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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lvlisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room i Clothes Dryer
<br />Besidential Ranoe
<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 />Rough Mech.z/rzLa 2t z1
<br />Final Test
<br />Meter Release
<br />raz 2t7FINALZ/7y'2a /7/zs,rt
<br />Notes, Remarks, Etc.
<br />oWNt:R BUIt-OER DI:I-CARA'I'ION
<br />Bu{nc\\ kl I'r.rc\rf Codc) Atrv Ciry or CouNy qhich ..quircs J pcrmir b ..i{tu.r. rlrcr. inrpt c. dcnnni\h r rcn.t ,nJ'
<br />nrucMc. prior ro ils isuncc. alvr rcqunc\ rhc,pplicrd lnr such F.n,ii n, filc r \i8ncd {.tcotnr rhar tuor \hc a liccn\dl Pu urir
<br />t, rhr F,vi\n s rrh( C.ntrrn s Li(ctr\cd li* (Chtr,,lcr 9. Connn.tunr! wirh So.rior 7(XXl ol Oivnbn:1otrhc Bu\inr$ 3nd
<br />Pi(nissi,)ns CoJc) orrhrll{or\hc i\crcnulihcrctro rd'h.l!v.ntrrhrtllrlc(l!\ctlnii,'n ny,i,,] i,,n',f\r.'i{?0lllbyrry
<br />,,t'nlir'trrrUI\lr r \rhJ.\h rhr 'ml.J h'r,r'rf^ 'k\. rn m{rtlJtr f\c l"unJh 'l.l llr.'((rvr'
<br />-1.
<br />os owmr oalnc fmpcdr- or my enploF.s earh w08cs a, rhcn $b compcns.lion. *iI dd ll8 *6t dd ihc shfiE n mt
<br />iorcricrl .rofl€rd lor sk (Se.'r044. Amims lnd PmfcsionsCodq Tn C. turoas Lkcnc L5w &Es nol q,pl, to 4 owmt ol
<br />ihc rmFny *r$ buiul or Lr{mrc$ rh.Mr ord who dcs s(t s* iinsclfor hcMlrorrhrcu8hnis m tcros. cmlloy.cs.
<br />trovidd rhlr ruch inpmrm.lr m ml hcnd.n or onc..n ror eL. It howMi tlE trildins m iqeE@ h $d wnnin om ror
<br />of conDhrio( rlE Owrcr Buiur *ill harc rlE hrdcn o,lmving tlul lE or sfie dii ml bdld or irpoh 0'c pmFny for thc p!{bs of
<br />_r. !s.w.cr.rrh. prcleny, amcxclusivclycoir.rcriiE *irh lkcnsd.odrrs.rorro mnslrucl llf, pmFr (Se.7044, Bu\im$
<br />and EDE$ion Codc: Thc Coorracroas Li.c.s. Low drs nor 0!plt to afl owncr ofDrol.rly who blilds or imtmvcs thcroa,
<br />a6d who conimcls ln suh omjccts eilt ! Conlndo(s} licco*d PtrRMr ro rhc Contmbls Lianse LaB).
<br />-l
<br />!n cxcq,l u.dcr S<lio B.&PC lorthis rclson
<br />!I}Bf,DII5.:g&IIENSAI&N
<br />DECI,ASA:IION
<br />I lErcby lfItrm undcr Fndly ol pcrju.y onc ol lhc lollowing declaBions:
<br />,lhrt!!trd sillnui' nnr Ccnii.rrc ofG)n{nr t) scll.lNrrcLr $orkcr'compcn\dt,n. ar phvidcd fd byScdi,,tr:17(x)ol rho
<br />t-fitr Corl..lhr rhc ptni)nnu.c.l rh. work r(, slrich rhc r.nnn i\ i(sucd
<br />ldr " "*, .,,, ,",Ur,U' *,,k.^' c. rNtrMri()n irsurrn.c. ,s rcqutcd by Sccri,n, .l?0o or r hc L$or Codc. lor l hc E-.$nrrnr. or
<br />rhc *ort ntr $hi.h rht plrnir ir i$En My workcs conFnsar ion iNurxncc .:ri.r a d ,l'ti.! Nnrbcr irc:
<br />ft2Alela*u Z.4/E-7 za
<br />-l
<br />anilylhat in rlE rcrfortuftc oarhc *ork lor shich rhi.,,.rnir i$ iqsEd.l sh.ll nol empl.y dry p.ron in any 'Mmrs s 16 becoc snbi.d lo rh. *o*cl comp.nslion hss of Cllitorniq tnd .gr& rhal if I should becom $hier lo rhc
<br />workctr.oqEnsathnpmvisionsotSdion3700olrhcLlborCode.I$all,ronhsithomplyqilhrls$Povirions.
<br />WARNINC: Faillrc b $curc wurkc(' .onrlrns{i(r covcnSc is utrhrtul. nnd $rll \thjccr rn cDplot.r
<br />'o
<br />siminll Pcuhic\ ud
<br />hlndrcn $6uend dollm (!10o,00o), in rddnion to lnc cosl or.onFnqrion, damEls as Imvilcd for rhc
<br />ini.r* and r .rtut \ fc.s
<br />6 Ze)
<br />utl;xtlt]-crlNl3acraa
<br />IIECLAf,.6.I&N
<br />IhctuhydirnuMnp.nrllyolpcrjurrlhalInnli.cnvdundcrpolisn.fchrprd9(coilDEminswirhSccrion7{XlO)ofDivisi l
<br />ol
<br />'bc
<br />Bu\i.crs !tujPoLssions C.dc- dDd my licen\c n tull forc lnd ci 1..r.
<br />7v/?oa
<br />a-r^"-, €
<br />cQNSTBIl(.:U!.NLEliDlIilinCAN1;I
<br />I hcrcby !rrm und.r pcnultyollcrjury lhll rh.re is r.on{tucrion h.din! a8.ncy ior thc Pcrfonruncc ofrhc work rrn whicn thn Fmil is
<br />is\lcd (ss lo9?, civ c ).
<br />I-SILIQINLDICIj!1IIIA!
<br />Ilk'rliynnlnnu .rltnrlry.l J'c4rll) onc.,rhrli,ll(i*nrgd..lJrrrn,n\:
<br />Dcnnnirion t,cnnn+A\tino\ Norilicrrion licdcrxl Rc!uhion\ (Tirlc 40. Pir(,
<br />-R.qukcd
<br />lrlrr or Norifi uror
<br />-l.cnifyrh
<br />lnc icdcr{l rcsuhl n'n\ rsurdn,s dstr{d r.mvll rrc mr nptrlkobh lo tht pojd
<br />-l
<br />ccnifyrhsr I havc reud rhn upllharioo,.ds{r.tha! th.,trvc inrornulion hcorel I{gd
<br />odiom..s lnd Sr{rc tjws rclalins k} hoildi.s .on(ruc! ion. rnd hcr.by aulhoriu rcEc$ntlrircs o
<br />tr.onrfly snh rll Cnyxnd Counry
<br />!bov. mnliorcd pm,)crly for
<br />Amli.anl or agcnr Si8Nturc:
<br />r rh'{ C[ydnd L-.utrry ro,cnta uFn rlr
<br />"",. rZ /"o
<br />"-243
<br />I
<br />COMMENTS
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