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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DELCARATION
<br />I h.rcby .tfrn uido t elty of pc{ury rhd I d .rcopt fion rlE Conr*bR Lirn* trs for 0E fotJwi.g G&en (Se.?O31.5
<br />BuliNs rd Pof.$io. Codc)i A.y Ciry or Cou y ehth r.quiEs . Fmn ro @dM, all6, iq,row. .hmlnh or Ep8tr uy
<br />sLu.rlE pritr ro ic issurc. llso r.auircr th. lpplicot for su.h Fmir lo filc . si8r.d sral.mtrl thd Ir or rh. i! lkoed pumur
<br />to rh. pmvisions of rtE Cinlmrd\ Liccn$d trw (Chlpr6 9. ConmEing wnh Sction ?m0 of Divisnr 3 of rh. BBiocss 6d
<br />Pmf.ssions Cod!) or lhar lE or sl* is crcflU rlrcrcfmm !d rlE b€sis for rh. rllcgd d.nprion. Any tkJhrion of S6rb. 70! 1.5 by ey
<br />applicafl lor a l,emi slbjcr thc applicdnr lo s civil pcn6hy of nor mr rh.n ,lr hlndEd dollus ($500),
<br />-1.
<br />os owncr ofln prclcny, or m, .mphrrcs wilh wa8.s {s rhcir ek @mp.nsalion. wil do tE wo* orn dt srarw i\ nol
<br />inlmtu or off.r.d aor sk (Sa.7044, Busircss ond Profcssions Codc: Tto Co.rr0clols Liccns L.* &cs not a! y ro owncr oI
<br />th. pDFdy wlb hrillr or iftprtB E6n. and *lr d6 fth ur hifrrcltor hcrslfo. rhmuSh hk orh.r own.mployecs-
<br />!,ovidcd rhal slch impmwmnls m ml i edcd n oficEd aor slc. lt lFw\u lhc t{ildine c inpt$Emfl i! sx wnhi, om l€i
<br />of complcrion, 0E Ovnc. Builtu wiu tgB
<br />'lE
<br />t rd.. ollmviit ihal lE or rh. did d b'rild or i,prDw dE Fotsly ld llE I'orPos of
<br />-l,
<br />as owrer of lhe pmp.ny. 3m crchsivcly conlrEl in8 wirn liccn*i conlreloB to con(rucl lhe lmj.cl (Ss. 7et4. B!\ines
<br />.nd Bbli$bn Codcr Thc Cd.ktrcioal Lkcnrc Law dcr nor Eiply ro rn .un.r or p.oFny who builds or improv.s lhcrcon.
<br />and *ho co mcls for sEh l,orccrs wirh 3 cor racto{t lien*n l,uslanr to de conttucrols Lirn* L,w)
<br />l ncxcnr trndcr Sccli, .a &P( ijrrhirrcr\.n
<br />raf,rEf,s:(aMt0sArl0!
<br />DESdAAIIII!
<br />I hcicby ltfirn undcr pcnally of pdiury orc ot llE aollowi,s dRld!|ioN:
<br />-l
<br />hlw &n will mi.l.i. a Ccflifr.l.of Cooc ro S.la-lNlE for *dI6 onFnera6n. as provklcd lor by Selion 3rm of ltf,
<br />L.tor Codc, for lh€ Frfctrm of th. *orl for shich lh€ Fmil is hsucd.
<br />I h.vc aM will @inlain worl.s comF.s.rion insu,Nrce. d! eqlircd by srrio,37{)0 ofdE rjhor Cad.. for lh. pc,{omme of
<br />ric work aor which Ois p.mit is hsql My workgc .oq)clsrion insumc c..ftr d poliy nuober m:
<br />I f\
<br />-l
<br />anifylhat hrhcpcdbrrorcof lhcw.rt for rhi.nihis pcflnn is issu.d,I shlll not cmphy any tccon in any nu..cr
<br />s a h tsom slbiecl ro rhc w6rlN conFnsrion lasr of C.liaodia, 6od lgrc rtur if I should heim subj..r b ltE
<br />worlc* @ntcn\alion lDvisions 6tSccrion l7(x) oa rhc Lrb Codc.I sh,ll. ronhwirh.rmply wirh lths povitioN..
<br />WARNINGT Fuilurc rD su. qork r' conF.sar
<br />civil lio.s un lo om tundr.n rh.usnd dollus ($
<br />ion covcrugc i\ rtrlawtul, ind shrll loytr ro siminul Felll\ ad
<br />s{rion 1076 olrh. Iltrr C&1.. i.rcrc{
<br />D.,.: 4'c{-(Z
<br />Llt;ENS[D!0!r&tqr0B
<br />PECIABd-IIQN
<br />I h.Er,y !!tnn ondcr FnalryolFrjury thd I ad lienEd lndq pmll\ion orchnprd 9(cdnmn.ing virh sNtt n 7fixJ) olDivision l
<br />of llrc blsim$ Md Prcfesions Codc. ud my liccnrc h in lull fora sd c,Iccr.
<br />c 72?)i5+-'l ^t6
<br />(ANSIBIJCIIAN.LENDIiiTi.AG.EN.gI
<br />I hcrot'y rltnnrrndcr Ilnrlryorl.rjurt rhdr rhm is r conntudi{,n lcndins a!.,ry lnr rh. Nrtofltun.c orrh. s.rk lor w[ich rtn I'cnnit h
<br />i\suc lSc.. :loe?. Civ. C )
<br />-l
<br />ccniirrhn l havcrcad rfiisapplicarion&d slarcrh lhcltnrc inlbrmt I ase ro co'npl, *nhdllCiryrid Cou.ry
<br />rriles ofrtisCny and Counryro enlo xlb. rtEodinomcs and Srorc tjws rcl,rin8 ro buildins con
<br />lbovr mnliomd proFfly 'q-q,'/8
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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 />Meter Release I I \
<br />FINAL /n lu ll{ .1M qr\
<br />Notes, Remarks, Etc. 1 ,, - -f-
<br />ID/SIG.
<br />Duct Work
<br />Other
<br />Final Test
<br />D.te: Okner:
<br />AIELICANLDECIAAAII()!
<br />llrrhyrflnmu dcrpcnrlryof prluryoicolrhclallo{inEdcclnrnrnnN:
<br />l).nn,liri,nr l,cirnirlAshcsos N.rifi.rri{nr l,c(lcril R.ruhtnm\ arirlc 40. P n6r
<br />R.qtrtr d l-crrfi of N.!fi.di(
<br />I .cnify rhd lh. Lldcral eluhrions 6g&lin8 6b.nos ,.mvd dc nor appltubl. h rhis pmirt
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