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MECHANICAL-INSPECTOR RECORD <br />ID/SIG.COMMENTSDATE <br />Appliances <br />Ivletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />r'Pre-lnsulation ,-s-/9J /.fi/<Z <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Tvpe I Hood <br />Tvpe 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 Belease //-/f /t J/-_t*,gbFINAL <br />Notes, Remarks, Etc. <br />rr\\ NaR Bti .t)t,tlt l)lll.( ,\R,\'l ()N <br />wola(tsqs c(tI\!PFNSAT(rN <br />IIECIASAIION <br />I hcrchy dlfirflund$ I/-nrllrofp.rjrryom orlhc lnllowire dcchrurinn\: <br />-l <br />luvr drd s ilr 'minrrin ! C.nifi.lr. urcon{nr ro Scll ln\urc nr sorkcs comPcnslion A Irovidcd lor b, Sun)n u{n or rh' <br />Lilxtr Codc. rbr ihc pcrlnnun.c ollhc *oA tu $hich rhc n rmir ir issucd <br />-l halc lnd will mainlsin *orlcs conpensdion ilsuucc. !s egliE! ny Se.'lion 3?00 of llE Libor C.de. lor the lcrfomme of <br />th. wort lor qhich rhi! pc.ot i. hsen. My workcK smFnelion insMe .etr 8d Flicy nunb.t @: <br />Rnicy Nunhur <br />-trrf <br />ncs: <br />-l <br />c.nify lhll in lhe l,craortuB oath. volk for {hich rhii Frnn h nsucd.l shrtl nor cnDloyuv p.Mn in rnv msrcr <br />m as ro troft subj*l io rlk wort6' compc.salio. l4wr of C iforn und aAB dar if I slblk tt.om subjcct to llE <br />rc*61 onDcosrion oDtisions of Sdioi ITOO of rh. ttrlnr Crnc. I shdl. fbnhsirn onlilv sirh lhoe l,mvisionr. <br />WARNIN(; t'ilurc ro ecurc *orldi & cnrllolrr lo .rini.d IEMllis ad <br />h onc hundrd rhou\ltrd corpcnsliotr d.nEgcs as provid.n for lhc <br />Sr.ri( :1076 ol rhc l-!hn L-,xlc- <br />DICLIEIIIIJN <br />I hrrhyrlnmundcrpcmlryofn riDryrhl( I aD li.cisd undcr ntuvhi(,noiChrpfur9(.onnncncin8 wirhSc.ri ToUo)olD^isn'n l <br />oi rhc Buin.s$nd Pmfcssioi\ Codc. aM myliccns is ir lull li,rcc mtcrltcl <br />b <br />I hcrcby 0flirm undd pcnalry of Frjury <br />isslcd (se.losr, civ. c ). <br />i hMins rBc..y lor lhc p.rror'rufr. olth. work ror whichlnis p.rn'n is <br />rcnhvolard nor dprli.ahlcl. rhh pmF.r. <br />ahvc inlbmr ion is corer. I .gxe ro omply Bith tU Cny lnd Colnlv <br />lurlF,izc rcpNntali,cs or rhh Cny lnd Colnrl ro emd uPon tlrc <br /><-)9' <br />Uvre r . <br />d <br />APPROVALS <br />Duct Work <br />I htrcry afinm undc. Fnolry of perjli rh l dn cxc.r,, r'runr rtu On rr.k,n l-iccns ljw lor rhc rt lowin8 r'rq,n (S.( 7o:ll 5 <br />susnMs rRl Pnic\\tun C.dc) Aiy City or Counry shich rcqun$ . n rnrir lo connd.r. alrd. irtrllorc dcfr,li\h or np.L rnv <br />(rucfurc- prir t, ib issuah-.c. ulso rcqrirts I hc rmlkrnr fttr suchrcrnir ro filca nS cd slrlcnEni lhllicornt is Ldcn\cd ,urs!.r <br />lo lh. porili(jns.i rnr Cl,nrh.rols Liccnscd ljw (ChaPrct 9. cunnncrrirs eirh S.cri.n 7(xx) of Divi\ion:1 orrh' Btr(in'$ trnd <br />Pn,fc\\iuN (id.) or rMr hcorshe i\cicnfl th.rcrromind rhc hisk ntrrhc rllcs.d crcnllion Anyliohrn ofsdirnTolf5hvdv <br />anplicr r.r , Frnril subFcls lh. l,lli.rnrro,civilpcntllyornorihnrhnnlivchundrcddollad(S5fi}) <br />l. rs owncr ol rhc F,Adr. ot nU .nPl{,rc$ wirh *+c\ r\ I hcir $L comPcnsrri.n sill do rtu wllt ond rh. {durc i\ nor <br />inrcnJcd oroflctod fitr slc rss 7L{.1. Blsirl\sdnd Pdcssions Codc: Th. C('ntr.ttr sLircn\c liwdocsnol aml}t,an wnool <br />rhc0nr|Eny wh, hnilds or n\rcvcs rhcNn, rnd wll, n*r.uch q,* hi'n\rllor hcrcllot rhouAh his or h.r o*n cn{lolc*. <br />pruvidrd rhar such imro(nEnr\ m frn imcndcrl o olTcrun ltr $1. ll howcv.r rtu iiillin! or invovcnEnl i\ {,U wirhin nN )cff <br />olconrrkrn,n. rtro$'nfi 8ui[.r sillhau rhc burdc ortmviD8rhr l* orshcdi] nor ruildorinll)orc tht pn,triy for lh. PurIDe of <br />l.r\own r.frhclnolsny. r.r.lusivcly contrlcrin8 lirh liccn{d $ntrtrs l{] conitur rtE PFrcct (Scc 7O*r. Buiiflc$ <br />rnl Prni\snn Codc:'l h. Conlr(clols Liccn\c l-a* d..s.or,t)plr lo nno$ncr oiPror^-ny sho n!iB\ ot nnFov.s lhcrcon. <br />nd uho $ntnds io! such ImJccr\ sir h . C.nhdo(s I lircnscd Pur\utrr rorhcCo rudd \Lk n{Lnw) <br />-l <br />a cx. tll undcrSc.'ion-.3 & PC t{rrhisictw' <br />Lcftlci{ Addrr*: <br />- <br />,r lpt rcrl,riiitill tixi <br />I hltby amnn u Mcr pcMlly.ln(rjxry om ofrhc followin8 d$lnBIi,,n\ <br />D.nrlirn,n Pcntrirs.A\tr(os Nori6cari.n [cneral RcEolrrn,ns (Tirlc,ll).lin6) <br />_Rcqun d knc! nl Norittorion <br />=