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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNER Irtrtt,I)ER t,lil-clRAl toN <br />I hcrchv rlnnn unrlcr prDrlry,rl !.rjry rl r I nnr e(.nu [on] rhc (bnrrJ.n6 l i..tr\. ll* ,nr rh. t,ll(Ni'rs rcr{ lsc.70.11 s <br />pnli.rtrr tur {rcnnilsuhj$r\lhc rt,tlicrnlk) civillEtrxlryol r(, nnElhrn llvc hur r.(lilollrr\($50(r) <br />-1. <br />3s owNr .rrh. preIrny, or ny .Dplorrs wirh w.B.s rs .h.ir slc omp.nslion. *ill do tlE wtrk ud llE slrEl@ is tul <br />inloicd or ofcEd for slc (56.7044. Busincs lnd Pror.ssions Cod.: Thc Conrracroas Lien* Lle d.Ds nor opply lo e ow*r ol <br />lh. pmllny sho hilds., iqmE tE6.. ond who dm. sh {o* haos.lr or hcNlf or lhr.ugh hir or hd own cmployccs. <br />provid.d Ind such itrlNtmnlsN ml h'cnd.dorolreEd forsL.lt ho@rr.lh.ltuiui4 or nqhtm n$HenhinoE,te <br />ofcolpbliotr tlr Osftr Bui*tr will haw llt hdo ofFovi.g ur h.dshcdilml tlild or in{mE lnc ImFny for ltt plrlhe ol <br />-1. <br />rsow.of <br />'h. tmlcny, rmcxchsivclymtrlraclinS wnh kcnscd conlmcim lo onstIlct lhc prorcl (Scc.7O!1. Buritus <br />Md A.ission Codc:Ihc Conrrekr's Licc.r Law docs Nr anply ro !o oanfi orpDp.ny who huilds or improvcs thcrcon, <br />6nd who onrmcls for such pn,ifls $irfi a Co mto(9 licenscd puBuanr ro rnc Clntacror'$ I.iocos t s). <br />I! ckmDl u lcrh{trcL,B.&P.C lor thi. rc!$n <br />ua8f,E&i:cqM@sAla! <br />DECLAAAIIT}N <br />I bcr.by rrfirm u.dcr Fnllry .f p6j! ry one of th. follo w ine d.c lqll ions: <br />-l <br />ha* oid *ill minrsin a C€niftatc of Consnt ro S.lf- lnsurc for mrk.G oryEnslrion. a lftvid.d for b, Serio. l70O of rh. <br />rjbn Codc. lor lth pcrtbmm. of lh. sut aor which lhc permir h issu.d. <br />-l <br />havc and willmainrain sortcd compcnsarion iosurrncc. !s rcqlncd by SNrion l?u) ofrhc tnb.r Cbdc. rot th. r(lfoirErc. of <br />i1r_&1 lnc.ft <br />t? <br />_l..ditrlhd in rhe p(Iomrmc ol rh€ wort tir whi.hrhkpcrnn ir iqsu.d.l sh.ll ml cmployonypcMn ir rfly.Mmr <br />s N ro trrom subj.ll lo lhc wutcs' conrrc.stion h*s of Califohi!, a !8N lfial if I snolB b.om iuhiccrl. rh <br />work.( ompcnsorion pmvisionsofScction 3?0tlof thc L3t[r Codc.I shall. fontvirhoq,l, wirh rhos pmehions.. <br />WARNIN(; Ixilurc h {c!rc slrkcis .. rFn\Jrion cot.ngr <br />.'n'l firc\ uf h. ,'r. hdnJrcd rhutrlJ J JolLr\ '!lr)o,flvr',sc.r )i 1076ul ihr li}x <br />Itl A <br />\c /t4 <br />I <br />DXlll3NT,IJ:i <br />I hcrc$y nfatrnr undcr pcnully of p.rjury thal I am licensd lndcr prcvision ofChlpler 9(.onfttuiis snh Sccriln 7000) olDivision I <br />oa rhc Btrsirc*n.d Prorissions Codc. and myliccnF h ir tull <br />€,29 Cto O <br />O <br />I hcrchyrfitnrundcr p.ntrlrynlrrjuryrhir lhcrc isicotrsrucri.n lcnJir8 r8crc,Ior lhc nc.tolnun c orrhc <br />i*ucd rs.c 1097 Civ C I <br />I enify rhd rh. lcncol rcgullriotrs <br />l.cdilyrhir I hrvc Md rhisrlfl rocomFlywirh all ciryrnd counry <br />ddi r.! x rlSrr.l.r\'\ nlr!otrhis Cnt and Counryro.trrs upon lh. <br />nh,vr nf, ri,rrd prcnrny ir *"14L <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 />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL ^\-\s l-lx4t\.i <br />Notes, Remarks, Etc. <br />Grease Duct <br />Above Hard Lid <br />bnd.ar Addrc$rpprlr:ir,rinpiili,rirnn= <br />I ln$y imnn undcr pctrllry oipcrjury onc n,lhc lolkwin8 dccl,r0rhns: <br />Dcnmliliofl PcnnirrAsbc{o\ NorificiinD Fcdcrul Rc8uhti()nr(litlc 40, Pdn6) <br />R.qtrtcd lxircr o, NorifMrbn