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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS ()ltNtlt itr .t)t:R Dt:t,('/\Rl ll()N
<br />I hcrcby rm.m under pcnally of Fqury lhal I m cxcnfl nln lh. Conlrtloh Lkcnm trw fo. lhc folloeing Ersn (SE.,(r3l.t
<br />Bu.im3s ,rn Prcfcssion Codc): An, Cny or Coumy *hi.h EguiFs a Frmn l. consru.r. allcr. inP.ow. d.mlish rcr'lr ;/
<br />slructuB. prior l. irs hsuu... .lso rcquircs rhe applicafl fot ruch Pcmn b fih r sisncd sLrcmfl lhd nc or sh. ir lk.ned pumonl
<br />b fi. pmvisions of rtE Conm.bas Lic.n$d tlw (CtBpl6 9. Collerci.8 vith S6lio. 7000 of Division 3 ol lhc Busincts a.d
<br />Prcfcsions Cqjc) o, rh hcor shc h cxrtrq,l rLEfioftdd rhc b8ir for rlE allcScd ctcoPlion. any viololio.ofs€li.n?011.5 by.ny
<br />appticant for a p.mil sbjsls lhc l,)plicafl ro a .itil pcmty of nol mo llun fivc hundrcd doll&s (3500)
<br />Lrs osncroilhcprcIl:nt.ortrryctrlpk,rtc\wirhwiscsx\rtun('hconllctr\ulion-$illdorh.sork r]rlrcnnl m'i' n
<br />lrrcRlcd orniiircd n, \rlc (sN 7(},1. Busiru$ ud lt,li\\iurs c,{lc I hc Conrrrttr \ l-icctrt Law tlo.\ nor lnlly nr M ou mt oi
<br />dE Impcny slb trildt or i,.4Ktrr\ ItLrt\n drt $ho dds nrh so,I himscllor htrtllor rln.ush hi\ or hci ostr cnrPn)vcc\.
<br />Fmv cd rh i nEh iflIn'v.nr s rrc nor ir[cfrldl oroffcrcd n] {l: ll ho*6.r, rh hurldng or in4n,v.nr r i\ $ll wnhin orc )trtr
<br />ol.. l|)lcri,r rlfOtrrc!Buildrr sillhrrc rhc htrrd.noflrt)virr! rharlro.rhcdil n hnU.r nryrov. rh. Pmniv turrh! N,Ir'{ol
<br />l.!so*Nroirtupn,ncdt.rmcrchtrivclyconlr lirr3 Nirh lnri\cdc. ndos t, d,r{tuc' rhc rojccr (scc 7u-1. Btr\i"ts
<br />rnd ,\ a\\ir Codc: 'rh. Conrrmntr's l,ir.nsc l-!wdoN nor tt]Ilyro atro{ncr of|n,pt ywhohuil \ .r nqrrovcs lh$c.n.
<br />nnd \ho.onrruc(r.rsuchpojccrsuirh!Contrct,(tlicnscdfursuinrhrhcC{ n'.roi s Li.cn$ Lnw )
<br />-l
<br />m crcnpt udc, Selior- B. & P.C. for this @$n.
<br />TtlAtrESILcAIIltENlAITAN
<br />DDCI,IXAIIQ!
<br />I helcby alrum urder pcnalty oI lcrrury on ol nE i,llowin8 dsloarions:
<br />lhrvrr $lll riNririr(tdi,l.rrcoiCon{nrt,Srll:l nhlor\lorkc ..n,Ff\rrrotr r\ pn)vi .d nt htSc.li(trrll(xrolrht
<br />LrfttrCod.. i,n rl[pcrlonnxn.c ofrhc tr rk lir *hirh rhc P.nni i\ n{td
<br />-l h!!c ond will n&i.rri! wolkcn compcos.lion iistrBnce, as totuned by Sccrion 3?00 of lfie Llbor Codc lor ltrc PcrfomB of
<br />nnshichrht ptnnn n Gsucd. My sortcF .onFnidion i.su
<br />/Z -t-7o ,-
<br />6mc ceicr rt plicy numhd @i
<br />6 o0 // fz1 b -/ '/,
<br />I clnify rh0t in lhc pcrlormEc of rlL work for {fii.h thir t rmir h ksucd.l shdll nol.m,,loysny IE$n in a.v @nncr
<br />s !sro ttotr lubjet to lhe wo cB'o'npcndion hws ofcaliforni!. dd aeN
<br />'hat
<br />ifI should bc{om {biel lo llE
<br />qortcn cofrpensrion p6vtionsolSerion l70O6frhc L.bor Codc.l sh,ll lonh{irh coq,ly vilh lhos Pmvhions..
<br />WARNING: Frile lo surc erk 6'@tp.n dion @m8. i3 unhwtul. and shlll slbttl ai oPtovc. ro ainidl FMti.s &d
<br />.ieil ,incs ot lo orc hundrcd lhouund dotlss (lto0.00o), in idCili.n to rhc cosl of.oq'.nslior, da@8es as lhvidcd ror rtE
<br />Setion 1076 oa lhc Lltor Codc, idrcEr ud .llmy\ fat.
<br />I I(:rNSIJD CoNTRACTftR
<br />DECI"ATAIU!
<br />I hcr.by ilftn undcr r.nuh, oap.rjxry rlu I sm li(nsl undcr niovisidr ofChaPrs 9 (.ommNnr8 qilh SL$lion 7ftx)) nrDivi\ion ]
<br />oi rhc llusirc\\ $d Pdassids Cutc. ud lny lic.tr* il ir (ull nEc ard .riccr
<br />C-za 2rt
<br />z7-,/r
<br />!:oNsrBllcu()N-Lllllac-dcErlr
<br />I hcnh! sl6 n utrdc! F.lhr or pcrjury rhdr th.rc N a conslru.rion lcdinB +ctrcy aot rhc Ii.rturmnc. ol rh. worl nn whi.h this ltmil n
<br />i\lucl lScr :l(l}7. Civ. C.)
<br />AITLUANLDICI.ABAIIIIN
<br />I rrR.hy nnnm u M.r rnrlt, o, r.rjury onc of rhc lnllo$i.e dchrrrio.\
<br />Dc'rnition PcrDih Asbcsro\ Noiificdlion Fcdcral Rcsrldnn,s (Tirlc.{r. PM6)
<br />-Rcqtrn
<br />d lxtrcrof Notificolion
<br />I ccrriiyrhnrrhcrrdchlrcSulario"srcgardins r\b.{o\ rcnsvrl lrc nol +lli.ahlctu rhis [+cr
<br />-l
<br />anify thd I luw E d tnis lprlkaion ,!rl slare lhal lnc .bvc i.foriuaon is coBl. I
<br />odimmcs lnd Stdrc tiwr rcl,lirr8 to buildin-s onsrudiotr !d hftby sulhori& r.presolli
<br />as@ ro.6nDlywilh!ll Cny!nd Counry
<br />ircs ofrhk Cilydd Counryro cnlcrlla,o rhe
<br />!l.i)vc mnrbncd pn,pdy fur insl'cdn'n
<br />Alplic.ni or ASenr Si-lndlx
<br />Pcmhc nrrc (pinl)r
<br />-
<br />t\/-rzz
<br />Appliances
<br />lr/etal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Ivlisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<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 />Openinos
<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 u7/tq 6h'f,6
<br />Notes, Remarks, Etc.
<br />Vents
<br />o.n, //-27-/r ^**,,_
<br />^" //'ztltr-
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<br />-T
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