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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER I]UII,DER DI.]T,CAR TION <br />I hcrchy arltnr uodcr n.nnlr, iil rrrjrt rr l d crc ifl tro r rh. c trtrntr( Liccnsc tjs rhr lhe tollo$in8 rca$n (s..70.11;t <br />ausir.ss aM Pturcssi(,. Cod.): ny Cilt or counry *hi.h rcqutc\ r licnnir lo coonrucr. llrcr. iq,.vc. L!.tu i$ ur rI'Jn Jny <br />{nr.xtrc. Driorro ns hsurtrcc- il\) rcquirc\ lhc trDplicnrr ior \uchFrnrir b nEa \icncd nsi.mnr rhnt hor (hc ir |ccnscd pn uml <br />k, rhc F,vi\ion\ .irh. Cunta.tn ( l-i.cn\.'l bq (Chrnr.r 9. Connnch_ir8 'irn Sccln,n 711[ of Divi\i(!r -l ol rhc Bx\incl\ rnd <br />PtufcssnnrsCodc)or rhd h.or s[c ncxcnrfl lnercnonrud lhc h$is lbrrhclllcacdcrc'nlrion AtrylioltrionofScdiotrTO]l5hyuny <br />rpplicanrtur!p{m,irrubjcchrh.nprlicrnrt,d.ivilprnaliyolnor !trcrhrn fivc hundrcd doll0n(S5Ur). <br />I. as owM of rl* pmFny, or my cmploF.s ,irh ws8ci $ rhct slc com!.nsdio.. aill .,o tlE wqt dd 0E stL'tE ie ml <br />inknd.n tr offcEn for st (Sa.7044. Bwircss dd PretcshB Co&r Tne Conrocl.ls Lt B tiw dc! nol lpply lo an owft! of <br />ilE ptuFny who builds d iq'mc dEmn. {n sho dG uh w* hinsclf o, hcelr or ihrensh his or h.r own .nployccs. <br />prcvi&d rhar ikh in{,mwmnh m mt t .rxLd ff oltold tor E!.. lt hwEr tlE tlildina or itrpD{cin is eld sirhin oB Fr <br />oI @nplctbtr rlE Ootu, Buik&. wiU tbw rtE tlrrlcn ol tevir8 rl'n h. or stu dn d build or ir{,mw $e FoF!} 6r da F"F$ of <br />-L <br />6 o*B o{ rhc ,hpenr. d.rlliively co rrcl inE wnh !c..$d onrndds lo co[(Ml th€ porccl {Sft ?044. Au\itus <br />and PDftssion Codc: Thc Cofllrmror's Lkcnsc &w dcs not aptly ro ,n o*ns ol pFFny who builds or imr,rcvcs lhsNn. <br />md who conrr.k for skn pnrirs wirn , C.nrEdo(s) liensn lusuilr ro rh. Conuacrolr Lirns kel <br />Ir'n.xc rpr uM.r S..ri.n .ll &PC larlhhrclson <br />Dat€ Owncr <br />lra8a!f,liraMfElsAlloN <br />DECIATAIIIIN <br />I hcr.by nfirn und( ,.orht of pdjury om ol lhe ,bllosins dcl,raliotrsl <br />L or Codr. tur rhc Fnnnmn.c ol rlr $ rk li{ wh.lr rh. t^_r trrr i\ i\srui <br />-l hovcand rillarrinloi. *orkcr'€omp.nsuli6n inslrukc- us rcquned hySc.ri.r:1700orlhc Ltbor Codc, forlhe lcdrtrtuncc of <br />thc workforwhichlhh pernit is irtucd. M,works codlcnsarion inru6tc ffi$,,td tblicy nlmbct @: <br />Polic, Numbcr:Jxancs: <br />I ftnify $ar in rn n rf.rmrc. ol rhc *otk for which rhis Frmir h i$@d. I shall nor cmploy ey rEMo i. ant mnno <br />s N ro b.<am subj.rr ro llE *olkeB Conq..$lion bws of Cdlifomi& dd $g@ thrr il I 3lbuld 6c.od subrel to llE <br />wo*sl comFnsolion lmlisions of s<rhn 3?00 of rhc Libor codc. I slull. f(mh*irh onll)l, wirh rhos tmvlsions.. <br />WARNING: Failurc io surc worl.R .omrEnslion ev.Bs. is unhwfol. ard shall .ubj.tr & er.ploFr <br />'o <br />dimiml FraLics md <br />civil fi..s u! ro om hundEn lhousnd dollm (3100.0(D). in lddirion ro thc .od of.on xrelio.. d.nD8!s as ,nvid.d for lhc <br />Sdion 10?6 olrhc Llnor Cod.. inrcasl ard lnomy s fe\. <br />UIENITLCANINACIOB <br />DEIIABAIIgN <br />I hcehy lffiirnu.dcr lcnalry ol p.rjurr rhlr I om lidnan lndcr rmvi\b. oiChaptd 9l.ornm,.ing wilh Satton ?oOO) o,Dirhb.l <br />of lh. Busimss lnd Pmr.ssionr Codc. un my licctrr i\ ir full lore Bl rrrccr. <br />Lkcn*Clr$: O fi4 817 <br />D.,.: 4/t/l I <br />I hcrcbyafiinnuid.r Fnrhyofp.rlurylhor rhcrc h!con{nrrion b nrs !-qcncy tu rhc pstutuh.c of rhc wdrk fot *hich rhi\ Fnnit is <br />isslcd 1Sc. .ll)97. Civ C). <br />-l <br />cenil, rhd I har Ead fiiq appltcarion ,nd ir c rhor rhc ab.E inaomrion is .oEcl. I l8ru lo on{rly *ilh !I Cn, a.d C6u y <br />ordinoftcs and St0rc tjws EhtinB ro blildinBco.noct rcl)rsnt tiws of thh Cily and Counly to c.t€r ulDr rlE <br />$ovc mnriomn tmpeny for inspetio <br />Ap/i.nnt d A8cnr sie.rurc ?1r/B <br />Appliances <br />It/etal 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 />Rouqh Ductwork <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 />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech.l?-/7-/8 ZtA to)'. t ,v atl/a) <br />Final Test <br />Meter Release <br />FINAL l- r/-r/.J I edilo f?9 <br />Notes, Remarks, Etc. <br />tr.dcr's Addrc\\l npllrcrnil'rii.rn-tii6F <br />I lmbyn0innuDdcr Fnnllyofpcrjuly otu ofrhc rblb*in8 delaruri('n\l <br />Dcmolirirn Pcrmih A\t&{or Norifi.,rn,n Frci|rrl Rc!!l,rions frirh 40, P.n6) <br />R.+ncd htr(of Ndrirsrbr <br />_l ccniry rhd rh. rcdd,l rc8ullr ions rcBordin8 &sh.sros rcmvd N mr .ldicablc to $is pDj*r. <br />I <br />I <br />F---+--- <br />i-