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MECHANICAL-INSPECTOR RECORD ,
<br />APPROVALS ID/SIG,COMMENTS OWNER OUILDER DELCAnrIION
<br />I hcEby affrm udcr lt.llry of lrjury 0u I !n.r.qr rnm ft. C. r&ror' LicM llw for tllc aoltovin! m$n (Se.ro3l.t
<br />Businc$ .nd Pmf€ssion Codc)r Ary Cir, o. Cou.ny whkh rcquiEi ! lcmn lo omlrod. all.( iq,ovc. &mlish or Epdn &y
<br />stu.lE. |rh, t. ir-r i.sutrc. ako rcquircs rlE lppliml for such Fmn b fik a siSnd srdcm rhd lt or sh. h licchtd pud;fi
<br />to thc psvirions of rhc Conhclor's I-iccn*d Lrw (Chalter 9. Commefting wilh S.clion ?000 of Division I of th. Blsinc$ 3nd
<br />Pmf.sions Cd.) or rhd lE or shc is ercmrr rhcrfrom rnd th. bask for thc alkgcd Gicnp on. Any !iol{io, of Selbn T0l1.5 hy lny
<br />rpplkai' for ! !.mn slbjdrs rh. amlic! ro ! .ivil pcdhy of mr mrc rhan fivc hu.drcn dollr! ($50o).
<br />-1.
<br />a wcr olrlE l!rcFny, m my .mpLy..r witn w.8ca $ rhcir s!. onp.nslrion. will do tlt Qqt ltd tlE sntl@ ir ml
<br />i.rddcd or ofcred for ek (56.1044. Busirc$ ud PrDfcashN Code: Tnc Co.tracro, s Lkcn$ t w dmi n t rrdy lo m owmr of
<br />rh. r,bFny sts hoildi 6, inimB itr6n. .nd who d.Es sh m* hims.li or hcMlf or thou8h his or hd om cnploycca.
<br />F ovidcd rhlr such inq,mrmnts m rcr iircrxLd orotu for st.la ho*ffi. ttF halding o iapEwmnl is sld wnhin om Fs
<br />of@nDlcrioil ir Osncr Buili,( wi[ bnw tlE blrdcn of Imvirg rhsl t or sh. dn ml build n ir{,bE lhc FDp.ny for rhc ptqDscof
<br />-1.
<br />asow.crofrhc prorcny. sncxclusi!€lyconrrscring with li.cnsed confi&roN ro.onsttucr rhc poiccr (Se.7s4. Bu\im$
<br />.ld hrlir{ion Codc: Th. Conrrebrt Liccn.c Law dei not aprlyio oowrcr otl,mFny who blilds or irynws ll.Nn,
<br />lnd who 6nids an such pmif,rs {irh n ConrEcto(9 lt.nsd l,urslq ro rlr Cotrrhcrols Lilne llw)
<br />t{oxf,!f,s:caMtrNsArlaN
<br />DECLAXAIO!
<br />I hdby arrm urds Fralt, ol pdiury o* ollh. fouowhB d(lallioN:
<br />I hrvc klrvilLnridrir t('c ilicdc ofcon\cnr lo Sell.ln\trc lnr w.rtcrr.orDcn\ !i,)n. rs nmvntud f{tr hysc.rn STu)ulrhc
<br />li}xtr(itrlc- turr[c p.rtunnrnrrofrhc rork fo' Nhich rlr ,l.mn N $ucrl
<br />I nawondwill minlain workcrl comr.rsslion iffuromc, N r.quiEd Sy Salion 1700 olthc Lrbo, Cod., for $c p.rio.mmc of
<br />lh. mrt tor whi.h rhir p.mir ir i$u.d. My workd omp.n\olion iffulme @tr rn lofty nunls el
<br />-l
<br />ccnify rhll in rhc pdfortumc ol rhc *ork td shkh lhir pcrn n i$ucrt. I shall noi .nploy 3ny pctso. i. any manncr
<br />s ai ro bccoft subjd kr rhe qort.n compcnslrion law. ofc,lifomin. rnd lge lhal ill should tEcom slbh.l ro ihc
<br />wo*crr cdmpcnsridn novl\ioN of se.ri.n 37m ol rhc hbor Crtc, I shall, fdhwilh cotrply wilh fios I'Drisionr..
<br />\. r r, r'.1('_r,.{ r1., I'l\rr:,.n..i'n{r.r trd lrNlrl.r\
<br />LICENSEIICONITACIII&
<br />IIECI,IIAAIIAN
<br />I hcrcbyuifiirnutrdcr Fn0hyolp.rjuryrh l om licensn undcr prorision of Chiprc. 9 (.omftftin! with Scctio. ?(J00) ol Divisnnr l
<br />of rhc Bliincsaod Pn,rcrsn, n\ codc. uri 'nyli.cn* ir in aull(tra uxl cftc.r
<br />D.l.:- ContEclo.:
<br />c0lsralr:r0NuNpu(i-[alNcr
<br />Ihcrc$y,ltrmxndcrtrslryofFrjuryrholrhscis0con{rucrionlcndinsoscmyforrhcpcrfotun.corrh.w.rkrorwhkhlh Fnnit is
<br />hslcd (Scc .109?, Civ C )
<br />APPI IC NT DF.(]I AR,\Ti(IN
<br />I hcdy,trrnrund$ Ftrrhy oltrrltry onc olllE hllorin8 dcch ions:
<br />DcnFlirn!'Pcrnrns A{tr{osN.riljuriohFcd.tul Rc8uliiorslTirlc4l).Pdn6)
<br />Rcquncd Ir(d or Nor'li.dbn
<br />-l
<br />ccrrify thot rhc lcdcEl rcBuhtions nsrdins aibcsrr\ rcnn,vrl!.c n 'lrrlicdhlc ro this pmj.cl.
<br />I .cnily lhd I Mrc rc&l thls q'tlic$ bn i,i tutc lh0l rhc ah,vc itrfoi.n{ bn n core' I nge k, ...rdy wnh .11 City .nl Counry
<br />odinr ..\ r.d sntr. uws rclir itr8 ro buildinS.onnru ion, rM hcrcby durtnn i7x rcprc*nr(ivcs t'i rhn ciry atul counry lo cnln ul}rt rhc
<br />nlx)vc nrnri(,ncd pbt nyror i s!.crionlru4rscs.
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Besidential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Bough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL l/,b llu ,4fh
<br />Notes, Remarks, Etc.v
<br />DATE
<br />Above T-Bar
<br />I n.x.nrr xndd Setion-. B &PC forrhisMstr.
<br />Dil.: Own2r:
<br />Ibli.y Nu tr$.r
<br />-Lxphs:
<br />-
<br />Li..n\c Cln\\r Li.cn\c Nunrll(r:
<br />-
<br />Lcnlcis Nam
<br />-
<br />Dalcl
<br />I
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