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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS o\INT]R BUII,DI]R DII,CARA IoN
<br />Ih0ch,r,lnnr! ddr r.nrhy.l Nrrury rhd I rr crcnlpl tu,mrhc(ir rrkm l.iccn\c ljw f{, rhc ft)lhring toNrn (sc.7oll5
<br />Btr(i|c\\ rtrd Pn,ic\si')n CoJc) An, Cily or Counr, *hich rcquir.\ n F-rnrir t' .unnru.r. ilr.t. nn[.vc. dc.(nish.tr rq'rt dn\
<br />nrucfitrc. |]riffr.i rr\ rsurncc. !l\o rcqur.\ rrr rnl'crnr kr \uch rr..rnnr !' f|. d \igncd {nrcnEnl rhd hr,t \rrc N lrc.,;..;;"'..,,"'
<br />h rhr E)vi{nnr\ .f rltr Contd.t( s Li.c.{(l uB rChrprcr U. Connrnrnrg *irh Sc.r'.. 7(XX) ol Divhion 3 ol'lhc Bu\incs\ rnd.
<br />Pnlcsior\Cudc)o.rhrlh!orsh.i\cxcmprrhcrcnonrJndrhcbr\i\l,trrhcnllctcdcxcnrpri(nr. nyvi{,hri{niofsNri(,n70.ll5hlrny
<br />rpDlicrrrtur|{nnir{lhjccr\rhrq,flic,rtur.irilrmlryolnrrxtrcrhrnlivchundrcddolhr\(S5ff))
<br />I.rro*rrofrhcnolEny.ortrrycnrtloyLrswiihursc\asrhcirslsconp.tr\rrit,n.*rlld.rh.sotkn lh.rrMhnnor
<br />i cmktrl .r oltcEd lar solc ( Se 701.,1, Busincls rnd Ptulc$nnN Cdc: Th. Conrrctr'\ l .ic. \c Lzw d.cs .or nPply ro m osncr ol
<br />rhc,ni|tny nlmiuild\orinllflruihcd)n,di sho,l({s \tr(hsn* hnnscllorhcr\cllor rhrughhis or hcr own r.rlno)cr\.
<br />provid.J rlrr su.h nnniovcnMh arc mr inrcndcJ orollcrL{ lnr\trb lll hoadvcr.rhc buildirs otinprcwNnliss,U sirhinom )ur
<br />olco{uhri,n. rtE O$ner Boikkr willhn}t rh. hlrddn orpmvin! rhrr h- ur shc lid ml hoild or irq,ro\t rhc tmFdy lnr il'. Pu{ns ol
<br />-1..sowMofthe
<br />rorcny. an.xclusiElycontracling lith liccnsdconrr(1oBr. ofti cl lh.,mFct (S.c.7014. Bu\im\r
<br />ud h!{csbn Codc: Thc C!.r.&roas Licco$ trw dB ml erply lo !n ownct oftmFnysho builds or improrcs thcrcotr,
<br />.nJ wh. .om@l* for such p6F.ts wirt a CoirEdon9 ltcn$d |,lNufl to thc Corta.lo's Lt.nF bs).
<br />D.l.:-
<br />llr8rE8f.grMtINsArtQ!
<br />DECI,AAAION
<br />I h.fthy omm unde, pcnalry ot tniury o@ of $. aolloviq ddmlions:
<br />I hrvc Jsillnrn rirr(tdili.rrcolCon\rnln)Scllln\trrrlor\orkcranml)cnldirr.r\ Pnrvidcd f{trnrSdn)i l7(x).frhc
<br />uhtrco.lc. t)rrh.p.rro, iin.rorllrc\rorkhr$hichth.Fnnit isi\sucd
<br />-l
<br />hav. ud will minlrin Norks compcns ion nNunncc. !r rcquicd by Sel io. l7{D oi lhc Lahor C.d.. lor fi. Pct @m. of
<br />rhr uork f.r wlri.h rhi\l).rnrir is ssct. My workds conrl'ci
<br />Cb
<br />in\urn..c .dicrurkl p.lty numhcr uc,
<br />fah ,l,l tQCAP C v
<br />-l
<br />ccnify rhat in rnc p€rfor@ncc olrhc sork lbr which
<br />'his lcnnir h nxued.l \hrll nor.mplo, d.t J;T;
<br />k as rJ lxeft subjNl to rhc uorkcs compcnsolion lsssoacllifomia and r*re
<br />'hd
<br />ill $ould nton* slhJecr b rhc
<br />wortcB.onFn,rtionpmvisionsofsctiofl31rOoflhcLltloranc.I\hdlrodhwnhcon{lywilttto$F,vhions
<br />WAf,NINC: Fuilurc ro wu{ workcN ernD.n\dion.ov.B8. h unlawtul. md shall subiNr s
<br />civil fines up to orc fiundrcd rhousund dollrs (Sl0o.1vJ0). in {ddn
<br />0
<br />lrEcLA&LullN
<br />I hcrcbyrlltnu cr pctulryorpcrjury th.t I anr liccnsl undc, nmvision orChrPkr 9(coflnEncir8 eilh S.crirn 70lxr.rDivkbn:l
<br />ol rhc lttrsi"cslnd Pdi$n,n\c(dc.ild trryli.cn* i\ ir lullnlrccu c,ltcr
<br />ts C)o /2o/31?t)o/ / Qt3Ut33, ts-7 07
<br />caNlilAl]l1rcll.1iliuNc-dlurrl
<br />is\ucrl tS& .l(l)7.Cir C )
<br />AITLIIATLDIiIIA&I.IIAN
<br />lllnhydfimundcr ncnnlly ofpcrjury o& ofrhc lollownr! dc.luurnnrs.
<br />Dcnnilirn,n PrDih A\hcros No'in.diotr r.nernl Rc3ulariotrs ( lillc,lO,l'rn6l
<br />R.qut d lx .r of Noriliclrtun
<br />I (nilyrlrr tlE r.dcrllrcslllrnn$ rgsrdnrs Nh.sosrcnFvaldrc mr nttlicohh lo rhisln,jccr.
<br />^snily
<br />rhlr I hlE rcad tlis ap?licar i('n ud nir. rhar rhc atnr inr{&'rto .ofrrl.l sgre roomply wirh 3ll Ciryand Counly
<br />ordinanc.s lnd Shlc Llwrrlarin!ro hoild repEc.hrivcs .l rhh cn, md
<br />lhovc mnlioncd rroDcny for
<br />Amliclnr or Axcnr Sisnlr
<br />x
<br />o r
<br />Appliances
<br />It/letal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />l\/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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 Release
<br />FINAL I I
<br />Notes, Remarks, Etc.3hr r{/*rr
<br />I +
<br />ID/SIG.
<br />Smoke Detectors lnstalled
<br />I rn.rctrfl trndrr s(ii(D .lr & PC lorrhn r.rvr,
<br />Dar. I
<br />t ,idd . NsR:
<br />-
<br />t dd! Ad&rs:
<br />-
<br />----+---
<br />t---+---
<br />I
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