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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.Ol4'NET, OUILDER DELCARATION
<br />I heFby atnm uods Fnalty ol Fiury thal I m .xeq,l fon rh. ContrloB Lker* tAw for thc fouowing 6atn (S*.70J 1.5
<br />Busi..s aid Proldsion Codc): Any City or Cou.ly whin EquiN r lf,mn lo otrnret. alls. in'prok, &mlhh or epat 6y
<br />sttu r@. Fbl ro irs issuftc, also rqlircs c apPlicMr aor such pe nDir ro 6ic a sigicd ddrcm hal lt or slE ir lieni.d purMr .
<br />lo lh. rmvisions of (r Contmid s Lisnsn L.w (Chrpr.r 9. Conmrcing *ilh Scclion 7000 oa Diairion 3 of lh. Alsinc$ a.d
<br />Pofcssions Codc) or rhor lE or slE is cremfl lhdcliom md th. bNG for rhc all€scd cr.nlpion, Any violdion of Sslbn 7011.5 by uy
<br />appli.a lor a peml.ubj6l. ih. appucani ro r cjvilpcalryofel m6 th,. ilw hundreddolrs (1500).
<br />-1.
<br />Lr o*flcr of rhc proF.y. or my cnplores $irh voscs as thcir sb coqEnsll io., eill do ttE s.,rt atrd tlE slr4rw i! ml
<br />inl.hd.n oi oflcrcd fol sle (5€.704:1. Busires ed P,.fc$ioni Cod.r Thc C.drstols Liens t v dms flol opply lo u o*ftr of
<br />rlE poFny wto hlilds o. irllt@s dse.. !d who d@s tuh wlt niisclt or h@lf or lhftugl hh d,Er om.nployccs,
<br />Drcvidcd thrl iuch imroErnts m ml inlcnd{t oroficEn for eE. ll tDrcE,lhc tuiuins or i,lheft ir$U wi0'ino Fr
<br />ofoiplcri,n, rlE Ow.cr BuilLr vi[ haE the hrd.n of l^ring th, rE or sh. dn not huih or i8{,ms th. lmrsry fo. lhc ,rqmsc of
<br />-1,
<br />aiow"!r ol rhc !mp.ny, 0 m cxclusivcly co nt r.ct in g wilh licctrscd conrachsro conslruct tlE lrmpd (S( 7044. Busircs
<br />ad filEsii,n Cod€: Thc Conrrcror's Liccos Lae dNs nor !,rply to ano*ncr oftmp.ny sho builds o. imFovcs thcron,
<br />und who com8ls lor such pmjcch wnh a Contmclo(9 liccnsd pu*unr to lhc Contnclols Ltcnsc L€$).
<br />I mcx€m und.rsclion . B. & P.C. forthn M$n.
<br />lr8trEBl:clru8lllArtaN
<br />DEITASAIII}!
<br />I h.r.by amrm undlr p.niny of Fjury om of lh. followiq d..lmlions:
<br />I hrrc rd will ru inrain a Ccnificar. oa Con*nr t, Scllr lnsurc t'or trorkcs con .nsar io., ,\ tmvidcd fitr hy Sccri{,n .17fi1 oi rhc
<br />Lahor CG,lc- r'o. lhc pqnnnuEe of rhc worh for *hicn lnc pcrn'ir is n{o.n
<br />l
<br />ZA r'.r" "t *,rr u.*n- n Nkcr' (nnlt( n\Jrr'n 'n$rrn.c, N r.qui.d hy sccriotr :r?(xj of lnc tj$or (i)de. fu rhc nrrfo@ncc of
<br />rhc krk r.r whkh rht Frnril is issudl. My worlcrs conrFns,r i(,' iDsunncc caEicr and llolicy nunrbcr orc:
<br />.,-", Slztk Frlrr/
<br />lccnifylhlt in rhc pcrformncc ofllrc Bork for which lhis pcnnil is hsucd.l shall rcl employany peMn in rny nsmr
<br />$ as lo bcconE subjccr to rhc porlGi cohtcnsrion laws of Calil'omh, and a€N rha' it I shouB L..E subjd ro llE
<br />qorkcl .om!.nslion pmvisions of Scclion 17(J() of lhc L.hor C.dc. I rhlll. fo.lh*ith 6ndy *ith rhoc tmvhions..
<br />WARNING Fdlurc ro suE eortcrs ompcnmlion .oErl8c is unl!w6l1. and shlll slbjccr an.otlor!' ro dimiMl IEMbics 0nd
<br />civil fin.s ut lo om hunded rhousnd dolls lsrm.ooo). in addnion to rhc cosr of compcnsario.. d tugci ,s trovidcd lor rn
<br />scrion .10?6 of lh. L,br C'odc. inrncsl atrd dlomy s fes
<br />o*..5-:2A6- noou^,. lW)
<br />UIINIEILCONITACIOA
<br />IIEII,ASAIION
<br />I hcEby driirn u.dcr p.nllly of pcriury lhal I inr lienrn u.dq ,'mtisn,n !l Cnepr.r 9 (6tmeing wirh Serbn 7uD) olDivnion l
<br />of rh. Bu\incis md Pmfcssk ns Code. olld my liccnsc h nr tull lora nnd cffsl
<br />\o t74.3 L
<br />o
<br />CONSIBIJCIIONIENIIIIG.ACENCI
<br />I h.rcby,firm und.r Ffulryorp.rjurythd rhcr is r.onsdcri,n LhdinS 4cRy lor lhc rrt'ormmc oflhc work fttr which rhh Fmn ir
<br />hsucd (Scc.1097. Civ. C )
<br />AITL(ANI.DECI.IIXAII!}N
<br />I h.$, a{im o M.r r.ndxy ofF.jury om orrh. lnllowin8 dc.lddb,r
<br />Dcnnhi.. Pc nn!Ashcsos Nolificolion ljcdcral Rc8ulalions ('rnt4{). Pd6)
<br />Rcquircd L.(cr of Norificnrirn
<br />I ccnifrrhrr rlr fcdcral rc(ul rbns r8ddirg d\l'.rtor rc r,vrld. nol qrfli.rhlc lolhis t'ojccr
<br />L5."alrln,"r t h,u.,",,1rhi.rtflicrrn,rndi crhtri rhonhrlc i'nnhrri( r\.orc.l I xrrclo.onr ywirhlllCirtri (i ny
<br />o
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lvlisc. 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 Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.5/r.rlv 2\r a(87ft<
<br />Final Test
<br />FINAL 9/9r /tz tDE i?|:/.9]P#6
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />Grease Duct
<br />Meter Release
<br />Dol" O*&r
<br />*,,,",, q2\t358t7 ,,,^,, (^126/(J
<br />aborc nr.riomd Imp.ny for inslction rurFscs.
<br />*r-*.nr",*n",,*, hfmnt'\
<br />pcm .c nrft {n..,, 7 o r'" Alb , ll <L
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