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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG. <br />Appliances <br />lvletal Fire Place <br />Evaporative Cooler <br />Compressor <br />Misc. Equipment <br />Duct Work <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer 1*274K w{utd <br />Residential Ranoe v <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Meter Release <br />FINAL 16ltulK AAhilfk K),,' <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCAIATION <br />I hcrny rfim undei pcBlry of F jury lhxr I a! .xcmpr fDm lhc ConlrocloB Liccns t,w ror lhc fotloqing rci$n (Se.7011.5 <br />Blsincss od PDfcssion Codc): Ary Cily or Counly wnkh BgliEs a Fmit lo oNttud. alt6. it{,rot. .IcnElilh or rcI,ln any <br />srtu.urc, prhr ro irs issum. !l$ rcqunca thc ipplicant fo. skh pcdir to 6lc a siBncd sllrm th8l lE or shc is lir(Ed puBanl <br />lo lhc pDvisions ol tlE Conlrmtoas Liccnsd l,w (Ch!pr.r 9. ComcminB wir[ S.cdon 7000 of Divition ] ofthc Businc$ and <br />Pmacssions Codc) or rhlr tc or ihc n c&qr rlErfroft sd rlE 6aris for rhc allcBcd .xc4)tion, Any viokionofSdlbn ?01,.5 by try <br />.pplicanr fo, a lclmil subrecrs th. lpplicet lo a .ivil Fn.lry ol .or DB tha 6v. hui&cd dollas (tr@). <br />-1.us <br />owncr oa thc prcFny. (tr my.n oy@s wnh qsscs es rhct sk ompcn$rhn. will do rhc work ald rslrB1w k mr <br />intenH 6r oncrcd Lr slc (Se.7044, ausi.css and Prolc$io.s Codc Th. C.nlEclor'r Ltcns tis &Es ml awly to d ownd of <br />lhe pFlf,.iy *ho hilds or in{,mts thcmtr et pllo dxs sun mrt himsclf o! h€sclf or tholsh hii d hct owo coplo}tcs. <br />providcd rhr' slch ihpm\\iMls @ mr i cfth oroficEd ,or {b, li hosc$ rtc }ailjhS or nr{mwd Lc $ld wnnin onc Fr <br />oa.orDlcrb rlr Ovmr Buildcr $ill h8k lhe buds! of pmvinA rhd hc o. shc dil mr huitl or intmw ,rc pmtEiy for tL purFE ot <br />-1. <br />a\ owmr oflfie pmpcnr. ancxcl$ircly conr&rins qirh liccn*d conrrcbs <br />'o <br />consldcr llE pmic.l (56.7044, Businsr <br />and Pnf6sbn Codc: Thc Comracror'r Lic.nsc bw des nol{pnlyro u ownq of prop.n, who builds or imtmlei ftercon, <br />aod sho odncG fo. such rmjcri *irh ! Oonhcro(9 licc.sd purunr ro rhe Gnl..crols Liccn* t w), <br />_l urcicmlr undcrs.dion_, B &PC n,rhisrN)n. <br />loxrE8{routENla.rloN <br />PECI.AAAIIAN <br />I hceiy a0irm udcr p€tulry of rdjuty om or rhc fotueing d*ladrionrl <br />-l <br />hlvc &d eill tuinrain ! Ccrlifrarcolcons ro S.laitr$rc for qorLcB coq,cn$lion.,s prcvidcd Lr hySc.lion 3?00 ofthc <br />tlbor dc. for lh. pcnormmc of tnc work for wfii.h lhc lEmit iq ksucd. <br />*l hlve lnd will tuinhin {orkcn .onFnqario. inrutur.. as rquind by sNrion l70o ol ltu tibor Codc. for lhc ,cdormncc ot <br />rhc mrt f.r *hi.h rhir Frnrir ir L*kd My wor*c6 mm,rnsa(ion insuraftc cmicr rnd Ibliy nunbcr ec: <br />-l.cnity <br />Uar in rhc lerfomre ol t sork for whi.h rhis,,$mI Li i*ued.I shall nol mrploy any pcisor in.nytun*r <br />$ as lo h.mnr subjd to lh. wortcB compcnsalion laws otcllifomin. do8Nlhul if I sk,lld lf,{oft $bjccl 16rlE <br />*ortss' ompcNllion tovicions ol Setion l?0o of lh. t$or Cod.. I shdl. fonh*i'h comply *iln lho* provisio.s.. <br />WI|RNINC: Failurc ro scurc mrtcn compctrsotinn .o!cr08c is unlawful. and shlll \lhjccr an cmplortr h diftinal pcMhks tnd <br />lo onc hundrcd lhousond dolltrfi It 000). h addniofl ro In€ cosr ofconFnsarion. ddmlcs ,. ,,rovid.n lor th. <br />7 z,(tv <br />I hctobl alfiirn uidcr !. rlrtof!c!ury r <br />DECI.ABAIIJN <br />undo lmtisio. of Ch.pt.r 9 (ommtuins wnh Serio. TOo0) orDivnion l <br />or th. Aueinc$ lod Pof*sions Coda. .,i 6y |tcn* k h tull f.rc. {n cfic.r <br />c <br />i\lidJ lsc. .lrrr?. (-iv C ) <br />[trn'nr rcsunnr8 sbcst,s rcnD!!| 0rc nor lppli.ihlc h rhi\ tmjc.r. <br />ion ltn sr.lcrhrt lh. ahor informtiotr n codd.I aBe ro@6t1, wirhlllCiry.nd C.unry <br />buidnr! conno.riotr and h.rcby aurlEriz rcprc*nra'ivcs ol lhh Cny rnd Counryb cnrcr lx,n r,E <br />7 z.q /8 <br />COMMENTS <br />Furnace <br />Pre-lnsulation <br />Final Test lrodca\ Addre\s: <br />- <br />,rl)g x:,rllr or.r't anlrrtx <br />I lm$y dtn nr urdcr pctrrlry oipcrjury otrc.flhc lnll.wirE dcchririons <br />,)cnnnirn[ fcmirwAslt(os Norilicrrion F.dcal Rcguhrions ( tirl.40. Prn6) <br />Roquncd l-crror.f N.rilkdri(rr <br />f-------T------ <br />F-