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MECHANICAL-INSPECTOR RECORD
<br />DATE tD/stG.COMMENTS OWNI]R Bt]II-DUR DT]I,CARATION
<br />I lErchy nitn un cr acnilry ol pciuy lhd I !m cx.rlpl frorn rhc (itr lrclors l-kctr\c l-r$ fttr ihc lalkisn,g tiR (Sc.7)115.
<br />Businr$ nDd P!or'.$t,f, code): nt Ciry or Counry which rll]unc\ r lf,r,rir to cdtr!ru.r. ilrcr. itrrpii,rc, dunnli\h oi rcl'ir $, .
<br />ro rhc F,!ni{)ns ol rh Coita.tn \ I ir.n\.d t-rs rchrnrrr L Conn .n(nit \irh Sc.riotr 7(XX) ol Divhtu :l oi rhc ln'sinc"\ itrd
<br />Pn'fcs\i,rtrCudc)urrhai lforshc itcxcnU rh.rdio rrrd rhcbrn\ lir rhc illctcd cxcnrfior Anyvi.hrn,nofSRri,)i70-ll5hy!ny
<br />rtrli.nDr ir r Nnnir nrhlccrs rhc rrDlicrrrhaci!ilpctrrlryornornnrthinlivchundrcd(lolllf(:15(l))
<br />-1.
<br />as o*ncr of thc I,oIEny, or d, cqrlortcs wirh $a8cs !s rh.n sb .onl)cnerion. will do tlE wdk tun dE sull]w k flol
<br />hrcnd.n or dllccd to, slc {S(.7{x4, BNircss md Profcr.i,o$ codc Thc Co.lradm s Li..nrc tiw dcs nor q'dy ro nn o{rd or
<br />rte phlEny who hdirl{ or in{hB ttrN( dld wno dds sh h& hi.r.l{ or h.s.lf or lhmu3h hh or lE o*n chpl.rccs,
<br />Imvid.d rtar sucn imt'oEEnls m mr inrcd orollcEt for $l€.li,h*r. rhe hildin8 o. inpmwmnr h sld wirhin om y@
<br />of.omplcrion, 0E O*ft, Auddd wll h.w r& htrdcn of pmvif,8 thd hc or shc dil mt ltuild or iryme Oc pDpcny for 0E !u{me of
<br />l. as own$ ollh. tmpcdy. 0n crclusivcly .onrretinS wirh liensd conhcroF ro conirucl rh. tmj(1 (S(. 7tr44, BNim$
<br />,nd Fotu{d Codc: Thc Conkeror'. Li.cnsc llv dd{ not nlply ro dnosnn oflrop.ny who builds or imFmts $.rcon.
<br />lid sho conrrcls lor such proj(rs wirh o CotrtEcro(, lic.n$d plrslo ro the Contactd, q LkcnF tiw).
<br />l)f,.rdrnr un(ld S.rr B &PC r'orrhi\rcN)n.
<br />UOBf,E8:I.COIIIEIIAIION
<br />DECI/XAIIQ!
<br />I hcrcb, ufirm uidcr pcnlIry of pojury om of tlr following dc.ledrirnsl
<br />l:rt\ (inl.. io.lhc I)!n,trtrL'nre.trh. sork lnr \h(h rhr Nnni ir '\\ur(l
<br />I h,vc andpill'minl0in workcrs' con{f, n sar ion insuramc. os rcquircd by S.dion 1700 ofthc Lil,or Codc, for fic pctfo,nEc. ol
<br />tnc wolk for whkn.thk lch l is issucd. My worl6 .om!.nsotion-in,uDtuc .orir dd li.licy Nnbcr e:
<br />",*, Z.unc\^ I)v*tticovt \YVNnrY,Qz,
<br />' \Al
<br />^
<br />")to4 I0
<br />-l
<br />ccniftlhol inlhcpcrlortun.corthc wo* aorehichrhisFrm k hiucd.I dallnor cftploy My p.r$. inlnymnncr
<br />$ 6ro b.cor srhj{i to ihc wort.* conFhsliion I0ws of Califomin. .nd tr8rc lhal ifl shoukl tEcotu subr..l ro rlr
<br />mrrdc omp.nslion pmvtions of Selion 3?00 of thc tibor Codc. I sh!I- rodhvnh @mPly eith rlbs tmvisio.s..
<br />WARNIN(; failurc h {ck firk$i c.n,Fisari('n covcB!. i\ unlrsful
<br />ciil linc\ op ro onc h(ndrcd rhou\! l dollur\ (Slur,(xN)). ir uddiri.n x,
<br />subjccr atr clnplorcr b siminal rnalrics lnd
<br />ir0r!c\ r\ tr,vi,l.rl ntr l[c
<br />Libor Code, inrdc{ md atrofty\
<br />c l0 t ^iiis'.
<br />r!!!l-Brr.t(
<br />I hcrby dm.rn udd.r pr llry ol !.rlury thd I rm liccn*\l uM.r provision of Chrplcr 9 (commnc iis rirb SFrir,. 70(x) ) ol Dilisioh l
<br />ot rhc llurinc\s Md ln,fe*i.n\ Codc. md ry lic.tr\d il ir tuU rar.c ant.tlt.r
<br />t1 14?+6
<br />u ?)
<br />I hcrchyrlftnundcr lcnalry.rlErjrryrhrl rhcrc isr.oriru.rion lcndinitrscNy forlhc pu ormamc ol rhc {dik tr which rhi\ pcnnn is
<br />issucd (SN. 109?. Civ C )
<br />AITUCANLDECLAAA.ION
<br />I lrl.])yrllnNundcr NMLIy ol pcriuy.nc ollhc nnl)winE d(l i,nr\
<br />I)cnrniri,i l'cnnirs A\h({o\ Norilllrri,n F. crrl R.g liri,nN r'l illc {), Prn6)
<br />Rcquir.d Iirrcr ol Miill(lior
<br />-lccrtifylhJ!
<br />rhc !.dcml rcgublion\ rcglrning oshc\ros rcmvllrc nor llPtlicrblc ro rhi\ pDi*l
<br />l.cnify rh I h,v. rcad rhk $!l inlonMrion h corcct. l lgB ro comrly*nh all Ciry and C.unr,
<br />or.linrNcs iid Sralc trw\ rclal ,cnrsnr iv.s ol $is Cny and Couf,ly lo .nrs upon lhc
<br />ak'vc nEnln,nd poren, i(n
<br />Al)Pliconl or Aaent Sisnat!4h'clft)
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation nlr,l/,Gru>ra'/f\-
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork to/>/?€u,r>.*t-/o,,'[(,
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<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 oho.//-?@zt>./8-
<br />/ r/t,-
<br />Bough Mech.'2/?o//t e ,?tivl.,?-/Q:---/(
<br />Meter Release
<br />FINAL 2zzl ,r'?- l/t 7r/ts
<br />Notes, Remarks, Etc
<br />APPROVALS
<br />Furnace
<br />lnstallation
<br />Final Test
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