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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS OWNEI BUILDER DELCAf,ATION <br />I hcrcby ortrn undcr pcnahy of Fr.iury lh.l I m.rcmpl liom lhc Cinhdou LiccM t w for ltr followine Easn ts(.?Ollj <br />Busin.s snd Prcfession Cod.)r Any City or Counry *hht Equircs ! rrmir ro @nsrrucr. !lrs. iq)o!.. d.mlGh or el,an afry <br />{o.rE, prhr ro it. i$u,re, alio eqlics rlE arrlter for such Fm ro fiL a saer.d smr€mfl rh.l li or rlE ir laccnsn pll,!@r <br />ro rhc tro{sionr 6f rtE Conra.or'r Licensn Law (ChlDrcr 9. ComrEnciig *nh Sccrkn ?000 of Divhio. I ol rh. Blrinc$ ond <br />Pmfcssions Codc) or lhll h. or stf, is.r.npl lh.Efmn rnrl rhe b6sk fo. th. alkg.d .rcmplion. Any violarion ofse&rfl 7011.5 by any <br />.Inlicair fo! a pcm subjer rhc arulic!fl ro i civil tc lty of nor mrc rlEn 6vc hlndr.d dollaB ($5m). <br />-1. <br />os owN! of rhc prcFrry, or my chplorss virh w,8.s a. rhci slc comp.nsrrion. will do ttE wk and rnc artrr@ is mt <br />i cndcd or oltcrcd ibr slc (S8.r04.{. Busimrr 8nd Profcssions Coder Tn Conlruslols Litn$ Law docs not rpt ly b an owtur of <br />rh. t nltny who h{ilds or inpmvN dEm( fuxl who dB Mh sd< hinictf o, h.rclf or rhmugh hn or t.r osn .mployccs. <br />ovirlcd lhri soch inprcemdr e ml hlcnd.t or o6cBd for sL. lf. ls*crci th. tnildinS or inlmrcmd h $ld wilhin orc )rs <br />ofonq)lction. llE Owffi Buit*r wil nlvc df, htrdd ofpmvi.g tur h or .hc did nor buill or inpbrc the p6Fty lor {E pu{,$ ol <br />-1. <br />m owrcr ollhc prcpcny. om erclusivcly contm€lin8 wilh licen$d .onhdos io onstdcl lhc pmiNl (Se ?&4, Busircrs <br />od Pi..6si6 Codcr Thc Cont,cr6r'r Lic€n* Lrw docs ton rDpl, ro u .wncr of ll()pdty who bnildr or iopbws thcr$n. <br />und who connnds for such pmjers wnh a C. nclo(, lhcnrcd purulnr ro rhc Conttoclor's Liccnsc tiw). <br />-l <br />d exeftpt undcr Sdio <br />D.tq- Orn.r-wonxria-ni;iGiii6F <br />DPCI4BAIIAN <br />I hc6by !ffum undr Dcnrlty ofpdju.y om of lhc follo*Utr d..L$rioM: <br />-lhr\r <br />,lqrllnufl.rnICcdillcrrc.,C.tr*rrr' Scll:link h sorkcra..nrFnr klr. r( fmvtrlcd io hyScclior:t7(xrolrhc <br />L'trtrCodc. nrrhcll.rfo'itric.ofrh. truik r(tr whirh rh. |{nri i\ n$cd <br />_l turc and $ill nrinl.in vortcr' .on{Ersslior inslamc. !s EquiEd by Sethtr l70O of lhe Linor Codc, for llrc dao.mncc ot <br />lhc work tor *hich rhh pclnil is istucd. My workcn .om!.nssl ion insurm.c .micr &rd Flicy nlmbcr m: <br />-l <br />ccniay thd in lhc pcrr'ormmc ofthc *ork for whth lhis Ir.rmir n ksu€d.l sh.ll nol cnployany pcNon in lny nanno <br />$ s b tEcoft subirr h rhc {dikc( .omn nsatbn lnw\ of CaliromiL ,nd ,!d lhar it I st xkl b..om rublc.r to lhc <br />workctr onFnsrionnmvkions ors(ti.n l7mollh. Llbn Crxlc.I shill, rodhwnh oml,ly *ith dnsc ,tuvisions <br />LICENIEILCONISACIAA <br />TICIAf,AIA! <br />I hcrcby.mirnund.r!.nrlryoflf,rjury rh.r I r li.rned und$ l)n,vn$ ol ChU.r 9 ((,nnmmin8 sirh Scclion 7lro0) ol Di! ir iotr :r <br />or thc ausi'L\sdtul PmtcsiorN Codc, $d nry li..n\c ir in tullnxtdrdclLrr. <br />Liccn sc C hss <br />-Li..ns. <br />Numbcr <br />D.le: CoDtdclo.: <br />larslBul:ul)NJ,trNqlN(il!.ENcl <br />I hcEbr_ alnn uMc. rEmllyoIpcrturyIhul rh.rc isn consrdion lcndn's nscNy for rhe t:rio.nrnc. of lhc sork nt *hih rhi\ Itnnil t <br />is\ucd rs( :1097. cn c) <br />AITLIIAI|LDICLAAAIPtr <br />I tt-..hylllt'nundcr I].naht oIt--rjurt onc l rhc ,i,llo$ irs d..h8r i{,h: <br />Dciblfn l,cnnirs A\h.no\ Norntdi.n Fcd.inlRcExhrnnN alirlc4l). Pd6) <br />-Rcqrncd <br />ldlcror N{{rl.rion <br />_l ccnifyrhJr rhc ltdcral rc8trhii,)n\ E8rding h.(o\rcmovrl c nor {Ili.ahlc k,rhis ttuFr <br />-l <br />enity rhar I hsec rcad rhh appltorior and srorc rtur rhc abok itrromor io. n.oGt. I !Ex6 ft @ndy enh a[ ciry and C.u y <br />odin!rcs and Srarc Llws rclr ing ro buildirB cooetocrio,r. urd lrcrcby 4urhor@ ,.prcsnlalivcs of lhis cily &d colnly lo cntd ulbn llE <br />abow d.tiorcd pmrcn, for insrctrion rurpos. <br />Applicanl o. ABcnl Si8nnlurc <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 i Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnslallation <br />F.D. Drop Test <br />Above Hard Lid I <br />Above T-Bar I 'fflIYttY <br />I <br />R ough Mech. <br />Final Test <br />Meter Release ^l r <br />FINAL dl,ll T wrw lfi,t <br />Notes, Remarks, Etc. <br />'llrilf /4tt <br />WARNING: FBihrc ro sccure worlerr otupcnsarion corcBgc is unla{ful. ond \h!!l suhjNr m cmtloFr ro dlminal Fnakics ind <br />civil filcs up ro onc hhdrcd rhols.nd dotl6 (SlOo.fiD), in addnion ro rnc co\r ofconp.n\arion. da@Ccs ne provid.d lor ih. <br />srdinn 1076.frhc Latry C.de. inrcrc\l rnd alLmy. fccs <br />I <br />I <br />--------r------ <br />i- <br />= <br />=