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MECHANICAL-INSPECTOR RECOBD
<br />APPBOVALS tD/slG.COMMENTS
<br />Appliances
<br />lvletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<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 />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 l-..\
<br />W-\L)O)FINAL t0-249
<br />Notes, Remarks, Etc.
<br />owNER BUTLDER DEL$RlrtoN I
<br />I hercby,atirn unrlcr p.olry of Fdury lhal I mcrchfl fisn $. Conlfaclon LheM l2w forthe followine @$n (S(7oll.t!
<br />Btrsincss rd Prolcssion Codc) Any Cily or Counly ehich Eqlirc! a |E mir ro onslrucl, altcr. idpDw, d.mlish or rcP.n atry !
<br />srructurc. prior lo ns i$u!re. alo Eques rlE eppli.ad fo. such pormil lo filc a iisn n srdrm thol lE or sh. h liccisd Prmarl
<br />ro rtE pmvbions ofdr Co.rtulolv Lic.n*d hw (Chlprer 9, ComcNinB wilh S.clion ?000 of Divilhn 3 of rlE Busincss and
<br />PmfcssionsCode) or rhir h.or sh. isercnpl rlErcfronand rn hosis lor lhc alb8.n.xctrlplao! Aryviol,lionofScdion'701,tbyrny
<br />,pplicdnr tor a pcmn subjets lhc .Irlicanl lo . civil pcnally ot mr mt lho iv. hundEn douss (t500),
<br />-1.
<br />$ o*ncr of rhc Impcny. o sy..l9lo}t.s with wagcs 0s rn $k comPcnerion, witl.L rhe wort ad ttr slnEl@ i mr
<br />i €.xkd or ofl.rcn for slc (Sa.7{r4t. Buiimss and Prcfcsions Codq Thc C.nrn ktr s Liccnsc tjv &cs n appl, to e owmr of
<br />fi. pDpcny *ho toildsor ir+rcwsrltmn, ud who dc ch *oa himsclfor hdslf or ltmlgh his or hff osn.nplotts.
<br />I,rolidcd lhar such nnl'olEmnts N re! hrcBird o.of.en for eL. Il ho*tri lh. hi di,B or in{ffim Lr$ldw rliroRJtu
<br />ofmrr|)bihn. rlE Osffi Buitcr will hlw llE t{rdcn of I'olins tlicl ,r or shc di] mi tdih or ii{,mw tnc !mt)ql, fo. lhc pul.c or
<br />-1.
<br />as owncr of rhe l,mFnr. an cxclusiwly conra.ring wilh liccEd contEclo6 lo ordrud rtE pmrel (56. ?044. BGifts
<br />and ProfssbnCoder Thc Co.tktoas Licc.s t w d@s nol apply lo m o*ret of pmFny *ho builds or inneve, $crcotr
<br />and who snrtuls aor sch Foicrs sith o C. n lods) licnsn puButrl lo lhc Consadoai LHne hw)
<br />-llncxcnpl
<br />u.der Sd B &PC lhrlhh,os,n
<br />-
<br />OrF-
<br />]llatrE8!:rqMtalalloN
<br />DECLIAAIO!
<br />I hcrcby amrm unn6,cMlry ofpnju.y orc oaln aollovinB d(hrEliotr.:
<br />-l
<br />harc ed wiu minrain d C.nirtllcof Conpnl to Srl nsurc for ,ortcN .on .nsalion. as pmvicd for by Sd ion 1700 of ihc
<br />L.bor Codc. for lhc pqform*c o, rh. worl ror which lhc lEmi n nsu€d.
<br />-l hrvc and will naiotri. workcrs coryEnsalion insuhmc. &i rquircd by scli,n 3?G) ollh€ Ijbor Codc. for lh. pcrformre ot
<br />rhc *..k fo, which thh ,lcmil is hsicd. My worlm .{mFnelioo iniurucc csicr ud lDlicy nuhh€r @:
<br />PolicyNumh.r: F{,
<br />-l
<br />ccnify rhat in rhc pc.formicc ofthc work for which lhis lE rnn is issucd. I ihau nr corlo
<br />$ ai ro hc.o@ subjcd k, th. worlc(' comrcnsrion bws of Cllitoftia, ,.d ,gd rhd if I sho
<br />so&da .onlEnsdrion Imvkions ofse! ion 1700 of lhe Lalxr Cod€. I nEl[ lonhwilh .ompl]
<br />WAIININC: Failurc lo scurc *o*.f @mFnerion $v.raec is r an .nptorrr lo nimiiul Ffulrici ard
<br />civil linc* up ro orc hundEt rhouend dollds ($loo.ml), in nnr. danugcs rs p..vnhd fd lhc
<br />Sccrion 1016 of rhc L{bor Codc, inr.rca md dlormyt a.ca.
<br />IICENIED-COITIIACIAA
<br />DECIAEAIION
<br />I h.Eby arrr udn penalry of,Erju.y rhlr I m lienscd undcr !|ovnion of Chaflo 9 (oo,EBin8
<br />.f rhc Bx\incs\ & Pmfcsions Cdc. old nry liccn* h in full (nN ,n cffol
<br />coNSrnIl(:IrQlLgNII !-atilNg
<br />I hct-b, lmm und.r F-nahyol pctur! rhu rhcE i\ a.on(ruclt$ hndins,ecn.y ri,. rhc lcrlirnrncc dlrltr work ror which rhn pctnrii is
<br />nsucd (S.c.:1017- Cn. ( )
<br />L.frlq s Add6!s:
<br />-
<br />d-PrucatlDltsl/x IloN
<br />I h6rt r 3lftrm undcr ncnnlryoftrrjury onc ofrhc tulhsiis dslu'Lrn,ns
<br />D.nn irio. PciinirsAshc{os Norificarnnr Fdldrdl R.Sulnrions (lirlc,10. Pan6)
<br />-t{cqunrd
<br />l.cncr ol Noriltoli,rn
<br />_l ccniry rhll rh. rdcral rcSuluth.s E8adins e\bc\xN rc'elal m n.r u|)pl
<br />l.cniry r[al I luvc rc0d thisupplic io {rr{dc(rr I .gm ro.omplywirh all Ciry and Coun'y
<br />o'di'u.c\$ d srrrcl-r*\ rulnhB b buildin8 ilcs olthn Ciryand Coun'yro cnlcrulnnlhc
<br />lhov. r rn,ncd p(rtrc yf r
<br />Amlicrtrl or ABenl Sistururc:*,", 4'/{'/fi
<br />DATE
<br />Duct Work
<br />"",-*",.,*tp,^,) / \,|FEt /4CL\!7A
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