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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ()t\NuR Bl ILDTR D|LC,\R\ll(rN
<br />I lEEby .fiirm undcr pcnslly of lEriury llEl I m.rcnpl fmh lh. C.nrracioB' Lt.nF L3w aor tlE follo*irg Ea$o (Se,7bll.5
<br />Aosincss und Profesion Codc): An, Ciry or Counry qhth rcqlires ! F mn ro .onsro.L !lr(. ioprovc, d.mlnn or rcp.n .ny .
<br />srklEc. Drhl ro irs issue.. rho Equncs lh. apdi.st lbr ruch lEmit to lih a si8ncd slalcm lhal lr or sh€ h lkcn*d pu^uel
<br />to thc pmvni.ns of rn€ Cont6toas Lhcnsd Llw (ChapE 9, Comtuncin! wirh Sc.tio6 7000 ol oivision 3 oflt. Ausincss and
<br />Pelcsitunr Cod.) or rhar l* or shc i. ex.npt ihcrcrron and iE b6.k fo, ih. dl.gld cxcn lion. Any vi,hlioi ofSelion ?0.'l,5 by ony
<br />0pplica for a p.mir subj.{ls lh. ry,rliclnl to a civil ,En.ny of mr mrc lh!tr fivc hund6d douai (t500),
<br />-1.
<br />&r owr otrlE nreltny, d n, cmploJcs }nh M8$ er rh.t sk @mFtrqlion. wi do ll! wort.d tlx cnf,le is tul
<br />i.krdcd o. o$crcd for eh (Se.7044, BNimss .rn PrcfBsio6 Codc Thc Co ,!clo s Li.cn5 L{w d..s Dl ,}pl, 16 osncr of
<br />ths,ftI,eny alF hr ds or in!,hrs rhc@tr dd sh. dc Mh ell hio*lr or h.rsc,a or rhmugh his or hs own.mpLyccs,
<br />providdl rhrt sMh impmsmnls @ ml inic.dcd r ofi.Ed lor s.lc. lf, homrcr.lhc toilding or inipmwd h sld vilhin onc tEr
<br />of.ouplcrion. tu O*ner BliLLr will hrvc dE hlihn of prcvirg lhll lE d rhe did rcl boild or inpbw {E l,Dpciy ror dt puPo* of
<br />-1.
<br />!s o*n.r of rh€ pmFny. .m crclusircly conrstinS wirh lia.kd onlretou ro con(rud rhe rmifl (S(. 7(x4, Burift$
<br />rnd Pr.ltsi{ Codcr Thc CorkNro. s Lkcnse llw dms nor apply lo on o*ncr of FroFny wto builds or imprcEs lhcr€oo,
<br />lnd who o mcrsfor slchllmi(ls *irh 3 Conhcro(9liarsn lusuanr ro rh. Co r..lois LiceM tjw),
<br />l oncxcmlr undcr Scctio a &PC lirrhhrcrv'n.
<br />IIOBTEf,SIAMIENSAIII}!
<br />DECI.ABAIION
<br />I hcrcby trflirm und.r Fnally ol pcriury onc of lhc folhvinS d(1,-dions:
<br />llvculqillmrinr3innC.nifi. .ofC.nsc hSclfln$ronrworkcr\..oDrpctrsdion.rslnovnlcdturtySccrion.]7( olrhd
<br />lrtxn Cod..li)rrhc Fnormtrncc.frhc w.rk n $hichrhcprfl ir is isucd
<br />trn*""t"'rr'n"n.,n".rk.n\rnncn\,,n'n.uirncc.rsrcquircd6ySccrii,n.lTtX)oarhcLJhorCod..LrrhcpcrlonnaNcoi
<br />thc wrk nn wlichthr Fcnnil is nsud Myworkcn .onrpcn\rrnr insurln c.nrtr mrl loliynumlB dc
<br />Stert+ G'v..!
<br />Qzrl35 3 \ -)Stzb /lt,
<br />I ccnitr rhar i, ihc p.rr.mncc oflh. wor[ for which rhis pcirnir is issucd.l sholl onl cmploy anyF.ion in any m.n.r
<br />e as ro lrom subJ€r ro rh. eo*dl onlEnerion kws .l Calilodia, ,!d dgec lhrt if I slruld beom subiLrl lo llE
<br />ertc6' o'npcnsrion provision! of Sftiio. 1700 or rhc kbor Codc, I .h,U. ronhwnh mmply wilh ll[E pmvishns..
<br />WAf,NING: Fdturc l. su. work r' snp.nsarion sv.mgc is unl,wtuL Md sholl subitl o ery'loyd lo aiminal Fmlrix and
<br />.ivil fin.s up ro oe hundrrl lhousnd dollm ($loo,OqJ), in addirion io lhc cosl of co,pcnsslior, datu8ci .s l,tovtdcd to, $e
<br />s..ri.n 1076 olrhe tllbr C6dc, iorcrcs end arbmy s l$s.
<br />LICEUTEDJONIAACIUB
<br />u&qlaaa.rlt!!
<br />I hcrcby atltm undcr pcnalry of pc.jury rhar I d ti.cnrrr rndcr F)!i\ion orchlprd 9tcorImminB qirh Scclion 7()(x)) oaDivision.l
<br />oi lhc BusiEs lnd Pmltsions Codc. ud myliccnsc h ir lull forlt I cltirr
<br />)o I f?.?t
<br />call.iml!:1laNuilDllilirl(ilrNl;I
<br />I hcrcby iinn uDacr pcNlryol pcrjury lhri rhcc h r condrucrion knJin! +cn.y tur rhc lcrfuxurrc olrhc wor[ Lr whi.ll rlrn Frinir i\
<br />issucd (Sc..3{}.)7. Civ. C.)
<br />atfucrNlDlictAxrua!
<br />Ilmhyfin!u dq prnally oipcrju'yoic ofrhc iall,,ain! dcchrnrior\:
<br />Dcnrlirtri Pcnnir+Ash.n.s No'i6crtion lrcderulRc,rtrhrirtrr\ (lnlc (). Pr i)
<br />-Rcquncd
<br />l.cuer ot Nolificari(n'
<br />_l ccnity lhrr rhc fcdcrllr.srhrionr (80din! rb.{o\ rcnx,vJ n ior rfdi.!$lc lo rhis,,oicr
<br />At ""niiy,hn, t tu,".oa,li\ rpplicnlion ard shre ihd rhc ahorc inrorrorion is..ndr.l.tm b.!n{'ly wir[ rllCirylnd Coutrl,
<br />o nHkcs rtr,l srdc Lnws EldinE ro buiklins conrru.r io nd ncrcby aurktrizu r.t,.{nrarivcs (,l rhh Chy nnd counrt ro cntcr up rhc
<br />rhovc nrntiotrcd ln,pcny for insnccl i(
<br />'n
<br />purnts
<br />Appli..nr .r Agctrr Sien,uic
<br />Atl";tlc.
<br />Appliances
<br />t\Ietal 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 />Rough Ductwork
<br />Vents
<br />Toilet Room i Clothes Dryer
<br />Residential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Ducl
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.</!l/ls ,w atEdfll
<br />Final Test
<br />Meter Release
<br />FINAL 9B '/tl 5-;*
<br />^tE*t<
<br />K
<br />Notes, Remarks, Etc.
<br />*", D /(o /13
<br />,,,", 5rlo // E .*",.,..
<br />trnd.r'r Nrm:
<br />-
<br />6/lo//6
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