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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcby alli.n undcr p.mhy oi psiury thal I d cx€mfl fom lhe Conuscrou Licetr* L.* ibr lhc folhwing rct$n (Sq.ml l.5
<br />Busin.ss ord Prof..sion Codc): An, Cny or Cou.ry whi.t requi8 ! pqmn lo onsltul. all(. imphl.. d.mu6h or eplir dy
<br />smkllE. ritr ro iG issuaBc. rtlo cquiEs llE +plkui for srch Fmil lo lik ! sigr.i slaLftnl lhsl lE or shc is liensd N6@l
<br />lo rlE pmvilioirs of tlE Co,rrrror\ Li..n*d Ltw (Ch{nl.r 9. ComcrcinS *ith S.ction 7000 of Divirion 3 of thc Slsin.ss lnd
<br />Prcf.ssi.ns Codc) or rh lE or .rE k crcq,l ih.Eiiom rnd th. halis for lh. llhg.d .xor0ri.n. Ary viol4ion of Salbn ?011 5 by ey
<br />optlka.r for a Fmit .ub.ialr llE atplics lo ! cilil !,cmlly of ml mr. tho !'iv. nundrEn dolds ($500)
<br />-1.
<br />!s o*M ot rhc pmpcnr. d my.mplorsr wilh we8.s 0! OEt $h ompenerior. eill d. th wk .,i ltE stnd@ i\ mr
<br />inhnd.d or orccd for eb (Se.7o44. Busircss d Pmfcssions codc: The contdcior's Licns Lnw dms ml arulyro om.rof
<br />rh. p'oFny who hoilds ot iryrcEs dtotr drd *hr dB sh ,qi hirclf or ncrclf or lhmush his or hc, ow. cmrlolt.s.
<br />pmvidcd ih,r sch inlpmrm s B mr idcDdcd tr ofioEd for srlc. It hok@. rh. t{ din8 or ihpmEmnt is sld wilhin onc )t{
<br />of.on!)Llhr. rlE Oqn6 Build6 will h{w lh. budcn of pmvin8 thrl lE or stc dit Dr boild or inlmw rh. pmtdy aor lh. pu{D$ of
<br />_1. or osrcr of lhc INFay. m crctusirly .onrr.crins *irh tiaisrd .onreb6 lo consdd ltE prciEl (Sd, 7044, BNim$
<br />a P,trf.{sno Codc:'rhc Conlrocror's Liccns. kw dBs nol opPlylo onowncr ofp,op.nysho buil& or impows lhcNn.
<br />,nd who omacls Lr sEh prcirls qnh r Conrtulo(t lk€n{d puBunl lo $. Conlr.clols Lirn* ll*).
<br />I lncx.mDt undcr SKtion .B & P,C, rotrhs rcason
<br />D . ()*n..
<br />!I}Xf,EBa.I;!DII!NTAII!A
<br />DECI,AMI&!
<br />I heEb, a,hrm undfi pclrlry of psjury om of thc followins dehnlionsl
<br />lhrvc dwillrrirrifr(.nill.nc.lCo\ciruSrlfln\urclitr{orkcr!c.nrPcn\xri,n,.r\pn)rnlcdturbyScc!onlTlX)olrh!
<br />l-rtxtrCixic, f(tr rhc lcrlnnru,rc ol !hc tr.rk l;rrhicI rhc ncrn,ir i! i\{.d
<br />-l
<br />h{vc ,nd will m.ibl0in *otkcts' compensarion ins!6ftc, as Equircd hy Sel ion 3700 of lhc Lslrt Codc. lot lhc p..fommc of
<br />llE work for ehich rhis !.rnil is Gs€d My sorkcs .omFnelior inrnmc cMit &d Policy numbcr 6c:
<br />-l
<br />eniiyrh0r inrhcpcrformorccofrhcwor* ror whichrhh p.rmn n Gsucd.l shollnol c,rlPloy loy p.^o. i.a.rnurcr
<br />$ N Io tl.and slbrir ro rh. wor*.B mq,.nsotion h*s ofcolifomi!. snd DgEc thd il I should be.om slbjcd ro r,t
<br />workqf ohpcnsorion lr.lhions of Scclion 1700 of lhe Lltnr Codc. I slall. fonhwid .omtly wnh lho$ PDvBidni
<br />WARNINGT Flilurc to rcurc wortcrs 6np.nsri.i ..vcrrt.
<br />.i!il fincs ur ro onc hundrcd rholslid dolhh {$10o,0(D), in
<br />Ser io. 10?6 of fi. tihn Cc{c- inrftnand$omy\ r*s
<br />",,,, al3)ttr n,,,-,, \(
<br />h unlawful. ond ihlll subjccr d y.r b nimintrl p.nrhic\ rnd
<br />I hcrchy lr'lirm undcr lcoolrrorr.rjury rhat I nli.cnrMutrdc!tnovisionoiCtulprct9(comnf,rnr8wirhSR.-lion7((())nrt)ivhi,.]
<br />of rhc Busirc*iftl Pmfcsrion\Coic. and nyliccn{ is in lull fttr.r, clfL{r
<br />!)
<br />IhcrctyrnnnrlndcrpcnahyurFrjuryrh rlrc is!connrucli(tn lcndin-!uscn.yrorrhcrdfonMNcolrhcsork for ahich rhrs Fnil i\
<br />issucd (Scc. 30r)?. Civ C )
<br />AI[U(^.NfD}:CLA.BATA
<br />I lub]_Jlltrtrtrtl.r Jrnnlryol tf,ijrloncol rh.l()ll rn,g,lccrrrri,nx
<br />I)c tr,hri,tr l'd r$ \h.{o\ N.rlicrlion I cturrl RrgulJrnn,s II irlc Jl,.I'an6)
<br />Rrqun lirrcrol Norili.ari(rr
<br />-l.drify
<br />(ha! rlE fcd.ml Egulilions EEudins lstrslor omvddr nor anpli.,bL h lhis ItmJc.l
<br />-l
<br />cenify lhrr t have rc.d lhis lmlicnr
<br />ordironccs dt Slarc LiqsElarinE ro hli
<br />ahov. nrnriotrcd prcFnyfor i.spdrion
<br />I lgra rocomtl, {irh rll Cirylnd Counry
<br />ircs ollni!Cny d Counry ro cntcrllx n lnc
<br />Applicd o.AgcnrSiCnolurc *", I lclrr
<br />a {-,
<br />Itt
<br />fr
<br />Appliances
<br />Metal Fire Place
<br />Evaporalive 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 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 />Rouqh Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 0/ill{,AI rffil t)
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />rl
<br />txrdcr . Nirr
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<br />Psnril.c m'm (prinl):
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