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MECHANICAL-INSPECTOB RECORD
<br />DATE tD/stG.COMMENTS OWNER BUILDER DELCAXATION
<br />I lErchy lrfrm u.d.r ncnalty 6f pc.iury lh.l I @ cxcmp! tren rhc C! .aclou LL*n* t w for llE folh*in8 e!5n (Sd.7031 .5
<br />Busircss .nd Pmfcssion Cod.): Any City or Conry whth rcquircs . pcmn b Nnsrrucr, .hs, itr9ok. rkmli.rh o, qut e,
<br />srMle. lritr ro ic isslN, aho Eqlirs rhc apllktrfl for sct Fmi ro 6h s sigftn ir.rcm lhot lE or rlE i. lic.€d Fl!!@r
<br />ro lh. Firirio.$ of dE Conaebri Lisns.d t w lcluprc 9, CrnmBing *nh Sdion ,000 of Division 3 ol thc Busim$ ,nd
<br />Prclcssions Codc) or th.t IE or slE is cr'qr rhcrcfrom and rlE basis for th. ullescd crcnFio.. A., viol,iio, of Sdirn 701l.J by any
<br />applicrfl tor { netBir iubjels rhe .pplk.nl lo . civil penalry of er me lhe live huodr.t dollss (lsm).
<br />-1,
<br />as owmr nf thc rolEnr. or hy cnployes wm qagcc as rhcn sb .oqrnsltnrn. will do rlE w.rt ed th. shrE is rol
<br />lcdct dr ofcrcd for sk (Se.7oa4. Busincss a.d Prof.*ions Codq Th. Conrrktr\ Liansc LaR docs not rDply l. ,. oq.cr or
<br />rhc pmFny who blilds or im0mws rtfui, lnd who dms sah w* himsclf or hcr*lf orrhrongh hh ornfio*n cq,loy4s,
<br />lrovid.d 'h!r
<br />sxch inporcmors& mi i.lcndcd oroficmd lor eb.Ir. how.E, fi.itrildinBor i,rFoEnr nsUwilhinotu}ls
<br />ol co'r{,hrion, lhc Owncr Bui}:lcr $ill har llr hor&n of fovin8 tlur hc or shc did nor blild or inDmr $e prFry for ltf, pn,los ol
<br />-1.
<br />!sosmrotrhc pmpcriy. an.i.llrivclyconrEriry *irh li.cnEdcorrmcroFt, ondod rlr p,oid (sd 7044. BusDcs
<br />a PDft.rirnCoder Th. Contdols Liccb\. ti* dcr mi.ppl, tu downcr ofrrotcny{ln' nuiEs or imFovcs lhcrNi,
<br />a.d who o Ecrs for sucn pmirk wirh D Conrncronr) ltctred Fur\ua.r k, rhcConrador's l-kcnc. bN).
<br />w6I(F Rs' collTPFNsATIoN
<br />DEI;IAIAII!]N
<br />I hcrcby ottiirn undcr pcnrltyofpqjuryonc olrhc followi.B dslararions
<br />-lh0vcondBillndnain0Ccnili.deolCotrsnrn,Scllltrsurclu"orkc6coUcoslri,,n,rsF)vidcdinb,sc.riotrlTlxlorrhctitnr Gxlu.lor (hc lcrfonuncc., thc Eork ld qhi.hrlr 0crnril is issucd
<br />_l h!v. lnd will tunnrin*ork is conrpns,rion insui,mc, dr rcquncdbyscctiotr 37mollhc t hor Codc. fo. thc p.nimicc ot
<br />rhc sort for which rhn Fmn ir ir$.4 M, workcl. corFnsdidn iniurdnd @i.r ond pli.y numtE uc:
<br />Polic, Nunbcr:Jrpic'
<br />I..nily $dr in rh. p.iror@..c ofrhc work lor whhh rhis !.rmir h hsucd. I snall rcl omplot any lcNn in lny manmt
<br />$ as lo hcconE subjd to lhc *orlcs'compcnsalion lnps of Cllifortrir and agrcc rhar if I sl&lld tE om .!bj.cl to llI
<br />*orkcr comp.ns iontmvisionsofSsrion:1700oflhctitbrCodc.lshall.fonh*ilhco nly wirh lhos ttvisbns..
<br />WARNIN(; liihrc k, \..urc qorkch .ntrrpcisdnnr &vrfusr i\ u hwtul. dnd \hrrl srlrjcd flr cnrtlo)cr to dminrl pcnuhr\ ind
<br />rilil linci up lo one hundad rhou\lnd d.lldi {Slln.o(x)). i. lddnion ro rh.ofconp.trs|iion. d!m8!s ss rrovid€d tor rhc
<br />Sdrion 1076 oI lhc L3tnr Codc. inrercn lnd arcmy\ ler,
<br />utrNsElcoNra, .rQa
<br />DI:grInAIlQN
<br />I hcrb, rllloluidcr pcmlrrofp$jurv rhlr I rn li..n\cd und( !tuvnn,n.l Clrprft 9 (.orMn.i.g $ith Scdion 7O(Ir) ol Divntrrt.l
<br />ol th. Busirc\s d Prcttst'nsCodc. Md nry li..nsc ir in tullbr.c elcr'lc.r
<br />l.icens. clas:-_--Liccnsc NuFb$
<br />Datc ContE.lor:
<br />C!]IEITIIqIO!.IENDINC.&GINIT
<br />, h.ehy n,nr undc. Fnrlty or pcrjury rhd rh.rc is a constructiotr tnding .scmy io, rhc pcrlortuicc .r rh. $dk ror ehich $h Imil h
<br />issucd(Ss 1097. Ci! C )
<br />AITI.ICANIDICLAIAIIAX
<br />I tsr.iy urlln udcr t^-nulry oI trrjury oN nrrhl fi,lk,$ios dcclsBrtn,\
<br />Dcntrnli( l'cir n\ Arh.{os Norifi.rriotr lidcnl RcAUlnliotrs ('rfb.10. PM6)
<br />-Rcquirql
<br />t.llcr ol Nolifi cdion
<br />-l
<br />ccnili rhtrl rlrc lcdcr0l rc.qular ion\ rcsirding lshc(os rcmval !,e nor 4pli.ftlc b rhi! flriu.
<br />IccnilyrhlrllBrrcldrhi\apfli.{nnrr $rdrhnrrltr h*c iir.n,lroi i\cotr.r laBrNloco rllyuilnallCiryatulcou.'y
<br />ordiuKcs 0nd Shlc Llws Ehritrs ro huildin8 consrddion, ond aurhorizc rcpeicnlirilca orrhk Cirt rd Couolyb cnrs ul]on lhc
<br />nbovc nEnlioftd pmDcdy ftr
<br /> Arplicrtrr or Alcnr Si[mrtrrc:
<br />Pcrmilc. nlm lrinl)l
<br />^". r\2rll I
<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
<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 Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 7 ?lM /a ltLry^A(E
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Above T-Bar
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