' DI'CI "{RATI(}N
<br />I h.ahy!,tnnrund.rri.ullyolpcrjuryo c oirhc n,lnr$insdc.h,arioN.
<br />Drnirlirun Pcrnrirs A\hnos Norifi.rrnnr FcdcalRc[ulnrnrns ('l'irlc.l0. Prd6)
<br />-R.qut
<br />d txrrcrolNolific{bn
<br />-l
<br />anifyrhar llE ltdcrd rcBularions rcBsdin8 ostxslos rcmovll rle nor orplicablc ro rhir pml.cr.
<br />-l
<br />cerlify thd I naw Ead rhis lDriicoli.abvc inlorrurion k c6rsr l arxe ro conplr wnh r ciryandC.unry
<br />odin!rccs and Slatc Laws rcblinS lo d hcrch,Nthtrizcrcprcscnlltivesof rikCiry dColnrrroc.tc.ulx,nrhc
<br />!h,vc mnrn,n d nmpcdy n,
<br />Appli.!.' or Agc SiSMrurc /r{
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