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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER AUILDER DELCARATION
<br />I n Ehy alfrm urd.. F.alry ol pnjury lh.l I @ cxcq,t &om rhe C. reloN' Lic.ne L.w lor 0E lollowin8 rc&$n (5.{.7011 .5
<br />Blrincss ud Proacsbn Cod.) Any City or Colnly rhich rquiRs r psnil lo Nnstdct. 1116. itrllror. dcmlith or Nr6n any
<br />3r1uc1uE. prior lo ir. issusre, d$ Eqlircs rh. appltrnr for such pemil ro fib r sig..d rl8lcmnr rhd tE or shc h liccnscd pumel
<br />lo llrc F.vlsions of dE Conlmctor's Liccn*d Lrw {Ch,pter 9. Co,nmncine with Scction 70m of Divkion I ot lt BBincss ard
<br />Pref.ssions Codc) or thor hcorshc Lr.rcry rhcEfioms rlE bsh for rlE allc8.d cx.mptioi AnyliollliooofSccrionT0ll,5byany
<br />applioit for ! pcmir sbjNts rh. arulicnfl ro a cilil p..olly of nor mrc lhan fitc hundrcd dolhrs {5500),
<br />-1.
<br />as owmr of lhc pmFny, m ny etrployEs wilh wdgcs as rh.n $b comlr.Nrthn. will do tll wort ud lhc slructft ii ht
<br />intcid.{t oroilced for sk (S€ 70,14. Bxsiftss dod PrcfcssioN Codc: Tn Coirdcror's Liccnsc tra do.s nor qlplyr. an owmr or
<br />llE pmlsty wht lde or impmE lh.mr 8id wtu dBs sxh mlt himsclfor hcrrllor ihmueh his o her own €hployccs,
<br />Pmvid.d thar $ct ituoEmils @ mt i.rqdcd ororcEd for eh.ll l$wcrc( tlE tDildirB or impmwmnl h sld qilnhon. J{r
<br />of@nplclkrn, lhc O*ncr ltuil:lei $ill hot rhc bud.n of FovinS lh.l hc or sh. dii m' boild or ii{mw rhc pmpdly lor dE puqDs of
<br />-1,
<br />$ owtur ofrhc lopsry. am .ictusihly contrscrins eith liccn*d conrrador ro o.stocr rh( Folfl (Sc., 7U14, Bui*$
<br />lnd Pmf6sion Codc: Tn. Contrlols Liccns. Law des ei.mly ro e ownc, orEopcny sho builds or impovcs lh6mn.
<br />aid who oitacts aor sEt pDrsls wirh ! ContEcro(s) li..tred l,6unr ro rh€ C.nlrElor's Lians Llw).
<br />-l
<br />am cxcmll undcr Sdio.-, B. & P.C. tbr lhis Eason.
<br />trc.8rl8f,,raMtElsarloN
<br />IECI,Af,AIIQN
<br />I hcrcl', dllinn un{lcr pcnaltyofpcduryom oflhc folk}wiq d€laruliotrs
<br />-l
<br />hlvc dn will minhin r C.niaf,.l. of Consnl lo Sclf-Inturc for rorlffi .onD.nsl ion. as pmvi(k lor by Sftl ion l7m of lhc
<br />Lrbor C!dc. lor ih. p.rfo'funs ol lh. wrt fd whkh rhe Fmir i. isrucd.
<br />_l havc and will maitrrain workeri comFnral ion insuErcc. !s rcquncd by Ssl ion :1700 of lhc Lntu Codc, for rhe
<br />UN
<br />-l
<br />ccnilylt in rh. r,cfornE.cc ofrhc {ork for whicn rhh pcrnrn n nsucd. I stlll nor cnpk,y any pc^o. i. sn, idkr
<br />$ n\lo bcd,m iuhjccr ro rhe sorkch.odpcnra'ion laws olcalifomi4 'nd as@ rhd ifl rtould ttrom hidbrhc
<br />s.rtcr' @mr.nslrion rmvishns of Serion :1700 of rnc llbr Code. I rhlll. lonhwnh .ooply wnh rh,e pmvirion$.
<br />WARNINGT FailuE lo scm wortcrj ompcnerlion covcr.$ is unl0wtul. md shlll subirl .n dll,lo'er to Einidl Ftultis lnd
<br />cilil 6ncs uI lo on. hundrcd ltouslnd dollas ($100.000). in addilion lo lh. cost of conFnsrtion. dlmg.s .s lrovili{ fo. lh.
<br />Sdian.l0t6 of rhc klry Cndc, inrcrcdanddhm, s fe\
<br />I.IC.EIIEI!:ONI&TCIA.B
<br />UIi(IAEAIION
<br />I herbl rffii,n urdcr pcn ryol p.rjurr rhar I nlic.n*dundcrpovi\iuolChllcr9($tr,ri.i'rtwirhS..ri,'nTIXX))ofl)irinotrl
<br />or rhc Busircs atul Prcfc$i,)n! c'on.. and Drv li.cn\c i\ io tulltu,clRlcric.l
<br />N
<br />taljil8ttroNLrxDlNl;_lliElt.l
<br />n{'c(rrsc. 1097 ( iv ( r
<br />A}ILIIANLDECLAAAIIIIN
<br />I hcrc6y ,lImn undcr p.n,lly ol l).rrury nrc of rhc follo$in8 d*lnrat n,nsl
<br />Dcnnlirio" Pcrnils Asbc(os Notifiurion Fcdc,ll Rcsul ionrlTnt 40, P!n6)
<br />tuquncd b(.r of Norifi .rtun
<br />I ccdilirhd rhc Icdcralrcgrh(i, s ntdil
<br />'E
<br />a\htno\ rrnx,vd m mr 4lliclhh ri rhs F,Jccr
<br />-l
<br />cenif, rh I hrvc .cad rht uppliclri(,n a.d srarc rhar rhc alnvc infomEr ion is cotur I agni r. ftmply wirh a CnyDndCounr,
<br />odinlnccs !trd Srorc l,vs rcl,rins to huildinE orxt h.rchyaurhoizc rctrck arivcs oarhis Ciryand Counr, ro ctrrr up.n rlE
<br />ubovc mnl ioncn Impcny i'or
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh 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 />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.?/t't(/*1gd
<br />Final Test
<br />Meter Release
<br />FINAL V23/q ';Ail#
<br />Notes, Bemarks, Etc.
<br />COMMENTS
<br />Furnace
<br />Dlte Orncrl
<br />^,bl%Its
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