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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER AUILDI]R DET-CAR{'I'ION
<br />I hcrch, ullt xtrdcr Fnrhy oa rcrury rhlr Iu!ciclnpr lioh rht C'(! rackm Licci\c Lrw r,tr rhc rolk,wing rcrsD r\rcTrll5
<br />Bu\nrss trol Pnlcssion Codc): A.y Cir, or CDUnty qhich equtes ! I]c nrir ro . n{tucr, rlicr. in{mvc. dcnnhh .r E$t Mv
<br />\rnrcru,c. rritr ro irs nsuncc. rko rcqutcslhc arDlicnrl fu such p$nir b ilc tr sisncd sratcmnl rhrt h. ur shc is liccnscd Pur\uanr
<br />b rh. pmristrr ofltr ConlBrtr'1Li.cns.d tiw (Chlprq 9. Comnrncing wirh Sc.rion 7fiXJ oi Divnn'n I ot rh. Dxincs and
<br />Pmfcsnnrs Codc) or rlllr t* or \hc hcrcnrfl Ihercriomand rhc l,rsi\ ror rhc allcgcd cxdnplion Any violrrionofsccrionT0.ll S hv rnv
<br />applicrnr li, dp.nnn suhj€rthc atnlicnnr b a(ivirpc.uhy.rior.ntrcrhan l-r!. hondr.d dollars (Ssm).
<br />I\Ll.J','trncrolrhcnr'Ndy.i{mrrilnli,yN\tr h tr l8c\ !\ lhcn y,b .o'nn r$r ion. will do lll sork ud rh. {fl.run il n,l
<br />'
<br />'nrcftlcd rr uficrc\l tor sL (sd 70.1-1. Busirrc$ und Pn,l(\sions C,rlc 'I'hc Co trrcrol s l-iccns t,rR dod nor lt,I,ly ro !n ordr of
<br />rhc pft,pcny whobuikl\orimp,'vcsrh.'dm.8ldwhddo.rsu.huudthinxcliorhcrkllorrhnnrShhkorhcro*nc nlovcc\.
<br />lk lidcd rhlr su.n impn,v.ntnr\ nE mr inr.nl!\l o, olltFd lbr el: ll h)$ttr. rh. hu rldine or ir9n,v.nrfl h sld I irhin ntu )t
<br />or $ lrlcri(r, rh. owncr lruillo Nill nlvc rrt hutlcn ol pmvirS rl h. or nr did ior buiU ot nrymrc rhc Is,Fny nn rhc Prrxc o,
<br />l.!sowmrofrhc!'mpcy.am.x.lusivclyconlrdinBwilhlian$dco.a.lo(loconstrucllhcpFj.d(Se.1O{4Bu\incs
<br />aod Eol$i.. Cdrh: Th. C.nlEcrors l.kcnse L,* des nol apPlyro !n own( ot lrf,p.fly who tuildror imlrovcs rh.rco..
<br />and who .ontncrs lor such tNieh wilh 0 ContB.Io(s) liccn*d psuor ro rho Conlr!.lols Li@ns trw).
<br />I o*,..L
<br />DECI.A8AUO!
<br />I heEby amrn und., Fnllry olpdjury om of lh€ following dechrrtions:
<br />-lhrvcud*ill
<br />Bnn i'r a Ccd ificdc oI Con\cnr h Scll ln\rrc nlr $ofkcn .onrFn\i nnr. \ liiJrd.d lor 6) Sccrnrn lTo0.frh.
<br />LlhtrCod..lhr|hc pcrnmr icdorrltwo lnr which rhc Pcrmil i\isNd
<br />-t havc lnd will nainroin qorkeK com0cns ion insurance.0s rcquircd bys€lion]700.1rhc tibor C.dc ior $c pqao.mncc oI
<br />rlE work for *hkh rhli F Nr Ls issucd. My workcr' onl.nortun insumNc curicr uid Flicy numh.r uc:
<br />lfll ccnify rhar in fic p.tror@tr. ollhc *ork for whkh lhh F.nir k hslcd, I shall ml cmoloyuy leMn in anv mlnE'q; arb b..nm subFr b Ur @rtc. 6nF.erDn hwq ofcahfomin, and aEm rhd ilI \tNld t cod qbl.lI to rlE
<br />qrkes oop€ns.lion pmvisions ofselion lT00oflnc kbor Cod..l !ll. fonhs h omllr *ilh ltoe Povlsior3..
<br />WARNING: F,ilurc ro scurc qo sr'smllcnsdn,n d,vcmg. is unhwlul. and shall subj.rl !n cmplortr ro dimin.lFrullts !trd
<br />cilil nnes ut lo onc hundEd lhousrnd dollus ($lm.om) in .ddnion ro thc corr ol com!.nsalion. dlmgcs as po!i'l'd for rhe
<br />Sdion 1076 ot lh. L!b{ C.nc. inl.Ef dd aromy s fes,
<br />-,",6\N1:ttl ^*o-,,x
<br />utENs[]LtoNrB tlotr
<br />Df,!IA&TI&N
<br />o, rltInrrm$ nl Polc!\iilN Culr. $d nry l(c \c1\irrlirlln&. ,l.rf!.r
<br />coNtralJcuaNIllDrNc.&iENct
<br />I hcnby d,tun undcr Fnrhyotpcrjrryrhar rhcrc i\ r otrslrucri{,n Lndins lgcn.y rrtr rhL ldlhxuncc orrhc worl iit,hici rhis l'.mit i!
<br />is{'.d (S( l097.Civ C ).
<br />trnd.i s Nam.
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<br />AUIT$NI.DEqLANAIIAtr
<br />Ilrnhyilnnutr d Fctrrlryoincrjuryoncof rhcfdbwintd.clir.rbns
<br />Dcnmlnn'n Permi's Asif,dos N.rilic.rion l:cdcr!l R(-qublions ('l'irl.4l). Prn6J
<br />tuqunrd trrl.r olNoriliulion
<br />I.Mirvlhd r M lcJcrtrl rcsulll ion\ re dnr!.sl*{.s rcmv0larc mr +rli.rhlcro rhis Pnjccl.
<br />-l
<br />ccniryrhnr I rhv. t,il Ihi! l,)tlicnli,,n ml srdc rltrr rhc{brc artunn ion is coBr. 1 4rc r, comfly wilh.ll Ciry an'l (butrrv
<br />ordinrmc\ itrd St,r. Lrss rchlinr ro huilding connrudion. ind hcrchrautlitrrc rcfrcsnrdn$ oirhi\ Ciryrnd Coutrrr ro cnrcr uB,' rhc
<br />rhrvc nrnrnnrd nopcny lor in\|xd
<br />Applicair o, Agcd SiBMtur+
<br />p*ir*n*r,inr,t ^",.J12? JAotl
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />NIisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />{oilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Ducl
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.Lo r11(8i.1,?)u l/
<br />Meter Release I ---_1-\
<br />FINAL .y \//fiAM p:4)
<br />Notes, Remarks, Etc.I U
<br />COMMENTS
<br />lr/etal Fire Place
<br />Other
<br />Final Test
<br />sl,O 1
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