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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG,COMMENTS OWNER BUILDER DEI.CARATION
<br />I hcr.by rmrm un&r pcnalry or Frr!ry ihar I d€rcm fhm rhc Conr&ros Lken* ks for $e followiog @$n Is(7o:11.5
<br />Blsincss a'n Pmfcsion Codc): Any Cny or Cou.ly *hhh rcquirer a Fmn lo onsrud. ahs, isl,bv., &mlish or qEt'mv
<br />snu.rft. ri,r ro irs hsune. lko r.$ircs rhc opttlicanr for sun Fmjr ro fih a si8md srahm rhlr lE or shc is li.cnsd pu,sa
<br />to thc povtions ol Ltc Cotulclol\ Liccn*d trw (Chaflcr 9. ComoainS wnh Scclion 7000 of Division 3 of thc Busincss rtrd
<br />P,lfcsshnsCod.)orrharlEorshcisrxcntlhcrcfromlndrh.barnforrhcdlc8.dcrcmlriotr.An,lhlarionofserh.70ll.5byany
<br />.mlic.d for a l.mit subj6t! rlE appli.qr to a civil pc@lry of n ee rha, fivc hu.dnd dolla3 (S5@).
<br />_1, ai osrcr ol rhc ttopcnr. or ny cqrlorecs wilh q!B.s .s rh.ir solc comncnsor ion. will do rl." work ,rd th. srBle i{ mt
<br />iftn&n or ofcJ.d ftr slc (5(.7044. Busifts od Ptofcslions Cods Ttc Coni.r.bls Liere L,w rh.s nol ,pply io m owmr oa
<br />rlr IDrEny wlh bilds or nrymG llt@( !d who dG uh w* hn$clr o. tlNlf or rhElgt his o hd osn cnPloyc.s.
<br />,,ro!id lhot such hiJmwmnts N ml inlcfld.d or oftnn ror eL. li lbwvc( th. lDilding or nr{,mwmnl ir $E *nhin oE Fe
<br />of$nphrioo. lh. Own( Buillr will havc rh. hldm ol proli.s rll! h. or shc did mt blild or inF.rc O. prcFny lor tF puqrs ol
<br />-1,
<br />!s owm ol lnc tsFny, am ctcl8ircly conlBcrine wilh li.cn*d .oir.ctoa
<br />'o
<br />oned.l rh. pmjel (Scc. 7044, Busimsq
<br />md ftDfc{rion CDdc: Thc ContBcror's Liccnsc Lov d@s nol lpply ro an o*ncr of[openysho bulld. or im,lrori rhcrcon,and who conlnEls for such prcjels wirh . C.nrmdo(9 lkcBd purlu.r ro ihc C,nrdor's Lk.ns. L{w).
<br />I mcrcmn! undcr S.cli.n . B. & P.C. torrh's rctr'on
<br />Drter Ome.
<br />!A8f,88S.:COMIENTAIION
<br />DEC!48AI!N
<br />I hccby atirm ulder p€ulry of pcrj!ry oft of fic followins d..lddrionsl
<br />Ihrlcarxt*illmnrinaCcnir,crrcofcon*nlr,'Scllltrs!.cnn*orkc6compcn\dbn.rspr.vidcdtorbySdrt,.l?(x)ofrhc
<br />ulxtr Gxlc. ri,. rhc pc.i,'romc.i rhc sort nn siicn rh. n nnn is nucd
<br />ZEI iNr rnd will maini, n workcs .onr!.ns.r ion nr\ur.n c. ,. i.quRd hy sc.r ion rTuJ or thc tjbor code. lor lhe lslormncc ot
<br />Ihc $orl ror *hich rht r.m is irscd My wo Lrl cofrp.nuidr in\ur*..c.ri.r rl ,'oliy nunrbcr m:
<br />stzr+< F.nd
<br />-l
<br />enifrthar in rfie Erfortunce of rhc wo* for *hth rhh ncrmir h hsucd.l shlll nor.nohy 'n, DcBon in any nMFr
<br />s m lo h.Lom sbicd lo lh. mr*nc omp.nslion lsws ol Cur.mid. uid aBrcc ltul if , shouh tEcom subFrl lo ltrc
<br />workcs omtEnsarion pmvisions of Sccrion 3r0o oa tFr tjbor Codc I rhall. fonteilh snrply wilh lbor pmvishns..
<br />WARNING: Flilue h sw qorkcs' onnc.lation @wEse is unhwtuL ..d shall sblrl .. cmplorlr b ciDinal Fnrtis and
<br />.ivil ,ims u! ro oN hundrrl rhouond dollos (S100.000), in ddnion ro rhc @it otconocns8lion. dlmges s prcvilcd for th.
<br />Sdion 1076 of6e Lihor Codc. inrcrc o.dllrimy s f.cs,u'd
<br />LICINjUrl':0Xr&IllAB
<br />DICI.ASAIIOf,
<br />nf rhd Bulirrc\\ xnd Pn'tc\\ion\ (tdc. d ntylirctr{ is in tulllhr.c a dcrtccr
<br />R lot-7 Ii L
<br />5 ilo /lb /*ffitu),tt-v_:---_
<br />!:olslalcuoNtENDtNclcElcI
<br />I h.Eby ali-rm undcr Fo.hy .f perjury rhd lh.rc is r constu 'i.i hidire rScEy lor lhc Frfornlft. or rlE work for *hich lhn IEml i!
<br />krucd (Sa, 1097. Civ. C )
<br />ATTUQII{II!!:IJ"BAIIOIi
<br />I l{rlrJ nlnnn u iJ.r lrnrh! orprrjrrt onc.frhc fi)lk,winA dcchrarion\
<br />Dcnn,litiotr l,crnn6.A\b({os Norifi.rrirr lrcdcrrl Rcguldri,nr\ ('rirL,10. P (,
<br />Rcqun(.t lllrcr.l Mnifi.arin,
<br />l.cdili rhd rl[ lcdcril rcgulrri{,is Rlirdins r\bc{os rcnurlrE nor rrtlicrblc n, rhis pbjd.r
<br />1l.rn,l) rhdr IhlcrcJJ,hnrrll'.. it'nirdnd(rh, rhcrtDr irion i,rnrorc.r I aarE t'.onjJ)ly wiih ,ll Cny nnd Ounry
<br />o imN.s ind stdc Loss rl itrg ro $uildin8 coniru.rion. rJ lrtubyaurhorizc rcrrcsctrr.rivcs o, rhi\ Cilya A,utrr) ro cnlcr up.n rhc
<br />rh'vc nrnriorJ pnpc yInr irsrB.-.tnnuurFxcs.
<br />A!'plicer or A8!nl Signoru D".:6/lo/lfi
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<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 Ranqe
<br />Hood
<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 />Bough Mech.{r'.t.4*, 9.n 't>t;s14 c
<br />Final Test
<br />Meter Release
<br />FINAL 57 \(//, c.'Di $J-,or*
<br />Notes, Remarks, Etc.
<br />Furnace
<br />Other
<br />lnstallation
<br />,r"y^*,*., 9 2 l\ 3 56 \ I .,0',",, 5 / 7b / I 3
<br />u,,", 5/ta /13
<br />I
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