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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BIJII,DT'I DEII:ARATIoN
<br />I hcrcby orrm undcr pcnslty of priury rfiat I am ercmpr liom rhc Co'n,acroB Liceose Law for rhc followinS @en (S.c.7oll5
<br />Busimss and Pmfession Co<Ic): An, Ciry o, Cou y rhich rcquircs a tEmi ro con*ocl, d, improrc. dcmlish or rcI'lt ay
<br />sl d@, Irior ro irs iisuu... olso Bquir.s th. .pllionr for $.h p.rni b nh a si8md sr .m rhlr lE or sh€ n li.in*d purser
<br />,6 rhc Fovirion! of th. Co turm\ Lic.red Ltw lchrprr 9. Comoerci.g wiu s.crion 7000 ol Divishn I of lhs Busiflcss and
<br />Pmf..sionr Cod.) or rnll hc or sh. k cxempr rlErchlm md rlE h&iis aor tllc lllcged .r.mprion. An, vhbion of Se.rb, 701! 5 by &y
<br />Dpplicair tor o p.rhir $hFck rhc rytlica $ dcivil pcmltyofnor rtuE rhln five hundrcd dollas ($JOo).
<br />I, os ownf of rh. p$Fny. o. my.nrrlolBs wi'h wagcs . hct $h mmp.nslior. will do lhc wort a lhc srtule n 6l
<br />inlcndcd or o,Icrcd aor sh (SN.7044. AusiEs, and Pmfcssions Codc: Ttc Co, Broii Li.cnc tra does @l appl, lo m own.. of
<br />th. ImFny wh. buikt! or iqmEs rh.6n. {rd aho dcs sh srk him*lr or trr.tror rhmugh hls .r h.r o*. cmlloyNs.
<br />lrovidcd rnd su.h importunls e ml inknncn or oficrcd lor sh lf. howri rhc blildins or i,lpolm nsk{ithinon.Fe
<br />of coq,llion. llE Owrcr Buildcr will hlt ltE ttrn o of lrcvir8 lhd nc or $c dii hr t{ild or i,qmvc di. poFty aor rhc Ptrrpoc or
<br />-1.
<br />os o*E of rh. ImFny. lm.xclusi!.ly conhdin8 *tn len*d conketoB lo on(d.l lh. I'oi.{l (Ss. 7044. BEituir
<br />lnd P,o,cssbn Codc: The Conrru.roli l.iccnsc Lap docs ior !!,rly ro d osnci of p,qicn, st. builds or inprcr.! rhcr.o..
<br />lnd who onlkls lor sucn !,oj.r3 wirh ! ConrEdo(3) liftn*dpu6lanr to thc Co Ecrols Ltcn$ ljw).
<br />-l
<br />ancrc.lPt undcr S.rl
<br />WOlr!(Ef\' COMPENSATION
<br />DIiCIAf,AIIA!
<br />I hcrcby afilrmund.r Fnaltyoip.rjuryonc oirhc followin8 d(tualiotrs:
<br />-r
<br />hrlc olnwill mri.llitr rCcnificalcofConscnr ro Sclllnsurc lor*orkss com0cn{lrn,tr. us pmvidcd rorbyserion lnnotrh.
<br />tilior Cdq rbr ihc pcrfonn.nrc ofihc *ork for shth lhc pcnn n issucd.
<br />I h!rc and will mrinilin work6 conp.os&rior insurancc, ,s rcqdE{ b, Setion 3700 of lh. tnbor Codc, for lhc pcaormtue of
<br />rhc vort for whi.h rhis pcmir is h$rd- My w6rks ompeneri.n insulMc tricr lrn loucy nlmh.r 4c:
<br />-l
<br />anify rh ir lhe ,,crformrce ol rhe worl for *hich rfiis pcrmir is iss&d, I shall nor cnfloy my p.rs. i. any mnncr
<br />"' N r. bccoft {uhtcd lo rhc wo.l.B c\nnp€rs,rk o ldws ot CrliLmi.. nnd dBmc lh,l ir I should tErom slhrcl lo llt
<br />workcr'conqaosdrionpmvir,om.rSccrionlT{)OorrlELahnCod.,lsh,ll.ionhwith.omplywilhlnospmvisions..
<br />WARNING: FailuE to sue sorkcfi s,qE.salion covcdgc is lnhwful, !d sn0ll subrc.r u ctrllrloycr to rin!.01 Fnslii* and
<br />.ivil finca up ro oru hundEn rhousnd dolltrs (Sl0o. )0). in .ddiln'n h rhc cost of comtcnerion, d!tu3cs 3r phridcd ror rhc
<br />Sarion 10?6olrhc t bor Codc. intcEsl atrd onomy\ iccs.
<br />o.*,- 7-t0'll n
<br />L(r} NsF:t) ('()N I',R\c',r(rR
<br />DIiIL${IIAN
<br />ot rhc ln'\i'rc\\ x0d ltolc\si,tr,\ CnJc- rxl my li.cnsr n in lL'llli)'rcrod o,tc.r
<br />t /07171)
<br />?-l
<br />CoNSTRTJ(:T(IN I
<br />'NDIN(;
<br /> (:I-NCY
<br />Iud (se l(D7. civ c r
<br />A.ITIJCANLDECI,A.BAUON
<br />I lxid,y finuu ncrn nilrvol|{riuryoNoIl[cnnlosirxdcchrdion\:
<br />Dcnmlirion Pc'n,ir\ A\h.{o\ Norifi.ari(B Fcd. l RcguhiidN rl irlr 10. Prn6)
<br />Rcquncd Lcur oaNrhii.rri(
<br />-,
<br />ccrrilt rhul I hnvc Eld rnis r,plicrrion lrd n.rc rhor rhc !t k inforrotion n .orer. I ag@ ro d,mtly wirh all Cny ond Counry
<br />.iilindnc.s and surc lf,ws rcldi'rt k, huildi cotrsru.rnr. rkl hctoby rlmri^lcltcrnrJiivcsofthisCilyondCouDlyloenlcrutonrhc
<br />rhr. Dr i,rrd pn)Ptny for ii\txrri(,r
<br />Atllicnnl or AB!nr Signort *,", a 19-10
<br />Appliances
<br />tvletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipmenl
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Bough Mech.
<br />Final Test
<br />Meter Release I
<br />FINAL /o/n ltf 2M ,r)
<br />Notes, Remarks, Etc.T-/
<br />-+
<br />D.le: Osncr
<br />- G/ta
<br />-l
<br />coliayrh rhe lc{crul rqllarions EsdrdinB asltsr$ r.fr,lal arc &r amlic$L ro rhlc pm.iccr
<br />Pcrmirce nurm trinrt:E
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