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MECHANICAL.INSPECTOR RECORD
<br />OI{NER BUII.DER DELCAXATION
<br />I h.Eby lron udd p.Mlry of rci!ry llEt I m excntr tDn fie ConrE$6 LiM* t w for tt fouoeing rcs$n 1Se.7031.5
<br />Busiress 3d Pmf.ssio. Cod.): A.y Cny or Cotnly *hict rcqun s . Fmil lo 6ncnEl, !hs, in{'bvq dmlish or EItrtr dy
<br />stktuE. prbr lo irs hsu'E. rls rcquiB rh. applicMr lor such pcmir ro 6k. iiEmd srrrcmnr $, lE or slE i! liensd lwrd
<br />lo tlE prcviiion. of llE Conrturoi. Liansn Llw {C1Epl.r 9. Conmrcing wnh Sccrion 7000 of Divhion I oa rlE Businc$ snd
<br />Alf.rsions Codc) or thal tr o sh. k crcnpr lhcr€fiom ed lhe basis fo. tlE dL8.d cx.nprion. A.y viotrdo. olsdi,n ?031.5 hy !.,
<br />lppli.afl for a pcmn slhttr rlx .pplkanr ro r civil pcmty of not mrc ih& nlc hundE{ dol,&s (6500).
<br />-l.i\owncroilhcpmltdr,(Itrryrr!IDt.\$irhsr!c\a!rhctwlc.otr,pcnllln'n.Iilldorhcsorl0ndrhcslMrurci\nori c lcd orolirc hr {nu (S$?(!,+. tsusincssntrd P$r.\st,!\Cod. ThcQ,itxckn s l,iccnse ltr$doc\norlpplyro!no$ncrol
<br />rhcnn)I.ny uho huilds or nnfn,r$ rlrtu .r *ho Jffs su.h *r'* hirnscll or hcrcll.r thhuAh his or hcr osn cmrrhy.$.
<br />prcvidcdrhnrru.h i'np(^nrnh rr nor i'ncnd.d orotitrcd i(tr srL ll hoscvfl, rlrhuil ing or inpn,v.'tunr isRrld wirhinonc rrrr
<br />ot.oq'lc'i{,i.rlNowncrBuitlcrwillturcrlEhurdcnofpn,vin8rhdhror\fudidnorhuillori p.ove lhc ID|ra, thr rhc purlnn: ol
<br />-1.
<br />as owmr ol $c p6p.dy. mr cr.hsivcly co ra.tins with li.cn*d .onr!.lds ro .onerucr $. r.mid (s(. 7044. Burms
<br />arrj P,olission Codc: Thc Controcrols Liccnsc Law d6s nor lprlylo rn6wnd.aprcFn, wno blilds or nnprovcs licrcon.and who m @h ror skh poic.ts sirh ! Conrncto(s) liNnsd pusuaN blh.ConrB.rocs Lkcn* l,e).
<br />-lm.rcnp
<br />undr Sdio
<br />D"", 07 I t 6
<br />ll!I-L-\!t!ll1
<br />I hcr.by rlinn und.. pcnallyofperjlryoncofthc rbllowin8d&lr n,is:
<br />Ilrrcntltil ti'nrinr(cnll.)r.o,Conlc 1.Scl!|t{rclitso,kdi.rmlcnsnri( ,rtpmlid.dkrbtSccrn.lT(x)ofrhc
<br />Lihn Ci)dc, ntr dr Nrtunnan.c oldrc work tur *hich rft,Er0ir n i{ucil
<br />J hale and qill hlinl.in eorkeu comp.nsorioo insurlkc. as rcquhcd by SccriDn l70l) olth€ tibor C.de, for ltc,'.rfomrc oi
<br />fie work i whth thic pcrnir is ksud. My worlids @n ansrion insurancc cnid &.d loticr,umbcr m:
<br />Pohcy Numh.r: _ Erp
<br />-I
<br />cenif,lhat in thc p.rformmc .f lhc wor* ror which rhh perm is nsucd.I shrll not cnploy !try F6on inunym.rcr$ .\ io l*com subirr to thc *n*c6 oryensBthtr lows.f Caliaomi& and nBm rhd irI sh.uH tf.6m subF.r to rlE
<br />wo*m.$npc.srionpn'vi.\io.soa56rio.lT00oarhcL3hrCnic.lshau.fonhuirh6q,lywnhlh.Ep6vjsaoN..
<br />WARNINCT Fnilorc lo $curc workcs comFnurion Lsvcogc is unhwf!|. ut \h!ll srbjd an onllloycr to .nmi.!l l)culrls ond
<br />.ilil fines up lo om hundrcd lhoumnd doll.tr (Slm.mo n lddirion ro rhc cost of compc.salion. danqcs as pro! cd lbr thc
<br />;lr';|ri )s-":
<br />LIIINIDTANINA!:IOB
<br />D[$/lntruoNIhrtoh!rflt u cr pcmlly ol F-rjury rh Irm li.c.{d utrd.r F)vi{i, of (lhrpicr 9 ($'nnrh.-ing wnhSliri{'.7U )ofDrisi{r.l
<br />ol lhc Busir.sr Md Prnr\sidns Codc, urxl nry lic.nsc is i. tlllti)r.. rlcll!.r
<br />l)rrr
<br />taNEltrlJ(:lt0Nl,l,N0lNri_d(iENr.!
<br />isuc.l(Sc( 1097,Crv C )
<br />At[tlQrNfl]Ijlt1lB^tlQ!
<br />I kr$, illim hdcr ,!.n!1ry ol rcrjury orc oirhc roUosing dc.lar!tion\:
<br />Dc.blirnin Pcrmir\ A\hcsros Nori6crrion !icicr.lRcSulari.tr\ (Tirlc "10. P,n6)
<br />-Rcquncd
<br />htrcr of Norfr$bn
<br />I ccnilyin rhc lcdcml !!8ul!rions rc8nrdin8 lsh.eor Efr,vll"E.or amliclblc r, rhis nDjc.r
<br />I L{nirrrh{ I hlvc rc{d rhhrptli.rrirnrudldrrhnrrh.nhvd intorn i,'n i\ romd I asrcc r, comply tr irn all Cir, rnd Counrv
<br />ordi.rnc.\ rtr.l Sxtr.lns\ r building .oodrucrbn. snd h.rchy lurtntrnc Eprcsflrrrivcs ofrhisCily&d Counryto cm6 upon rlE
<br />!bo!c mntioncd pmpcnt lor
<br />A|)lrli.inr orAgcnr Si[nlr
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Ev aporative 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 Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Dam per
<br />Opqnings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Ro ugh Mech.glHL?'I i-tn 4ct ,.r{zc,/
<br />Final Test ll uU
<br />Meter Release
<br />FINAL tcllplfL ''d.nqrl ,/'Y))
<br />Notes, Remarks, Etc UI
<br />I
<br />t>4-nz/rz/ 19
<br />Lienie Chss:_Lkcns Numhi _
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