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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ol*G-Blildcr Dc.ldfion
<br />I td.by !flirm unds r.mhy ol pdjury lhal l .m .x.mpl form lh. Conlr&loB LiaG. t!* for $. lollowifir rao. (ia 703 1 .5 16i!63
<br />end Pof6rion Cod.): Any Chy or Counly shich r.quiB . pc@ir ro @Buuct, rlq, imprev., d.@li!h or Ep.n lny nnds.. prio, ro h!
<br />sru!.c...b. E{u6 rhc.ppli@r fo.sucn p@nlo filc r 3igicd sllrdc rhdn or sh. i.licdcd plBom ro rh. psvi.iotu ot $.
<br />Conhcroar Lic.E d L,w (Ch.pld 9, Conm.mins wilt Sdrion ?0o0 ofDivlion, ofrh. ButinBtud Prof6rio6 Cod., o. rh.l lE d
<br />sh. it .i.6p tnftt'om .nd lh. b.!i! lo( lt. .ll.gcd .eftflion .Any vioLrion of Serion 703 L5 by &y lppli6n! for r p6nl subj..n dic
<br />lpDlionr lo . .ivil p. hy ofmt mE lha liv. turl,.d dolla (t300).
<br />I, a owncr of lh. pDp.ny, or my .nployc *ith wry6 ru th.ir solc comFdl ion. will do th. wort tnd lh. rlruc1u. t nol i .odcd
<br />or olls.n for d. ( 36 ?o44, BurBr .nd Prof63ioB Codc Th. conhcror'3 L@6. L.w do6 ml lpply ro rn ow.d of tt. pmp.ny
<br />*ho bril& o. ioprov6 rhdon. ,nrl who do6 ru.h wo.t hitulf or h6.lf or rhrouh tk or hr own .dployd. prorid.d rh.r suct
<br />inprov.m.d. r. m( ilr.ndcd or ollcd for !k. Ir, hov.vd. ih. buildina o. imrbEm..i i. sld whhi. om y.r ol conpLrion. rh.
<br />Os.6.Buildr *iI nrr. O. blrd.n ol provins rhll h. or rh. mr blild o, i6proG fo, th. p.rror of ul.),
<br />$1, s o*ffi orrh. prop.nr. m .rchlivcly.onr.crins vnh fi.cc.<t conrturoB ro.odrrucr rlE prcjer ( s* 70.1,1. Bcin6s snd
<br />Prefdrion Codc Th. Conrrdor'. Lic.@ Us doB mr lpply ro u ow6 orpropor, sho bdldr or in rev6 tho@. , od who
<br />co.t..( lor such lrold3 *nh ! co..6don, li..G.<l Dui.4m ro rh. Conth.roas Li*N. Lr* )
<br />I o.&npr undc.Serio._.8. & P.C. foithar6on.
<br />IOAtsEBS.CAI4TEISAIIaI-uEEIAB4]IO!
<br />I hcr.byafinmu cr p.nnllyolpcrj'tryoncofrhcaollouinsdeclararioB:
<br />I hlvc dd will naintiin . C.ni,lc.r. ofcoM loS.lf-lNurelorrc.k.E.ohp.netion,s! provd.dfo,byS*tioil?00ofrh.
<br />Lrbor Codc. aoi lhc p.rformncc oallE work for whict th. ,.mil ie i$ud.
<br />I h.ve and will m.,.hrn work.,i @mp.nslio, rsuonce,0s r.q!n.d byS{lionlT00oalh.Libor Cod.. aorlh.p. ormnccollhc
<br />wolk lor whrch lhis p.rm i '$u.d My wo*.s coftp.n5non insunlc. oris lnd poli.y nunb( &.1
<br />l.cnirylh in th. pdromahc.oarh. rvork roruhich lhis r.mil is issu.d.l st&ll.or c'nploy.ny r.Ron i. a., hanncr $ s ro
<br />b.clnc aubj*l lo lhcwrkas @nD.nslpn lrus ofC.Lao,n{, lnd lsr€lhat
<br />.oftp..stio. provisioro olS..lion 1700 oaih. Llbor C.ne I shrll
<br />f-E - ts
<br />WARNINC F 'lu4lo *ur.work.c onp.dlrDn co!.6g. rr unLwful, and shlllsubjNr !n.mploy.r to c.immlp.on6.nd c,!il
<br />fin6 up ro o.c hmdr.d rho@d dollm (l100,000).in .d<tnbn ro rh. cofl olcoop..$rion, dimgca 6 provid.d for rh. Scrion 1076 of
<br />rh€ kbd Cod., inr..d .nd .norn.y r les
<br />!!CE!I!D.(9NIBASIQAiD!EI4B{I!()a
<br />Ihcr.byrfirhund.rp.nalryolpcrjuryth3rIamIic.nscdund.!prevhionolChaprs9(on'ncning*irhS(lion7000)orDivilionIol
<br />rh. aBincssand Prof6sioc Cod.. and my liccns. h in fullforc. and.fcct
<br />*,., 9-g- td
<br />CONSTRUCTION LENDING AGENCY
<br />I hd.by aliinn und.rp.nalryolp.iuryrhar rhcrch.consrrucrion l.ndins oscnc, ior th. p.rionnAnccofrhc\vork tushichrht p.rmit is
<br />iss'.d(S( 1,097. Civ. C )
<br />arltlc^{llplcuaarpN
<br />D.molilio. Pmils-kh.$os Nolific.lion F.d6al Rr8uhlioB (TnG 40, Pon 6)
<br />R.qun d kr.rof Nolificalion
<br />I.difr rhar I tu!. r..d
<br />'his
<br />applic ion
<br />ordidncB rnd Skrc Lrwr rcl inglo oarhi5 Cily.nd Colnly lo.ntd npon rhc
<br />abov. nEnrioncd propcny for
<br />^*, C- B-rs
<br />Appliances
<br />Metal Fire Place
<br />Evap Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled ,./-2.
<br />Rough Ductwork 16.{ l- tB a
<br />/rZo,,,,"*?1
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<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 />Rough Mech.ll'27-tt /-<52 Z -)
<br />Final Test
<br />Meter Release
<br />FINAL r 2-J-tg t '-r-2C 2 ,.)at/-c.-,&
<br />t hspecuon Forms\Mechanicaunsp6clor Record doc 03.31.06
<br />C.rtr:
<br />PolicrNudb.r: Erpn s:
<br />(Tnis sdion n.cd mt h< complct.d iath. p.mn is aor On hu.dr.ddoll6lll00lorl.ss)
<br />( t!rir(!
<br />lcnde, 5 ^dd'.s
<br />I c.nify lhll lh. rcddt Esul'lio6 agedirS abdd rdovdl lrc rcl.ppliclbL ro rhis proidr.
<br />I lsre to conply *nh lll Cily lnd County
<br />I
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