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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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.
<br />Final Test
<br />Meter Release
<br />FINAL lp/t"lr ,t\Gt
<br />Notes, Remarks, Etc.
<br />OWNER AUILDF]R DIJI-CARATION
<br />I hcroby dflirnr ukl& pcnfiy of Frjury rhd I m cnnpr rro,tr rhc Conkdor' Liccn{ L.w t)r thc lolt,$ins rcxsn (scc 7).ll 5
<br />tJu\incss nnd Prolision C{rlc): Any Cir}, or Cou.ry *hich rcquir$ a n flnil ro ondtu(l. rlrrr, nnprovd. ddmrlhh ur Nt\' r My
<br />{fl.turq llitre, irs i\\uh_d. rl$ i.quircs rhc rfDli.nnt nn \&h Jf,mn t, filc! \r8ncd nnr.mnt rhd h- or shc,s lknscd fuNurlt
<br />b rhu ptuvisi{nr of rhc Grnlrlct.tr \ Licenscd l,r* (Chnpls 9. CommcrEing sirh Sc.in,n 7(XX} oI Divnion :l ofthc Btrsincs trtrd
<br />alpli.Mlnri!.nni'suhjNrsrhcrprlicrtrrto,.ivilFnillyorn.rnk/.rh fiv. nunnrcd doll.,s (15()())
<br />l. ar owM oa rnc popcny, 6r my cmplotiir sirh erg.r .r rh.ir eh conqro\aiio.. *ill do E wort !d llE slBt@ is ml
<br />inrc,isi or olYcFd for ek (3(.7044. B$ircss rrd Profcsions Codc: Tnc Contrrcrols Licen$ Llw der mr rpnly ro owffi oI
<br />thc ImFdy eh. t{ild\.r irqm6 ilE6n. orld *rD dm skh eoll himsr or h.Mlf or rhmu3h nis or h.r o*n ctqrlorccs.
<br />ptuvidcd rhlr slch i ,htcmn* @ mr cnr.d or orcrd ror sh r, h'rcw, ilr hildinS tr inqmwmnl is old wilhi, o* ycs
<br />of.omplcrirn, tr o' rcr Buitlcr wil haE th. hrd.n oapovirg $nl h. or rnc dil mr hild or rprer lh. FotEly fo, tlE purF$ of
<br />-1.
<br />asovBrofrhc pmFny, oncx.lusivclyconlr.clinS wnh licc.sen conlmcloN ro connrud l}E pmi4l (S(.7044. Bu\in$i
<br />0,rl h!tosih Codc:'lhc ContB.roas Licctrsc Law docs nor applyb ono$tur 6tproFrry who huilds or nnprov.s lhcrcon.
<br />rnd whl) onrftds lor such Foj.rrs *irh ! Conimcro(r) Iic.sd pIswr b rhc C,nradols Li.€n€ L€*).
<br />I rm.xcrDl undn S('mn ,B.&PC forrhisEMn.
<br />D.r. Osrr:
<br />rlt8trE8S:CIIMtElsAIM
<br />DECI,AAAtrO]!
<br />I h.r.by rfrtrmuod.r p.nohyoaFrjuryoncof lh. aollosinSd(ld bns:
<br />-l
<br />haw !tu will rMin'.in ! Ccnifrc c of ConFnr ro Scla'lnsurc lor *ortns oh!€n*rion, as l'lvihd fo, by Sdion 3110 ot th.
<br />t hor c.dc. lm lhc Frlol1Me of lh. m* for qhich th. IEmh h ksu.d.
<br />_l har and will minrain workcis ooncnsrion iNuBrce. es rcqutd by Serion.l7O0 orr& hhor Co.lc.lor th. p6lomm. of
<br />thc sdk tor qhi.h thii p.mit is ia{cd, My workcB .oftp€nsrion insurmc @ier [d poliy numtxr r.:
<br />Poli.t Ntrnrhcr:-lixpircs:
<br />-l
<br />cc.rify rhlr in rn Frformme ofrhc wort for which rtn lErmn is hkn.I rhatl nor eilDloy an, pc*or i.a.ymmmr$ a. ro b.o'E $bjcd ro rhc work6 mnpcMraon ln*r otcrlilomia dod leE rhd il I should hc<om subjcl lo ltt
<br />workm mop..sarkr prcvirio.s oasdion lr00 of ttu l,bor C.d., l stdl fonhwith.omlly *ilh llDs povisiDns..
<br />WARNINCT Flilur! r, $cuc work$r conlpcneri.n svcragc is ul,wrul rnd sh l subrer on cmrlorr to aiminal llcnlltis dd
<br />h ohc huidr.d rhox{tr dollrrr lSlfi).UX,,. in Dddirion n, rhc.oi of c.mFnstiotr, &tu8es as provided lot rhc
<br />Sc.'t,6 1076 otrh. Llhor Cod.. inrcE{ rnd 0rl.rfty\ lNs(2 Lt,,,.,r,-
<br />LICEISEI2IINIA CIOB
<br />DICLIarI.IION
<br />I hrrhr rflnnrrnd.r p.nrhyol p.rjury rhnr I an: l,.cnai undcr pn,!i\n)n olChi!r.r 9lconunckine $irh Sc(rion Ttroorol l)ivi\ion.r
<br />or rhc Bu\iDc\\ and I'rolt$i',nl Cod.. rnl n,t li..r\c i\ in tull li)r.. ul c lt.r
<br />I irn\.( h\\: l-i( \rNu rl*r
<br />q)llirB.ucltl)NLlrNDtN(i_dti[Nl.l
<br />I herchy arltm uMs lcnilryofFrjurylhlr rlrrc t a con(rud6n i.ndi!,A lscn y ri, rhc Frlnrtumc orrhc *ork loi shi.h rhi\ Nnnt is
<br />issucd (Sc. 1097. C1v C ).
<br />^uu$nLDLeL
<br />.SAllQI
<br />Il{trbtJllnnu .rJf, rl!yol rrJuryomof rhclnlk,$i',9d..lrrrri{rN
<br />I)cni)lniitr Pcnr{\ Anf,{o\ Norill! nr I.ctlcrrl Rcgulnrtnr lr(t,llr. Irid6i
<br />-Rcqunc,t
<br />I!d.rdl Ndii.Jri,,n
<br />lcrniayrhJi rhc l.il$rlrrguhrions r.!rdinStr\btnostu m!tr1 rr. hor nfp i,:rhlc b rhit lmjc.r
<br />-l
<br />ccnify rhor I hlvc rcad thh aldtorion {d stltc thar th. atovc infomlio. n cotur I aSre ro omlly *ith ,ll Cily od Counly
<br />ordimms dd srarc Lrw* el,li,e b huildi.B .onstrucrbo i,i h.rch, {urhoriz. EpEs,lalncs ollhn Ciryand Colnlyto ent6 upon r
<br />rlorc miomd popcny ror
<br />Appticsl or A&nl SiSnaturc:
<br />,,,.*,X.*,")2._u--
<br />P.o ,a <I A(q "^4r,..i
<br />7 t
<br />I
<br />II
<br />I
<br />Metal Fire Place
<br />Vents
<br />",,", 1//z/t7 ^-*,\ /b-
<br />l {"lr' lL' .
<br />I
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