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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS 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 />Rouqh Ductwork
<br />Vents I
<br />Toilet Room / Clothes Dryer ;-75-
<br />Residential Range \
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 'ilY\61 fr{)/
<br />Notes,.Remarks, Etc ,(-|
<br />il>lr9 w{2. i.W la 9zA.v.e._t(-,/,,4
<br />{; -Zt- - lfi Cast&.t){o^/C.al>hP,t f -.t.J6)
<br />U
<br />OWNER BUIIDER DELCARATION
<br />I n rcby lftum und.r nc lry of Frjlry rhlr I m crcn9r 6on rh. Cotrrh.ro6 Liccn* Llw fo, rhc fouowing EMn (Sec.7ol l -5
<br />Busift3s r.d Profc$ion Codc,: Any Cily or Co&ry shhh Equn$ r Frmr lo @inMl. dld. inpmle dctulht or r.t{n 3n,
<br />srmt@, Fbr ro irs ksm.. rbo rcquiE. rn rpplhanr lor su.h Fmil ro fih. sigxn slllcm rnd l.E or sl& b lieosd pNer
<br />ro rh. I'ovirioN ol rlt CoflEctoas Liensd Lra (Chsprcr 9. Co.rftming Birh S.crion 7000 of Dirkion 3 ol llE 8usitr$s lnd
<br />Pnracr.ions Codc) or fi.l lE q sh. ir crcnpt lhseiiom od rhc b8is for rhc ,lhFd cx.mrlion. Any viololion ofs.dion l0l1.5 by a,y
<br />applic&nl for ! p.rmil sbj.rls thc lpplicul to ! civil p.mhy of not mrc lhs 6v. hondEd dollas (5500).
<br />_1. ae owftr of rlE popcny. or my cmplorc! sitt tagcs $ lhe ir slc conrp.nsolion. will do llE wmt &d lhc s8r@ ir ml
<br />inrodcd or oficEn for sh (3*.7044. Blsincs dd Profcssiotrs Codc Tnc Co .scrols Licn* L{w d@s nor q'ply ro r. owmr ol
<br />thcpDFny uho hiLti or inpmB tF6o rnd who des ki wo,l hins.( or hcNlf or lhmuSn his tr ncr oM ctrrployc.s.
<br />nnvidcd thrl such impmwdnls e not htc kn.roftrcd fors!..1( lnlw, tlE buildin8 or iryorcm irsld *hhi.oN )Ea
<br />ot complelion. lhc Owrcr Buildd wil lErc lhc trd.n oatmvi.g lhar tE tr sh. did d trild or impmr .h. ,qxny for dE puqEr of
<br />-1,
<br />asowncr o{rhc pmFny. !hcrclusirlyco mtin8,nh lccnsd conrracroBloon.rtur rlt lr,r{ (Sec.7044. aushcs
<br />lnd P,triti\iD Codc: Thc Conr.achis Li.crs Lae d@s.ot oDplyro d 6*n.r orDmr.dy who builds or improvcs lhermn.
<br />aDd who .o mN L u.h Foj.{ts vnn a Conlrero(9 li.c6.d tuBulnt ro $c Co,tractor's Li.cns L!N).
<br />lr orcnrt, undfSr.ri(rr .B &P.C ntrrhi!tur\rr
<br />O*ftr:
<br />!!l8f,E[t:CaUfBSArrQN
<br />DECLIAAIION
<br />I h.rcby atltrm udcr pcndly of lcrrury orc ot lh. followi.E d.claolions:
<br />-l
<br />hlw ",i will minrah , Ccnificare of Conrnr b S.r.lnsuE for Mrkas oftIE erion. a pbvid.d for by Scclion l?00 6I rhc
<br />tibor Codc forihe!oto,lj1!N offie wort for which lhc pcm i\ hsu.d.
<br />_lhavclndsillmuitrr.in*orkcE comFnsution insurrncc. !s rcqlircd h, Sccrioo 17fl)ofrhc Lnbdr Codc. ror lhc lcrforurcc ol
<br />rhc $ork lor whici I hh ,lcn,i' is nsrcn, My *ork 6 qnnp.nsllt,n insurlncc cadicr dld lhlhy numb.r ac
<br />PolkyNmtd: EiliE!
<br />l.cnify lh in rhc lcrlonuN of thc work for whichlhis p.flnit h issucd.l sholl nol cmtloysnylccon inrnytunf,
<br />$ asro h.om su6jmt ro the Norlcl empcnstion laws otcrlirndis, and arrc rhlr irI rh,uld litom $bjer b ttr
<br />uorkss cory)cnstionpmvisions ofSslion lT00 or lnc Llhor Codc,l shall. fonhsirhdmply wirh rths Povisions..
<br />WARNINC: Faihrc lo $cm *ork*( .o'npcosarkln .ov.hsc i\ unhwtul. and sholl subjd 0n cmplorr lo oimitul rEMh6 and
<br />civil lincr !p lo onc hutolrcd I
<br />Scclion .1076 ol I hc I lhr Codc.
<br />in addiri.. h lhc cosl oicompcnsliotr, dlmgcs as polidcd lor rh€
<br />I lEEby alfm undcr p.Dlly of Frjury lh.l I u licn$d urder FDvisk n ofchspld 9 (.onmfting wnh sc.rion 7000) of Divisi.n l
<br />of rh. BNIN$ .rld Proa.sioB Crdc. .!n ny lcdc h itr tull fo@ rrd .itel,
<br />\ez 11q
<br />I h€rcby lmrfl undcr Irnrhy of pcrjury
<br />issucd (S... 1097. Civ. C.).
<br />i.tulins agcmy for rhc tdf(,lr,1mc of llE *ort lor *hkh lhis Fnil is
<br />AITLICINLDECLAITUAN
<br />I tmhy dlirm u cr |u0nll y or pcrjwy orc ol'rhc lnll,'win8 dcclur iinsl
<br />II i,lin,n P.nnih A\brno\ Norili.nrii,Iic cml Rrg!hri(nrs lrIb.{r Pnn6i
<br />Rcqtrr.d t rrcr olNotiricarior
<br />-l
<br />.cn ify rhar thc fcdclrl rcslllr ions rcsedin8 lshcsros rcmovrl rc mr lpllicablc ro rhi\ pmjd
<br />Ltccrrv rtr
<br />"b"Y''*d
<br />I hovc rcd rik lndicorion old srucrhar rhc ltnvc intomrion n.oG'. I rgi,e ro co,ply wirh orl Cityand Counly
<br />ro huildi.S .onsrru.rion. s,n hcEby trurhoria rcpEs.tarivcs of rhi! Ciry !.d Couly ro o16 utrn dE
<br />"1"f'-'
<br />-'L$'l\
<br />lnstallation
<br />LOltll v
<br />hi, tl
<br />ED. A.V
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