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MECHANICAL.INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNER BUILDEN DELCARAIION
<br />I h.eby .lfid !.df lcnalry ot nerjury lhar I m cxcnDt fiom rhc Coot ..16B Lkcf,s llw ror ln. rollo*ing E!$n (Scc.7o3 l:
<br />Bu.ims ard Profelsion Codc)r Any Cily or County whth eluiE. o pcmh lo of, rult. .lld. impmt, d.mlht or qEt M,
<br />sh.rw. prior io irs i!$ c..lso pquircs rhc lpplic r fo. such Fmir ro fit a sisrcd slalrmn rhrr lE o, 3hc ir liN,ed pulsMl
<br />io rh. rovisionr of rh. ConrMro. s Lk.ned t w (Chlprr 9. ComeNioS wilh S.ction ?000 of Divtion 3 of lhe 8u5i..$ an{
<br />Pmlesi,ns C.nc) or lh{r lE or sh. h cx.q,r rtcEfion lnd rhL bsis for rh. rlheed cxcmtrion. AnyniohrionofSelkr.?03l.5byrny
<br />arllic! for ! I,.rnir subjars rhc ,ptlic6 ro 6 civil Fnalry of ful mE rho livc tu.dad dolla ($500).
<br />-1.
<br />&i owmr of th. FpFriy. or my cmphyes with w.8ca sr lh.ir sh snPcnsdion, wiU do lhc ao &n {..utlN ir noi
<br />inrcn&d or oficrcd for *le (Sa.?044, Busircss and PmGssions Codc: Tnc Conrado. s Lkcnsc Lrw d@s mt .q,ly to u o*ncr of
<br />ihc Impcny wlb blilds o. inpmt.s dE6tr .nd who dffi ut! mlt himsclf or h.rslf or rtmugh his or l*r oM cnglorss,
<br />,mviLd th.r skt imprawnh @ ml int'id.d trotu ror $h. lt hoker. rE buildirS or hlhwmfl L sld wnhin om Fr
<br />olconplction, E Owmr Buildn wi! hlE tlE bur&n ofFovins rhd lE or she did mt blild or invoE rh. p,op.ny f.r rtE lDrpo5 ol
<br />-1,&iowcrolln
<br />lopcrry. amurlusilclyconlrsclin8 wi$ liansd co ra.to6 to co6md rhc pojcci (Se.7()44. Bunnc$
<br />.d ProfssionCodc: Tic Conx&roa3 Lk.nsc t w d@s nor aDrly i6 M os.cr .l p.oD.ny who builds or irymvcs ltscon.
<br />and sho contuts nr sEh pmixrs rirh ! C.nrruro(s) licn*d lusus o rhc Conr&rofs Licene Lrw).
<br />I !'n.rrmnr unJcr Sc.r B & P.C rarrhtrcrson
<br />TOf,f,E&{IIOMPEd5AlIO!
<br />IlECl,/$AIIllN
<br />I hcrchy amiinund$ D.nrlly ol Dciury orc olrhc followin! dslmliotrsl
<br />_lhJ\c unl sillnxri'rrtrinu Ccnin rrc ofCotr{ i t, S.ll lNurc tur sorlrrL .otrrrcDsari, . as pnivntd {nr hySccrion.lT(x).lrhr
<br />l-rhor (tnc. Ior rhc lcrli,nnin.c oi rhc sqk r',,r wnich rh. I[nn ! i\ i$u
<br />-l hav. lnd sill miotai. *ortcs .ontEns.lion insuErc.. rr rcquircd by Selbn 3700 of thc Libor Cod.. fo. rhc psrornmc. ol
<br />lhc w6rk lor whkh lhis lcmit is Llscd. My w.rkcs onp.nsotion insurmc fficr lDd polty numtcr m:
<br />Poli.yNun$cr: txttcs:
<br />-l
<br />ccnify lhor in rhc p.rforronce ofrhc qork for *nich this lcrmir is tsuc{.1 shrll nor orllloy rny pcr$n in m, monrcr
<br />s r\ ro ltoft slbiEl r{' rhc ao*c6 .odpcnsarioo hw. olcaliromi4 Md agN lhd ill slbuld tE.om rub,cd to rl'(
<br />eorkcG compcnsrio. proltions ot Scdion l7(Dofrh. trhor C.dc.I thnll,lonhwilh conrply wilh rnos,mvhions.,
<br />WARNING F0ilurc lo mw wortcB compcnsolion svmSc is unlawful. and shlll sobjcl d enplort, ro 6i,niml rmlics md
<br />civil fircs ur ro orc hundrcd lhols.nd dolla$ (5100.000), in.ddnbn ro ihs.osr of.onqEnsri... drro8.s as prcvid.d lor lhc
<br />LICEISELCONINASAf,lEtr f,^l.&N
<br />I hcrcbyriltd oidcr p{nalry ol prrjury rhdr I rr li.cn\.d uM.r lJn)vilnni olChrBcr 9lconnrENing *irh Sucrir 7(XXl)ufl)iv(trD:l
<br />oi lhc lrLFircss od Inr'cs\i({N (tdc. n d nry lic$\c i\ in tnlli{Ec rnJ.fic.r
<br />ca srBurl.lQNrlilDM-d1illt}
<br />IhcEbyrlijrmundcrpcnrllyolpc'Jortrhdrhcrcnrconi .ri'rn Ldrli',g lrkr lu rhc Pcrlbnruncc nfrhcr'.tk tuchichIhi\ P.rnir is
<br />issucn (Scc 11097. Civ C.)
<br />d.PIUCINLI'ECL$AII9N
<br />I hcaity u,lim !nd( Fcn,lry drprrlury onc ofrhc aollowint dc.lsrrions:
<br />Dc nliriun P$.irl^sbcdos Notiri.oln'nIcdcnn Rqulrrions(1irl.40. l'!na,
<br />-R.qutcd
<br />L.Icr ol Norifi cDri{n'
<br />_l c.nirrrhlr rhc lidcr tsul.rioni rcg,rdih8 istcfos rnbhlarc nor.mltahle Io rhh prord.
<br />-lccnilyrndlMvcreadthislppliclri.nml(arcrha
<br />ncah'vciDtunn,rn,nis.on(rlagrerocompl,{ilhallCiry3idCou.ry
<br />ordindnc.s and Stsrc kws rcl,rin8 ro bu ikitrB
<br />$.1. mnrioEd pmpcny n, instccrion
<br />6-
<br />E drl hcrcby aurlori- rc!rc€nllri!$
<br />Appliances
<br />Metal 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 />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 Duct
<br />Fire Darnper
<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
<br />FINAL r0 -10 -(yvtlo
<br />Notes, Remarks, Etc.
<br />APPROVALS DATE
<br />:::luffiK-^x'x4
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