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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS (,WNT:R BUtI,DER Dr]LCARATION
<br />I hcrchy a,finn rndcr lcnrhy or pcrlury rhd I dn crcmtr riomrh,Cd nEtoF Li(en\c us fltr rhc tulbwin8 e,$n (S.c7031.5
<br />Busiilcs\ d Pml.sln r Codc) Any Ciry or Counly which r.qutc\ r Frn,ir t, .d.{fl.t. rlrc!. inrtnivc. dcmli\h or rcrrn any
<br />slrucrurc. prior r) ils ilsu!trcc. rl\o rcqot$rhc rlplicnd tur such n nnir ro iilc r siEmd (!rqm rixr t( or shc i: lit.n*d Pu^uanr
<br />r. rh. flovnidB.frhc Contructtr s l-i!Tn{d uN (Chntr{ 9. ComnEncing wnh Scdn, 7fix).f Oivhnrn 3 of lhc Bn\inc\\ tr.d
<br />Pnn sn,ns Codc) or thar hcorshc is crcnrr rhcrcrnnn md rh. h is tnr rhc.lLlcd cxcmprion Anyvidllion.fSc.ri,,n70.1l.5ny,ry
<br />appli.lnr li,rapcnnir {uhjds thc applicn ro r.ivilpc,rlrydrnor nrrc rhnn lirc hufrtcd dollars (S5(x)]
<br />1-.15 ". ,* *,, '* *,*")..tr ,ny c'nnl,,r.r. tr i,h tr rscs r\ rhct qnr.o lliietiotr. eilldo rhc Btrk m.l rhc dturE i! nor
<br />rnrindcd or onc'cd lor s'lc ( SLr 7u,r- Bu\i'rcs rtul PNr.\{)ns ( dlc Thc Orntlclol \ l-iccn\c Lrw doo\ Nr lprly h 0n ow.cr oi
<br />rhcrmr^-ny rho buikk or n{rovcs lttmn. md who dmr such eort himsclfor hcr*lror rhr.u8h hi( or hcr oNn cmploycc\.
<br />providL\l r hd such ,nDmrm.h N mr i,n.ndcd .r orT.En hr slc lt', honcvcr, itf, huiLring ui ii{,Ntnrnr is v,Ll wilhin onc }u.
<br />ol..trDkr$n. rh.osncr BuikF lillhaE rnc tlr&n ofrovi.s rh( lE or shc lid nor huiklor impn)vc rhc pblsy fo hc Jru{n\c of
<br />-1.
<br />as owncr of rhc ,mtEny. sm.r.luiiwly conm.ring wirh lten{d @ntelos lo .onsrtucl lhc lojccl (S€ 1044. Bushcrs
<br />'M F.a6sir Cod.: The C..rkror's Li..N. Low des nol apllt lo .n ovns ol pnlxny eho builds o, inFrovcs lhereon.
<br />.nd who ontBcls for such pmFts sirn ! Co @ro(s,liccn*{ pu6!d! ro E Conhdols Lians L3v).
<br />-l
<br />lncicnrfl lndcr Sri!n-. a & PC
<br />&ry"*/om., lLl -tg ^s u,
<br />IIt)X.XIiBS]TAUI}:trItrllAN
<br />I,:ISIIIAIIQN
<br />I hcrchy atnrdunddr p.Mxy or pcrury orc ofrhc lbllowin8 deluarions:
<br />-l
<br />h!!. and sill tuinlain ! Ccnifrar. ol CoBn ro scf-lNrc fo mri6 onFrslrion. e Prcvidcd foi by Selion 3?m of fic
<br />Labor Codc, aor rh. p.rfo@ ofrhc srk for whkh rlE Frdr ir isrEd.
<br />-t havc and *ill minlsin {o,kc^ cornFBarion insuBft.. as Equircd by S<l io 1700 of rhe t b.t C.dc. for llt F{tormnc. of
<br />lnc srk for whtn rhk rE hir ir irnei. My wor*6 omt nsdio. insumftc ffi:r od polty nunbcr a:
<br />/'A, efliry thrr 'i rhe ndr6,m.nc. or tlE eork ror shrh rhh Frmn is issocd. I lhtll rcr mploy rn, pcMn in ony n1!m.
<br />'srsrobdomsubFrrorh.w,rt6i@trlEnsrionbssofc.lilodir,ddqgrlnlliflsholldb.sm$bi6rlortE
<br />rcrkcN ompcns.lion pmlisions of Sftrion l?0O of rhe Libo, Co<t . l {Ell. f.rlhvilt om!!y *ilh rts* Pmviibns..
<br />WARNINC: F.ilurc ro suc workcr con{E.salion .oleBsc is utrl,wful. dnd sholl subjel !tr cmplottr tu lnnrinnl IlMhL\ lnd
<br />.ivrl fincs up lo orc hu"dred lhousnd ddllds (SI0O,0O0), in rddirion lo rhc corr oaconDcnelion, dlmgcs as Pnvid.d for th.
<br />Serion 30?6 ofrhc Llbor C.dc. inrcrcn rnd dromy\ fer.x"'. \\- r.-{- \8 }a uoM
<br />LICENIEDIjONI&IGIAA
<br />DECIAf,AIION
<br />I h.Eby Inm undcr I'cnllry of pcrjury thar I nn li.cn(n undd pft,vi{h .l Choflcr 9 (conmr.i g wirh sccriotr 7fix)) ol Division l
<br />of rhc Busin $ dd Pnnc$iolN Codr, inl nry li.cnsc n in tull foet rrd .lla\!
<br />colsrBucuoNtENDlNi-ec[Nct
<br />I hcEby afiirmundcr p.n!h,olp.rj!r,fiar $e@ is roiqklion kndinS sSc y aor lhc poformrc of rhc mrk for qhict thh Fmh n
<br />i\\ucdlS.. 3ll97.Civ.C.)
<br />AITLLEANI.IES.ABATAN
<br />l lrtrhy ldrndcr pcmlry urp.ijxry onc otrhc nnbwinE dccl[urion\:
<br />Dc rliriUd Pc'nrir!Asb.n.sNorifi.0rion|cdcrnl kcEuhnnN(1ir1.40. PrdO
<br />Rcquircd Lcttc. ol Nolilrrtn,
<br />. l !.rrl) rl'r r1c r('ic'Jl .iulJr\,n.n'crJtr'! trtr'J^.'.liir.'l. rr +nl'!ul'c r, rl-\ nfl$.r
<br />--U rcn,r) rhJr ltu\c (nlrhi\Jppli.rrtr,ni'kl nJ'.rh hc h)r. nrfornkrn i\.otrc.l l!g'er,)conlnly wirhrllCiryindC.unry
<br />atsr. mnli.n d pmlEny fo
<br />kcppri., or accor siemrurc
<br />r insmrionDmrci ?r'vAV 1- r"{ - \8
<br />U'Zt SAGA
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lvlisc. Equipment
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release A
<br />FINAL
<br />Notes, Remarks, Etc.
<br />Duct Work
<br />Grease Duct
<br />. ConrEdor.
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