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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMEN S <br />Appliances <br />IVetal Fire Place <br />Evap 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 Range <br />Other <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />\- <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 I t <br />FINAL (DW1 dz9,/v <br />I <br />OwcrAuildcr D.clmtion <br />I h...by lmrn lndd p.Mny oap.lury $I I an q.opl aorn th.ConmsoB L'..8. Ltw lorrhcrolbw'ng ra$n Ga 70ll-5 Bs.r6r <br />.nd Prof6sion Cod.): A.y City or County shict .cqui 6 . pmi b .oBtru<l, rh.r, inpro!.. d.holi3n or Ep.t .ry rucru., Fior ld ni <br />irsunc., rko r.quir6 th. appli.lnt for such p.mir lo 61. , siBr.d slalcn n! ltll h. or slE is lic.mcd puBuanr ro th. povilioc oflh. <br />Co.taclo.t Lien!.d Llw (Chtpl.r e. Comm.Erng wnh sd6n 7000 olDivision 3 ofrh. Busrn63.nn ProfB!6a Cod.) or lhll h. t' <br />3hc ir .xcmpr rtdfion ..d rhc b!!i. for th. .Uq.d d.Dprion .Any violrr ion oaserion 701I .5 by &y rpDlicmr lor . pmi rubk$ lhc <br />.pplicrtrt lo ! .ivil Fmlty of d6t 60( th.! nlc hudrcd dollc (t5m). <br />I, a o*.d ot rh. prcp.dy. or ny chploye3 r'nh s.s.s I rlrir sol. cohp.turr io,. w ill do ltc worl &d rh. struduc ir f,or int.ndd <br />or or.r.d for sl. ( S- ?014,6!thd..d P.of.$ionr Cod. Th. Conttcrorr Lic.hs. La* do6 nolrpply ro !n own.rofth.pop.n\ <br />who builds or imprcv.s lhtun, dd *no do6 eNn worl hins.lror hcGclrorlhroush hi! o. h.r own cdploy6. providcd ltll rucn <br />improv.m.nB.r.noli..d.do.offd.dfor.rl..lf.ho*.r.r,rh.boilding6rinprorrm.dniobwirhi.oo.y.roaco,nplciion,rhc <br />Osn .B!ild6 *ill h.( th. burdcn or previn! thrl h. or 3hc not builit or inprolr f6r rhc plrpG. of $L). <br />l. a owor of rh. proDfiy. u cr.luliv.ly coirrc1iog wirh li..N.d conlndoB ro @Grru.l rh. prcjccr ( S<. 7044, Duinds ed <br />Prof.s'on Cod€ Th. Co.rrdoas Lic.nG t w dc er .pply ro m os6 ofprcpaly sho build! d inprevB <br />'h.r6n , od lho <br />conr.c|3 for such p,or6te witn ! ContEcro(, lic.n*n pursunl lo rh. Con1ncror's Licens. tiv ) <br />._l m.x.mpt undd Sation .4. & P.C. 6r rfii! re.- <br />loa(lBt@MtElsar10tslEcl.AsalloN <br />I t r.by lllm undq p!@lry oaFjury on oathc follo*inr d(hnlioB: <br />I h,!. md will tui rin . C.nificlr. ofco$.nr to S.lf-lBUr. for worl.G comp.nsr ion, B provid.d for ty S.crion I70o oa rh. <br />Lrhor C.d.. for lh. D.rfomanc. of lh. wort for wnich rh. D.rmil i3 ks!.d. <br />I h!v..ndwill m.ini.in worl.. omp.Mrion inruhnc...s r€qrtred by se.rion1700olrh.bborCode. fo.rh.performf,c.ofrh. <br />*orkss' comD.Mton rnslnn.e qrs.nd pol'.y numbcr e:.t <br />Policy Numbs:_.-,_____E rt.. <br />*crion n.cd nor b. comrlclcd iflh.pcmn is for o'E hundrcd doll.n lSl00lorl.s) <br />_l c.niay <br />'hri <br />in rh. p..lo, B. oalhc wort to. which ihir pnftir i5 i$!.d,I lhrll mt.mploy uy p.Bon in dy mm.r.o B ro <br />ind isre th.r fl3hould b..om. bj.ct to rh. qorr.re <br />fonhanh cooply wirh rho!. <br />WARNINC Frilur. lo sur. wo .m @nD.Nrti.. covcr.g. is unhwaul. .nd rh.ll 3ubjet .n .mployd to nimin.l p.Elli6 ..d civil <br />6nd up to on. hu ftd rholod dolla (tl 00.0@).ir r.idnion ro th. cGr ofconp.nstioD. dr scs a pmvid.d for rh. Serion 30?6 oa <br />li. Libor Cod.. inr.rdl lnd lnorn y e f6 <br />llcEls[psalrBAqroStnEcldS$p! <br />I h.Eby .mm undcr p.n.lry ofpnjury tul I @ li.cm.d und6 povision ol Ct'lptd 9 (@m6cing whh Setion ?000) ol Divbion 3 of <br />Butiness a d PtuLssions Codc li..os. is in tuU iorc.3nd crc.r. <br />I h.rcby aflinn und.rp.oaltyotp.rjurylhat lh.re t lcndinsasency lorthepcrlon.anc.ollncworkforwhichlnisp.n.it is <br />i$ucd (Se. 10e7. Ca!. c.). <br />l,.od.asNi6. _ <br />ATTIICAtsI:E,.DISIAAAIIAE <br />D.mlnio, PmiteArbBtor Notifiqtioi F.d. l R.guhtionr (Tnb 40, Pln 6) <br />_ PcquiEd t rrd ofNo(fiorion <br />_l c.nifr ltit rh. a.ddrl E8uhrio$ re.rding abBtoi ronolrl 4 .or .rplic$|. rc rhis prcjccr <br />t c.niryrhal In v. r.!d rhis (ppliclt ion ed sl!r. thlr th. sbov€ infomation Gcotrccl.I asrft ro codply wnh lll Cily and Cou y <br />ordimncG lndSl(. trwsrclalir8lo buildins coNrrucrion. rnd hd.hy .trlhorizc r.prcs.nlrti!.s oalhG Cilr.nd Couniy ro.nro lpon rhc <br />rhov. 6.nt ioo.d pro p.n y <br />) <br />1,I <br />51 Forms\M€chanlcal lnspoctor Ro.o.d doc 03.31 <br />Hood <br />rg <br />1700ofrhc Llbor Codc- I <br />----= <br />tl