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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE OWNER BUILDER DELCAAATON <br />I hcEby .frtrn und€r Fnalry of F jury $.r I m .x.trpr liDn rh. Conlrsrou Li.cne Lrw for rh. folk *ing Erbn 1SE.7031.5 <br />Busincs and Pmf€ssion Cod.)r Ary Cny or Co!.ry whhh rcquit a txror lo onslrucr. ah6. i,iprova dcmlhn or E'Itn lny <br />ddun. pIi,r lo ir. irsu4.. slso r€quiEs d. {pplisl for s!.h Fmil to fik. siSncd slltcmnt thlr lE or slE i. lieni.d puNor <br />ro rh. pmvhiotrs of lhc Conmcroas Lic€d$d Lle (Chlpt r 9. Comftrcine *ifi S.crion 7000 of Division I of the Blsincss dd <br />P,lfcssions Codc) or rhlr lE or shc h ercnfl fiftfiom Md thc beris for lhc ,llcgcn gerprion. A.y violati.rn ofsc.1b.703l.5 by any <br />rpplha for a tj.mi subier rlE rpnlic{f,r ro ! civilD.mltyofer me llu! fivc hu.dEn douus (5500), <br />-1, <br />os owrcr oatn potrcfly- or m, coplo}lcs with qrscs $ rh.n eb oopcigl b.. wiu do ttE wmk dn dE slurw n ml <br />inrcndcn or on red lor ek (Se.7044. Busimss dd Pr.f.$ions C.n : Ttu ConlE.rols Licens La* do.s nor Dotly ro u ownf of <br />the rmpcrry vno hild. or itrlmes $cNtr drd *nd dc *n so hidr.lf or h&klf or 6rcu8h his or n rowncmployecs. <br />providcd rhir ch iqfrkrnk @ tur intc.dcd .roilcEd for oL lt hos.6, ilE hrilding tr irpmwm is sU *ilhin om y@ <br />of conplcrior tnc O*ncr Buil,.r will lur rlr hmbn olpmving ihd hc or shc dii Dr boiu 6r itrl06w dE Fqtry lor rh. l)lrTrs ol <br />-l- <br />as osrcr ol rhc nl on ny. on qctusivcly conrad ine wirh liccnscd coni6.loN lo constMl lhc Imj.{l (S(. 7(r,14. BBincs <br />,rd PtoL$bn Codc: 'Ihc Controctols Liccnsc Low docs nor aplly ro 6n owno of pDl,cn, wlio builds ., intlmvcs rhcrcon. <br />and who onrGc for slch teiccls sirh{ Conhdods) liens.n nuF!'ni ro rr* contruc'ors Ltcnp L!w) <br />-l <br />! cxcmpr undcr Sccrio ll & l)C larrhi\rcrln, <br />ll)atrE8s:loMPENlarxlN <br />DT'cl ARATTON <br />I hcrchy aanrn un&r p€nllry ot pdrnry om olrhc touo*hg d(ldarionsl <br />-I <br />ltrvc srid will .Einrlin " Ccnin ,t of co.snr ro s.ll-lnsuru for workcn comprtrsol ion. !s [frlidcd ld l,y Serion ]7m of lht <br />LJt r Codc. for lhcpc'frrnEnenrrhc h,{ ror *hnh'hcnclmn n \.drd <br />1l hJvc.nd *ill E'nrJ worl.r' cnm,Ensrr mn ,n<u..R.. 0s rcquied bysaiion r7(x) ot rh. hb.t codc, rorlnc pdiffntrn.c of <br />compcnsolinn insurrmc caricr a.d policy oun$cr @ <br />)/r.--1' <br />(<'T Col >lt <br />-l <br />ccnny th.l in thc Frfomuncc olrhc solk for qhich this lcrmir h hsocd.l shall nor.rplot ony p.tron in uny matrncr <br />s, as lo hcom subjccr ro th. sorlcB .onrlr.N,(ioo ldm orculirorni{. ot 08Ec In.l ill snooB t$om subjctr 16 rlE <br />erkss' compcns ion lFvkiors or SNrion l70o 6f fi. L.bn C.dc. I shnll, fonnwilh com,'|, wilh rhoc t bvisio.r . <br />WARNINC: FoihE lo ecrrc sorkcn ompcnsrion covcBsc is lnlawtuL dd shall lubj.cr ,n .nplortr lo rnninal p.mhts nnd <br />civil fiflcs up to onc hundrcd thousond dollan ($100.m0), in add tur ro rhc .osl of.on{Etrerion. d.mgg rs t ovidcd ior lnc <br />/\1 /t-/g <br />ol rh.llt'\ o.s\rn,l Prolcs\io'r\ (int.. rkt nry lir.n\. n i0lnM,tr.. ri rllr.r q15 D<L Ll <br />LL <br />I hcr.hynfir uMcr Fn.hroilErjury rhut thcrc t. onnrudion bodins lScncy a{, rnc pcrlolrl@c orrhc work Lr whrlr thF prirnil i\ <br />i\\ucd lscc :11t97. Civ C.) <br />A.TILIIANLIIICI,IBAIXIX <br />lllrchy rflin undcr p{n.llyolFrjury onc ollhc rnlh$ins n.chnri,nr\ <br />l)cmninnrtcnnih A\bcsro\Norificarnnr Fcdcral R.lthrions(Tirlc40. Pd6r <br />Rcquircd hrrcr of Norif cario. <br />I ccdilyrhm rhc f.d.r0l rcBUlarions rcsordins &sbcsros rcnnvalurc nor 4plicablc b rhisrbj.cr. <br />_l c.difrrhli I h,!c reod $is 0t'!li. ionand slarc lh!' rh.nhorc inl'on, iotr n cotrd. l oEre ro omply anh all Ci' y .nd Cou.ly <br />ordinanccs aod Shre l3*s E,lrins Rprcsnhrivcs orfik city ond counryro cnrs !Ir). rh. <br />rlxr!. nr ri()n.d fr)Fny ntr <br />k ?-rtrt <br />Appliances <br />Ivletal 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 Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Ducl <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL afilL4Ia ,t\uqql ?.>) <br />Notes, Remarks, Etc.I U <br />ID/SIG.COMMENTS <br />I <br />I <br />t_