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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Appliances
<br />Metal Fire Place
<br />Ev aporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. E quipment
<br />Duct Work
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />T>lwtz&4ttutr +*il 4,74 )
<br />Hood I IU
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />B.zrrt, r,tcl2g lK',,,u/2.r/
<br />Notes, Remarks, Etc.I Vtu
<br />OWNER BUTLDER DELCARATION
<br />I hftby aflirm unds pcflally of lEdury lhd I m cx.nq fon tlE Conrlc1o6 Li.m* La* for the fouo*ins @sn (Scc.7ol l .t
<br />BuiiBs 8nd Profssion Codc): Any Cily or Counry whth rcquiB ! pcmh ro @nnf,(r. .116. inprot., &mlish or rprt ,ny
<br />$rudm. Jrior ro irs ksum. lls rcquies rl* .pt icur for su.h p.m,l lo lilc a sigicd slarm.t firt lE or slE ii licr*d l,umm .
<br />to lhe povisions of thc Conmcror'. Lhen$d Llw (Chrprcr 9. ComminS with Sccrior ?001, of Division 3 of rh. Busincsr snd .
<br />Prcfqsions Codc) or thal lr or sn h crcepl ihBcfron ud rlE baris lor rht .llc8c<!.rcmplion, Ary violsrion of Scdbn 7011.5 by lny
<br />rpplica for apcmir slbjcrs rhc llPliclnl to ! civil pctrlhy of mt mp rhu five h!.drcd don{s ($500).
<br />-1.
<br />&s oqn( of lhc pmtErly, or my cnplotlrs wiln wogcs !i thcn sL comFnsation. wil do tlr qot ed $. $enre ir mt
<br />inlciden or o$..cd ftr slc (56,7044. Businc$ ud ProfcssioB Cod.r Tnc Cnlr..rols Lior* hp do.s nol +ply ro e owmr of
<br />rlE Fopc y who huil& or iqm6llE6n. lDd who &E trh ft* hintcltor h@lr or ihrouSh his orhqos cnploy..s.
<br />pmvacd thdt such imp,lwmnBGmI hl.nd.d orofrcc<t for ele,Ii lD{ts. dEhliUinsor itrpeEmrr h $Be iinorc Jr,
<br />olmnpblbtr rh. OwM Bri&r eill h& rtE hrn6 ot provir!8 dEr L .r slF dil mr hih tr inrrmrc dE pmFny for rlx l,r4n$ of
<br />-1.
<br />!s owmr of lh. ,,mFny. am .x.lusivcl, conkrin8 eirh liceis! conradoF |o ons,tocr tlE ,roirt (Ss 7Or4 turi*s
<br />and Pinft$bo Co<lc: Thc C.nrturol s Liccnsc L!* des mr lpply ro m owncr of ,,mpdy wno bit& or impo!.s rh.rs...id sho .o.lr!.ls fu scn l,mj.rls wirh r Co.rEcro(i) liccn*d p!6@r ro rhc Conrlcbr's Licensc lj*).
<br />linrcx.nuu crscdio .B &rlc turr[\'({tr,
<br />uo8f,E8S:COMPtiNSATIaN
<br />DECL$AI]AN
<br />I hcrcby.fti.n und.r pculry ot pcriury orc otlhc tollowins d(laErioni:
<br />I havc a.d sill mainrain *ortcrl amn€n\ ion i.Nramc. { rdtli€d b, s*'ion !70o of rhc ltbo. Codc, tor tht p.rforroRc of
<br />thc work tor which
<br />'lln
<br />pcmit ii hslcd My soricc' .onwnsrion i.summc csicr and lDlty nunber m
<br />'co ro I ia61 1^s q,, ,/*
<br />-Ri/uu)cot L,u aa h . / U//c
<br />-l
<br />ccnify rhnl in lh! p.rao,mnc oflh. sork lor whth rhh FrnI h issucn- I shull nor cnll,Ly{ny ocretr in my manft.
<br />e at ro li$m {bj$l lo lh. wo*m conr.nslion Lws of Cariromi,. rnd 0Br rhd il I should tEom shj.ir ro rh.
<br />*0*6.onpcn{donDnljshnsofSdion3700oflh.titnrCodc.Ish,ll.fonhwiincomplywirh$o$pmvisio.s..
<br />WARNINC: Failurc ro sm m.k N cor4.n$rion .ovcnsc h unb*ful. and shall subjcct atr cmplols to cimiml pcnahts lnd
<br />civil 6ncs up ro onc hundr.d rh.u$nd dollm (ilm,rcO). in addition to lnc coxt of compcnstion. dumscs as [ovidcn aor rlE
<br />Sccrion 110?6 ol rhc Libor Codc, irrcrc( ond
<br />--*
<br />utElt[DtoNrt allaB
<br />IIECLASIIIAN
<br />I hcEby rliir und$ ptMxy or p.rjxry ihar I am liensd lnrlcr pmvhion oI Cniflq 9 (conrmrcinc with Ser ion 7$0) of Oiv(ion l
<br />ol rh. arsin.s{ Md Pft,f.$irnr Code. lid nry liccn{ h in tull forc ond cltt{l
<br />h o,t7-/4(q//, /lr
<br />CONSTRUCT(IN I FNDIN(: A(IFN(:V
<br />I hcrcbyofllmundcr pcndlrydrFrJu,!rh,r
<br />'hcrc
<br />t!L\,n\'ruclion hndinsoscncylnr rlN p6l nurne olthcuork tu qhich lni\ ncnnir is
<br />irsrd rS.. :1097. Civ C L
<br />A,PILICANI.IIEIIdMfIT'!
<br />I )*tby lflid und( f,ci!h, ofpcriurtonc.arhc lollopins d.clrroriotrs:
<br />DenDlili Pcnnn$Ashnos Nolili.lri.n Fcdcr.l R.sohrnn,s (Tirlc40, Pd6)
<br />R.quncd lxrrcr nl Norifi cdion
<br />I .cnif, rhar rnc &dcral rcslhrions rcBuiiins .stEstos Emvll e Rn 0plliclbk lo this pojccr.
<br />I .orafy rhar I hrvc .cad this alpltarion ud srarc rhar rnc .horc i,fo@ion is $Br. I lEc ro mody *irh .ll Ciry dnd Coumy
<br />ordironcc\ und Starc I iws rclll i.e ro b!toprc\cdraiiv.\ olihis CiryrJ (i'utrrt t,.nrcr uFn, rh.
<br />ahrw nf,nriorcil popcny lor
<br />^,, c/h/ld
<br />'o;lald (ri,'1
<br />Yl<xEt
<br />COMMENTS
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Other
<br />lnstallation
<br />FINAL
<br />-l
<br />hlvc &d willmirtd!. Ccnil*ltcof Cone ro Sclf-ltrilE for rorl6 onpeBothn. &s Flvikn for ly S(lbn 1700 oftlE
<br />L3hor tuc. lo, thc D..folrMe ol rhc erl fo qhth rh. ,shir is hsEd.
<br />-l 't t.bat---VJJ-aJJZ-
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