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APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />h/etal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <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 />Openings <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release I I <br />FINAL dJo t8 \Lf?- <br />MECHANICAL-INSPECTOR RECORD <br />OWNER BUILDER DEI'AXATION <br />I hs.bylmmu 6 Fdty of pdjury Od I m.xdo SoB lhe Colnnclos Lic@ L€w for lh. folloeiig !!en(Se.?031.5 <br />Bsin* ed Proterio! codc): tuy Cny o. Co6l, "tth rcqlir6 . Fnn to coturrud, ah6. inprcv., damlilh or rF.t uy <br />suu.llrc prior lo il! is@c, rl5! E9ut6 lt appticet for such p6Ei lo Rlc ! lignql $.tddl thll hc or sn. b Ic€tu d r)ueMt <br />to thc prcvisioc of rhc conrmtols Lic.isld tlw (Chrfld 9. Comacin8 wnh scdion 7000 ol Dirisio! I of rlE BuiinN and <br />P,!t*ioa3 codc) or rh.t hc or 3hG i! qdpl 0rftfDm,nd rh. bsi! for lfi. Lscd.xdplion. Aly violalion ofs6lion 7011.5 by dy <br />applicel for a F6h i!bj.d! ln rppli.6l to.civilpcrutryofnol mcthd n!. hoqlrcd &[d] ($500). <br />-1. <br />s oM6 of th. FoFly. or my @dorB wirh v!96 s th.n et conpqBllion. willdo ftcwort &d {E llirirc b ml <br />tnad.d oroffd.d for $1.(5@.7044. BBiIB dd Prcf*iosCodc Th.Com6croas Lh.e t wd6mlsr?lrlodoMsol <br />rh. plorqry who tuil& 6 itrprovB rh@!L od who do6 sldr @lt hirelf or hGlf or lhmuBh htu or hd om dplor6. <br />pro"idcd thd such inpmrEG ! & ml hlod.d orofad for sh. li now.lhc buildiis o. i6plo\€@t i! $ld wilhin onc tw <br />ofcohpLriol! lhc oltrTd Buildo sill hav. lhc hida ofFoviig tlld hc or $c did @l tuild or inp,ow fi. FDPety &r tlE Fnpor oa <br />-1. <br />s owd of rh. Fopdy. m cicl$ircly coirradi.g *ith licd.d coIlmroE ro consrtucl rlE Foj.d {se. 7044, BNinB <br />dd Proto ba Codcr th. Co Mrols Lictu L3w do6 Dor .!ply ro e owld ofprorqly who buil.Le or inp(vB fi66.. <br />&d qto @ ncr! for sucn F!j*l! with a CrDlra.ro(, licN.d puEronr lo rhc co rador's Lh6e t w), <br />-l <br />m ci.mpl und.. Serion . B. & P.C. for lhis EMn <br />UOESEIII.CqMIENIAI|O! <br />DESI.AMIIO! <br />I hcftby rmm utdd p6EIy ofpcjury ooc olth. lolloeins ddaalioNl <br />I har. dd will dif,llin . Carificat. of CoNdl to S.![-IGUE for ert6 @,npd.dion, E Fovkl.d for by Sclion 1700 ofthe <br />LaborCod.. forrhcpolome.c ofrn work for wtich lh. pmil i! issred. <br />I hrve .nd will maintain wortd compcftalion iNurMq s r.quir.d by Sol ion 3700 ofth. Ldot Cod.. for ltc Ffomm. of <br />inc @rk for which rhis p.mn ie isLd My world conFBalion i6u.ec ceir od policy n@b6 e: <br />4cp lN Svt&oFJcC! oF $arzk"aO <br />,"ri"r*,.*, - 7tp!E(llo?S3 I o,0"",, - <br />I c!fliryd in lfic Frtormrnc. ol lhc work for whicl fiis pdni is 6su.i. l thtll not dploy My p.Mn in .ny nsnd <br />& 6 ro bdoru 3ubjd lo rh. wolt6' @nFnsdion lnes of Crlifomi{ ad agc lhal if I should b.comc subi..l lo lh. <br />soi(6' .onpoelion prorilioc oasclio. lTOo olfi. tjhor Code I sltsll, lonh\rilh codply sith lhos prcvilioB <br />WARNING: Failur. ro slE worl6 .omp.nsrion ud sft.tlsubjd e aplord ro .rinirol Fali.s and <br />civil fincs !p lo o.c hundr.d rn.rsnd dolltrs ($l ion ro th. cosr ot .onpcerio,!, dan6g6 a povid.n lor th. <br />a <br />ucrls@latrIxacrla <br />DICIAXAIIO <br />I hslby rr!16 lidd Fblty of Fjury rbd t m U€!.d Ddd Fovilim orcl!.pla 9 (@tllreils wnn Sdnrr 70)0) otDivi$ion l <br />of lh. BailB ad PofeioB Cod€. a.d sy lic.@ i5 i. tull fo@c &d.ff€r 3s L1 <- <br />D z-o e <br />colirBlJcroN.LIND$cScErcx <br />I hftby lffim udd pcrahy of pqjury lh.t lh6c i5 a .orsrtuclion hndinS ,s6cy for li. psfo,:Mcc olllE @rl for whth thie Fnil b <br />issucd (Sc.. 109?, Civ. C.). <br />arlLtc NlDf,c!4ldlto! <br />I hoEtry arm. unde D6ahy olD.ri'rryonc oflhe folkNin! dslar ionsl <br />Dcnd ion Pennirs'Asb6ros Notificahon fedcBl R.cu lar N$ ( I'rlo 40. Pa16) <br />R.qutrdl Ldr.r of Ndi6calnrn <br />I cdily $,l rh. a.d@l r.{uldioN rcBardinS sbcros rmoval e. f,ol applicabl. lo this ptuj..1. <br />_l .arify lhd I hav. rcld rnis slar. rhar rhc ab.vc inlotuion is coEd I rSra lo smply wit all Cily dd Counly <br />odinamG r.d Staic L3ws dd heby aurhornc rcF6a1'ri!6 olinil Cir, ed counry ro ql€ upoo lh. <br />ab.vc m6rioo.d pmpcny fo, <br />Applic&l or &ml Sigmlurc:,bl, <br />lnstallation <br />Notes, Remarks,_Etc. <br />i- <br />=