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MECHANICAL-INSPECTOR HECORD
<br />APPROVALS DATE tD/srG.COMMENTS OII'NEf, BUILDER DELCARATION
<br />I he Eby &mm undd l,€iany of lcrjuiy rhal I M cxcnq 6on thc Conrs.hR Lien* ljw for lhc nnbqing esn (Scc.7ol l.5
<br />Bniincss ..d Pr.fc$ion Cod.): Ary Cny or Colnly whkh tquircs . Fmil lo Nn$Mr alr6. impovc d.mlth 6t Erai tnv
<br />sm.l@. Fior to ils issume, als rcquircs rrE tp, kdnr lor such Frmit lo lilc a siSncd slltc@nt lh,l lE or shc is li.encn luNst
<br />h rhe nmlision of tlE Conrm.lols Liccnsd bw (Cnlpt.r ,. ConncNing wiln Sction 7000 of Divirion 3 of lh€ Busincsi afil
<br />Pmtcrsk,ns Crdc) or lhnl hc or sh. is cxcofl lh.rchom ald rhc bc\is fot lnc olkged cxcmpli.n. Ary viohlion of Sctbn 703 1 5 by ,ny
<br />applicor for . pcmil subrcrts lh€ aPpliclnr ro ! civil Fmlly of nor tuE thd nvc iundt n dotEs (S500)
<br />-1.
<br />as owtur of lh. l,oFny. o. fry cmphy*t wilh wsgei 6 lhcir slc @nrlf,nelion. will do dt qdl {'d tlE *MnE i! er
<br />c.d.d r offcrcn fo sh (Sc.?O14, Boiaes. ard Prolcssioni Cod.: Tls Cllf6cld t Lkcn* l,* ih.s ml apolv to an ovmr of
<br />Itc pmp.lry *ho boildr or inphB llEmn, ud who d.rs tun ha hi@.lf or hcnelf Dr thmugh his m h.r own cmPlov..r.
<br />pmrid.d th.r seh inWDEc.Bcrcl tll. cd ffoftrcd for sle,lf. h.gffi.llE hildins ot irgotr.r Ll sldPilhinorc Fe
<br />olonpbiioo llE Owrcr Bui&r eiu htE lhc hdq of povin8 tt l hc or slrc dA mr t{ild r Epmw $c PDlEty fo. lt! pu4Ds of
<br />-I.
<br />0s owncr of rh. I,n r8ny, an crclusivcly conlElins wnh liccnsed .orracro^ io onslru.l ltE f/oicc' (scc. 7044. Businsi
<br />!'d Ro{6rin Codc: Th.Co.tmclols Liccls€ tiw doc! mr,t,,lylo an o*nct oflhlcdy $ho builds or im,,mE3 $ermn.
<br />ond *ho co mcrs for slch pmjek wi$ a Contmclo(t liccnscd ,!6umr to ih. Contrcclols Uccn* Lr*).
<br />-l
<br />am cxchpl undcr Sslion- A. & P C lor lhis rcason
<br />lgl85E8L:cQMSENSAUOn
<br />DECL/IaAIJON
<br />I lEch, !,nmmdq F xy ofFj!,, om ofllr folkr*i.g deladio.s:
<br />Ih3\c:ut$illnri rir!Ccnillc cofConr.rk,S.lf.lNurclitr\!orkc^.on,rr\rridr'r\ pn'vidcdiUhyS.rri( :l7urol'rhc
<br />Lfi,r C{ic. lnr rhc rcrrohiro.c.l ilEsork fffshich rhclf,nnir i\ isucd
<br />-l hr!. aM sall Eli.rain worlc* comFni ion insmB. ai d|uircd hy Sdlion 3700 ofrh.l,h.r Codc. foi thc Ff()lM of
<br />rh. work for phth this Frnit is nsd. My worl6 or'llEnsllion insurMa 6icr erd policy numbc. m:
<br />S-{a}r- fi-rnrl slkt<
<br />-t
<br />enify rhd in rh. pc,formmc oflhc wolt for whth rhis p.rnn h irsEd. , shau not cnlloy lry F6on in lnv m.ner
<br />$ ar m h.com $bFct to lhc wo crf @fitn$rion l,wrofcilifomio. lnd lsd rhd ilI should hccom !!bix.lothc
<br />wort6 ooFn{rion povisions of S€.r ion l70o ol ltr t$ff lhc, I {EU. fonnwi'h 6rply wnh tho* ,otilions
<br />WARNINC: arilurc lo s@ m.k6 omFnetion mveEgc h lnlastul. .ri shlll sutjcd ,n cmplorlr to siminal F@lla {.d
<br />civil fincs !p ro onc h!.dicd rhouknd doll6 ($100,000), in addilion lo rhc cosl of coqEneri.a dam8ca !s lrcvidci lor rnc
<br />Sccrbn 3076 of rh. kbor C.dc, i.rcEsl ond sxorEy s fes.
<br />DICIJSAIIQN
<br />I hcEhy rlnm uftler p.nrxyorr{tjury rhd I rm li{nsl undcr nn,viiofl oiChrlls 9lcommn.in8 unh S.clion 7fix)l 'rDivision 1
<br />o, rlr BusirN$ an(l ltof.$n,n{ (id.. . ry liccns n in tulllorcc d'd.flac'
<br />P,lnllci\b
<br />S.2'l.tt ftGC
<br />CONSTIIIJ(:T!IN I TNDN(; AG}'N(:Y
<br />I hcrchy nilrn undcr Fnalrrolr.rjurrlhsl rh.o h a.onsru.ri,n lc.din8 escE-y au rh.ldromEncc oilh. sork ror whichrht IErDi n
<br />i$ucd lss.:1097, Civ C )
<br />AIEITIANLI'EI;IAAAI1O!
<br />I ls$y riinn lndcr Fi,lr, olFrtury onc olrhc lollowins dcchro i\l
<br />l)c',x,liri({ l,o niF \hc\ros Norificribn rcd. lRcsuhrions( Iirlc 40. Prrr6)
<br />-Rcquicd
<br />l.rrcrol Norifi.miur
<br />l.cnifyrhar rh. fcdc,al Esol.lions rcs{dins usbcsros,cnn,vdnrc n r rmliclhlt ro $is p,oj.tr'
<br />prc.niry rh{ I hau sd rhh anpr
<br />odi.aft$ und Srar. lnws Eldin8 k'
<br />i. ion a,i 3t!rc that rh. at !c inGmiion h corel. I o8re lo cornply wnh all Cily ond Co(ry
<br />buildi.g.onsrrudion. ond hcrcby luitori*,cprcs. divcsoflhisCilylndCounlylocnls!,nndE
<br />lboE mnriomd pmFny for
<br />Appliances
<br />Metal 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 />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />6/Rough Mech.t/tt
<br />Final Test
<br />Meter Release
<br />FINAL L/1 y'n lrrfsItr**{
<br />Notes, Remarks, Etc.
<br />D",", S')tl '\(
<br />_*", s.1t.l7
<br />lrtliA
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