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MECHANICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS (,wNEt aull_Dt]{ DEt,cARAl lON
<br />I hcrhy r,lnnr undcr lcmhy ,,r pcrjory rhtrr I Un e\cnU tum lhc G,.lr rorr l-iccn\c l.a* ln rhc lall{i*ing rcr{r (scc70.ll5
<br />Btr\ircs\ rtrd Profc\\nrn Codr) Any Ciry or Coutrr, *hi.h r.qrnr\ n plrrnir n, .oiitud- nir8. inrltovc. ic nni\h L{ q{ir r !-
<br />h rhc lrovisr \ ol rh. (innri.t{\ Li.c {rl tjw (Chrflcr t, C.nnnr cnl! sirh S.rrn,n 7(X ol DivNion :] orrhc tsunnc\ )trd
<br />It.lcsior\ C.n.)o.rhrr h.orshc nex.nrnl lhcrclrorn{M rhchrsi\ lor rhc rllcgc{i cxcnrflion. An} vi)lnrionofSccrimT0.ll.5 hy rny
<br />apfli.rnr n, 3 ,[irnir \ubJc.r\ rhc Itpli.rir rr civilI.nrltyofnor nrrcrhln li!c hu drcddollaA($5(x))
<br />-1,
<br />a owftr ol rrF ,)bFny, or my €mplorr.s wnh wogcs as rlEi. slc @nFnqrioo. wix do tE e6k un tlE $f,Itm k frrl
<br />inbnd.d or ofcEd f.r $h (Se.?O14. ENircss and Prorcssions Codc: Th. (l)nrrbls Lic.ns Llw docs ior @rly ro un osncr o,
<br />lh. pm!.ny who ltriLs or in{,mEs rh.mn. od *ho d6 s.h m* hims.lfor hcr*lfor rhmuBh his or hcr orncmplorccs,
<br />,bvidcd th ruch inlm\\tnt e mr i, eo&d oi or.ed for st lt hos@. 0x buildiog or inpeEmni js sld wilhin onc )ur
<br />of conphti,n- ttE Owrcr BuiE r *ill h8w th. ttrdcn oirmving th,l lE or shu dil mt birild or inpow th. I,opqry for lhc IuF,* of
<br />I. asownoofrhc pmpcr'r. ae.xclusie.ly..nradins wnh liccnscd conra.roN b.onrrrud rhc Ir.j(l {se.7044. Businc$
<br />lnd Enf6siotr Codc: Thc Coniro.rols Liccnse Law docs not olllyro !novncr oiproFny rho blilds or imrrovcs lhcrcon,
<br />rnd who onlh.rs 16r rkh p.Fcr wirh ! Co 6cro(9licnscd nuB!! ro rhcConlh.rofl Ltcnrc t!w).
<br />I d ctcnlrr rndcr Sccr B & PC rorrhi\ rcrnrn
<br />D.lq_ Om.i_wor(riiia6fr; ili6i
<br />DECIIEATON
<br />I h.rcly 6fm un&r p.Mlry ofDdj[ry orc of $c tolloqing d..bndons:
<br />-l
<br />hive atd will tuinhin ! CcnificareofConscnr b Sclf-lislrc for workcm .ompcnslrion, as ImlidcdforbySerion:1700otrh.
<br />Llbor Codc. for th. perfollMa of lhe wlt lor whi.h lh. ll.rnril is issucd.
<br />I hnv. aod sill nrinraitr *ork.rs codpcnsdn,n iosla.cc- !\ rcquircd hy S.tl ion l?m ot rlrc t $r Gdc. for rh. p$fornlmc of
<br />ihc wor* ror which rhis r,.rnrir is n$.d. MyworkcA d,npcnerion in\lmncc.dicrdd txJli.y Nnhcr d.
<br />PolicyNGiM:
<br />_l c.nirr rhur in lhc ri.rfornErc ofrhc worl rd *hi.h this pcrmit tu issucd, I sh8ll nor cmployany pe6.i in rny nunn.r
<br />$ s'o b.r.nk subicl ro lh. wrt6 con E.sarion hwr orcrliromir. aml dgrcc rhd ifl stnuld b..o'm subjccl
<br />'o
<br />tl*
<br />workds omp.ni.lion lmririons ofScdion l7u)otlh. titxr Cod.,I dtsll, fonhwirh smply silhl]ns lmvhioos..
<br />WARNINGT F0ilurc lo surc qorkcrJ compcosarion covcnSc is unlnwtul. md sh.ll snbjd an cnplotcr lo qiminBl ri altics and
<br />cilil fincs u! to orc hundrL{ lholsnd dollm (Sloo.om). in ior to rhc co of.omprNarion. donEBcs as prclidcd f(n rh.
<br />Salion 3076 of thc L€bor Cdc. i"lcrcsl .nd {lo!ry's lccsq-$-tt
<br />LIDMEDIANIMEL]B
<br />IJiSJBAIIIINIhcfthyrflirnund.rpcnalryofFrjuryrhrrItr'nlienanuncrproeisiono,Chrt,rr',(.ornitui!,gIirhScri)n7(XD)ofDivisio.:l
<br />or rhc Bt\i.cs\$d Profcst,nr Code- dl my liccn{ is in tull loEc aftl cilccr
<br />COISIBICUON.LEDINCIGDNCT
<br />I fi.rby dfirn unds FEhy of F{ury rhar rh.rc ir a onstrodhn LndinS r8.my for th. Fforn4c of rl* tur* for rrrich rhir Fnn n
<br />issued (Se. 3097, Civ. C.),
<br />I c.n ili nEr rh. fcdcral rc8rhrn,ns reMling a\t (o\ rcDolal arc mr llPplicll,h b rl,i\ Fn,F.-'r
<br />-l
<br />enity rhrr I hsve Bd rhh applic ion dd na& riar rhc otnle infomrion h comd I elie ro comtly ei$ aI Cny lnd Comly
<br />odinlmcs and Sllrc Lrws rcloriq ro huildinB constEcriotr o,n n rcby.urhorizc rc,'rc$nr0rircs of rhis Ciry snd Couty to cnrd q.n rh.
<br />oh)lc mnrhrcd nq'cny lo! in\ptdbn
<br />Aplli.ant or &sn! Si8nolurc
<br />\itk -B1a
<br />Appliances
<br />Ir/etal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Venls
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar ttlrhlNtq baMt$/!a)
<br />l ,l ul
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL tr lRlN6./t<\.^D )M *\)
<br />Notes, Remarks, Etc.UI
<br />APPROVALS
<br />o.,. R-\3r \8
<br />Lrndd'!N!trr-
<br />Lind.c\ AddE\s: _
<br />,rppr rr.iiiiiEiiiiioF
<br />I horty,fann undcr p.n,lryof!.rjuryorc ort6. aollo*ingdc.ld i6ns:
<br />Dcdo,ilion Pcrmik-Ash.slos Notification Fcdctul Reeulnlions Onb 40, P!n6)
<br />_Rcquncd Lcrrc. oI NorifNtkn
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