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MECHANICAL-INSPECTOR RECORD <br />r"stallation <br />F.D. Dro Test <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Evaporative Cooler <br />Compressor <br />Ir/ is c. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Duchvork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release //\ <br />FINAL <br />Notes, Remarks, Etc. <br />OWNER BUILDER DET,CARATION <br />I h@by a,nrn und6 pa.lry of pdjury thd I d qchpt EoB rhc Cont$crdJ Lic.ns. Las fo. thc followiie ..asoi (5{.7011.5 <br />B6rns dd Prof<on Co&,: Ary C ) or Cou y whrch EquiG s Frd to mNlod, alra, inF.ve d.rvl9! or Rttr d) <br />,^due Fu' ro ils i$udc.. also r.qui,6 rhc @plkel to' such pq ro frk r 3isrcd $dffir rhar h. or iIE tTKc.d inu{ <br />to thc pmvisioN ot rn Conr.rcroa! Lic.nrd L.w (Ch./6 9, Comm.ncin8 *irh Sedon 7000 ol Divisio! 3 ot $. BBh6 od <br />PDa.sioE Cod.) or lhar h. or sh. E q@P $6ctoo dd thc b8n hr rh. dLe.d qmFi6i. Ary viohtion olsdb. ?01 L5 by ey <br />applic&! for a Fnn subjdls rhc applic&t ro . civil pd.lty of nor norc $& frvc hui<lr.d douffi (S500). <br />-1, <br />6 ollG ofrh. Fopary. or 6, .091016 wnh s.g6 a rh.ir elc co8posaio& will do U. woll @d llt erltw b mr <br />idod.d or otr6.d lo. slc (Se.r044. B!!i6 ed PlDfsioB Coda TIE CorlEclor'! Lic.@ l,v doB mt aprly lo u 096 of <br />thclroFly sho bil& or imFo€ UEE!\ !d who do< si et him.ll or h*lf or thmu&h hi! or 16 oM.dployq <br />provi.Ld rh,t suh ihFovffia @ d inldrkd orofcld tu sde lf. !'owF. rhc hrildins or irp.oc@t i. $! wit i. on.,s <br />ofcotrplioa lh. 0*!6 BdU6 si! haE tE hlrt , olFDviic thd h. o. srE did @t bjld o iq@E li. prDFIy ft,r rh. Frpoe of <br />_1. 6 olle oarhc propdry. m .r.lusivcly co.rEcrinA wirh li.ds.d .ont cro6 ro conrtud th. Fojd (Se. 7044. &sn6 <br />d hofesionCodc: t hc Conrr.croar t-iccnE LlN do6 nor aprlylo otr.o ofp,op.nywho buildi or irprcld lhdon. <br />and *.ho @rracl3 ror ru.h proj€r wirh acbor6c1o(r lico*d pc@r ro rhcconrBcrors Li.e tiw). <br />_l e ddpl u&lii Scrion . B. & P.C. lo. tie ra&n. <br />D.i.: Oiosl <br />tlatruB.1t(olltlNtat1a! <br />!!CI.A8AIIgB <br />I hqeby am"n und6 pmaltyolpsjuryo.cofthe fouosins d(luslions: <br />I have aod will,minlain a C61il-rc0le ofcon$nr to Sclt-lnsu.c lorworl.ts'.onrp.nsalbn,6 pmided lorbySsliof,lT00ofthe <br />Lobor Code lor thc pcraonmnc€ ofrn. vo* aor vhich lhc p.mil G issu.d. <br />Ihalc&dwilln.tainworkerllorpcNrlio,iNrnnc..sr.!trt.rlbyS€clionlT00ofth€LlborCode.foithcpdaonnmc..a <br />the work aorwhichthh pcmit ir isucd. My workss €omp.Galion insuroc. cmi.r a.d policy nuebd dc: <br />d-9&* <br />z <br />-l <br />c€aifo rhar in ltc Ddfomrncc oflh. wort lor whi.h lhis ,.mil is ilsu.n I d'all iot @ploy &y p.6o. in any menq <br />so 6 ro h.@6. r bjd to rn wo'[B' conp.Bllion L$ of Calitum6, &d rsr rh.r irl should b6onc slbjd lo lh. <br />wort6' @mp.@rion pDvisioN of ScrioD l?0o of ln kbor C6de I slsll, lonhwith cooply wilh rl'os pDvisioB.. <br />I'VARNING: Failu.€ to su. trorkG coftp.nsdion co!6!s. is u.la\ful, ud ,ull subjd e @ploF lo simiEl paaltb ed <br />civil fin6 up lo one hundEd lhoMd dolls (1100.000 in addnion to th. coe of.o ion, d,mge a provid.d for lh. <br />& <br />lrcEN!@cqNlnAcrotr <br />DEOJAAI'OII <br />I ha!!y .,ED mdE padliy ofFjury rhd I m licrG.d u.d.r Fovieion ofcn!$6 9 (@meiie wnh S6doo 7000) ofDivirnrn l <br />or rh. B$iiB &d PrcfBioa Cod., a'd Dy licce i5 in 6rll aorc. dd.r4r. <br />CLO }L <br />1l/zo/r4 <br />COISIAICIIOXUADIAE-AGIIT(I <br />I hereby alfi.n, undq p€nahyorperiuryrh rhda is a co'utrudiun lmdi ttrg.d.ya.rrhclElonnanccoilhe$orktr*hi!hlhistunirs <br />issued (Scc 109r. civ. ( ) <br />drfr( .Nf[!cla!alll]! <br />I h€4aiim undr pdrhyolpdjury oi. ofrhc aolbwins delararions <br />Demolition Pd,nils-Asb6tos Nolifi calion lcdgal Reuhltuns ( l nE 40, Pan6, <br />-Rcqut.rl <br />t-dl6 ol Noriicniod <br />-l <br />cqliry fid th. leddal rceulalioB r.g6din! abGtos roovd m not 0pplicabl€ lo thls poj6l <br />-l <br />cdi& rhal I havc @d rhir appli@riod and $arc rh{ rne abor. i.aomdion is corccl. I asre lo conply wnh all Cily md Cou.ly <br />ordinan€6 sd Statc Liws ro blildi.e coNrnclior. &d hftby .urhornc rcFeilaIiv6 oflhis Ciry &d Cordy io aiq lrDon UE <br />tt/2,,/ta.bov. odrion d proDdt, lo! <br />rt Er.4r, <br />vxEgan)w!eil <br />Metal Fire Place <br />Furnace <br />[------T------ <br />--------T------ <br />I <br />I <br />la' <br />GiNS,