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MECHANICAL-INSPECTOB RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcr€by amrm undcr penall, of F4ury lhal I m cxcnpl fbm rhc ConlreloF Liccns tnw for lhc lollowi.g een (Se.?0.1 1.5
<br />surinc$ ,ij Pof$sion Codc): Any Ci, or County ehth EtuirN a lErmn ro effirucr. drcr. improvc. d.mlish or rcpd y
<br />slrucluc. |rb,b iii L*u.N€. ,le nqtris rlE ,pdicer lor such Fmir ro filc a sisncd srar.mnr rhlr lE or shc ii ticnsl I'Usu!
<br />to lhc tEvhiom of$c Co reror's Lien*d Luw (Chspts 9. CommminS wirn Scctiotr ?0m oaDivisiotr 3 of thc Busincss ond
<br />Pmfcssions Codc) or lh0l tE.r shc is s.npt $cEliomdd lhc hoin for rhc allcgcd .xenwion. Any lioLrion of Sdkrn 70:]l,5 by an,
<br />alPlicant for a pcftit subjNts thc aplli$nl lo !.ivil pcMhyofnol mrc lhn.livc h!.drcd dolus (1500).
<br />-1.
<br />{s owrcr of th. pn'p.ny. or ny cmtloy&s silh {a8cs as rhcn sh snqFnsrion. will do rh wk !d tlE srrBrE ir mr
<br />inlc h .r oficrcd for $lc (Se 7()4]l. Blsiftss ind Pmr.sionr Cdc, Th. Coirarocr t-ien$ Llw dncr mr ,pply io M ow.cr oa
<br />rh. pn,I)cny who build\ or inlpob tlrB)d bd who d6 sch w.* timsclf or ncrclf or rtrou3t his tr hcr osn catlort...
<br />povidcd lhal $ch inFomnls m ml inrcndcd orofr.rd for eh. Il homE the tiildinB o! inpmwmnt t $ld *nhin orc Fe
<br />ofsnpLliotr th owN Builrd wil! h,r ilr hlrkn ofprovins thll lr or slE dn n,r hrild or in@hE thc nNrEry f6r e pu4ncot
<br />-1.
<br />as owftr of lhc fq,cn, omciclusilcly.onralin8 rilh liccnsd.ontmclonro mnsldcl lh. p,ojel (S.c.7044, Busms
<br />.rd Pntsrion Codcr Thc Conr&rol3 Liccnsc Las d@i mr emly to d o*n( of propcny who builds or imporcs rhcr6n,and who conrmts for sul' I,ojccrs with a Co.ra.ro(.) litncd puFur lo rhc Co.re&ii Lkcrc t w),
<br />-l
<br />rucx.nr u crsLrrn .A &PC f{trrhi\rcr{nl
<br />laatrEBI'toMPiltallaN
<br />DECLATArlON
<br />I hcrcby !flnnr undcr p.nslly ol pc,Jury orc ol rnc nnhwing dNldorbnsl
<br />-l
<br />lEvc ltd will mintlb r C.nifEdc of Consnr ro S.r-l.ruE for @ts oopcn$rion. &{ Fovile<l lor by Scljon l?00 of $c
<br />L3bor Codc, fd 0E Fdo!r:!E of 0E m* to, shi.h {E Fnir n issed.
<br />-l
<br />hale aftl will man ain worlcs' compcnsltion in,uEncc. trs rcquiEd by Selion l?0o of lhc lnhor $dc. for th€ pcrlorronce of
<br />n n$urnmc cu crlnd Fnicy Nmhn uc
<br />d rlrL
<br />I .cnity rh.r in rhc p.rfortu r. ofrhr work ftn whth rhis p.!ni k is\'.d. I \hall R,-,., _, [^_J. -;"_"-s a\ to h.sm subjer b ihc m*.r' conqxnsrion Inws or Cdifomir, rJd aBmc rhar if I stmuld tr.om eubir' ro trE
<br />*ortcr'corycnsllionpmvisionsofSctionlT0OofrhcbtbrCodc.lqhnll.ronh*irhsmplyvirhrtbstmvhionr..
<br />l4ARNlN(;: F.ihtu t, *cu6 rorkcA .onpcn\dion covcmBc unhrttl- nnl \hrll \nhjccr an c,npk,ycr b Gi nrl!.Mlric\ rnd
<br />civil lin$ up r. om hr.drerl rhou!$d dotlc
<br />Sccrnr 1076ofrhc Llh, C(rl., inr.rci dnd
<br />oft=5 1 lo'(
<br />I htruht !tnnr undcr ntr3hyofncrjury rh"r I 0m li.usld ,rcvisionofChryrs 9(commmiry wirh S*ri,n ?OO0) ofDivhion l
<br />or thc Busircrsotrd Pmrcssions cod.. en myltcnsc is infiilltorc&d.ffr
<br />I h.rhy nlli,n, u rl.! ltfrlrtol|rr'j,trtrl rrhq. \x.un!n'.iio
<br />n\uilrs.rlogT{\(l ir8 qcncy tor rh€ pcrfornrocc oilhc work lbr shi.h rhh P.m n
<br />ASSLISAIL!&CIAIAII(IN
<br />I hdrl,y atrm undcr !.nalry ot p.rjury orc of lhc follo*ing d(h,arions:
<br />Dcmlilion PmiG-Asbcnos Nolifiotion tu nl R.gohtions {'rnt 40. Pd6)
<br />R.qund lr cror Norifi$ri,m
<br />-l..diryrh
<br />rh. r.dfal rcBxlir ion* ,.8.Jding r\bcsros rcn,vi rc nor srDlhrhk ro
<br />'hir
<br />projet
<br />l.cnilirhdr I hnvc rcld rhis rl !8re lo comply sirh a Cn,lnd C6xnry
<br />0rivcs ofrhis Cilymd Countyto cnrcr uton thcordinaoccs lnd Stolc l-o*s rclir
<br />ok,!c n.nriomd trepcny inr
<br />AFth.rnr r Ascnr Sisnlru
<br />l
<br />^,", d.lt"'t8
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Boom / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />o penings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />FINAL 6lzt (3_,U,ll(l )
<br />Notes, Remarks, Etc lr
<br />DATE
<br />Drlq Owmrl
<br />Furnace
<br />lnsulation
<br />Meter Release
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