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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OlVNER IIUIt,DER DEI,CATATION
<br />I h.r.hy rrftnr xndcr r.rilly of p.riury rhrr I urcicnrnr ls,nr rhc (i ri.Mf LNn* lj{ rbr rhc Inlbwirs ren$n lscc70ll5
<br />Btr\inc\\ snJ Pn,r'cs\n,n C,xl.) Any Cir! or Counry qhi.h rL\tunc\ a pcrnrir ro conslrucr. llrcr, intiR,vc, dcmohsh d rFw iny
<br />srru.nrc. tior lo n\ nflmnc.. ah. rcqutcs rhc lpIliclnr li,r such Fnnir h fiL a sEtrL{ qrrcnE t rhd l[ or thc i\ liccn\cJ l!trsdr r
<br />h rhc l(rnn,n\ ol rh. Co.tr.tn s Liccn* tis (Chlflcr 9. C.nnncmirg +irh Sccrn,n ?(X)0 ofDivnion:1oflhc au\incs onn
<br />Pn,fcs\irn\codoorthnrltrorlhei\cxcn'pllhdltionrlnnlhchr\isi,,rhcrllcscdcx.nDrn.AtrrviolntinnofS$ri)n70ll5bruy
<br />aptli.rnr tur . Itr nnit $hjccts rlE qrpliclor x' a cilil ptonlry of Nr nirc rhM fiv. htr trdrcd doll,m l$5m)
<br />_1. !\ ow*. of rhc pmFny. or ry enploFs wnh wags 6 rtut $h onrlEnrariot, ,ill do llt wo* t d ltE sn!@ i, ml
<br />inlctu d or .frscd for $lc (Se.?044, Busircss ud ftofcssions Codc: Th. Conrradol. I-icn* t v dcs mt q'ply lo an o{nd of
<br />ih.IoIEny who buil6 or inpows th.61 dd *rb ddi lEh mrk himr.lf or hcrElf or lhmuBh his or hc. oen cmplolms.
<br />providcd rtar such impmEmnr3 @ er i.roldcd or o,rcrcn for sk lf. ,r,{cffi, tlE hoiHin8 or in9(Emnl h sld *irhin oft ,l.r
<br />ofconiplcrhn. th. Owncr Buitlcr qill hlr rl8 budcn Dfl,lviiB rhd lE o. BIE dki mt hiiu or in{mw
<br />'c
<br />popdly for thc purl.s .l
<br />l. 0s owrr of rh. pmFiy, am crclusirly €onnering virh liccflrd con|.lcroF io o.iroc lE pmirl (SN. 7044, Busirrcs
<br />!d Ant ssion Codg Thc Conrn.roas Liccnsc hs dc n6r ipply r. !nown4 ofpmpcnysho builds or imlov.s rhcrco..
<br />snd vlx, onlmcrs for such pmi,c with a Contmcro(O licctr$d p!d!.r ro rh. Conu(ror's Liccns kw).
<br />I ancrcmDlunds Sccriotr .B & PC. farlhn rer.nn
<br />uoBrESs:llJllPjgtaroN
<br />DECI.AAAIrcN
<br />I h.rcby 0fttm undc! Fnahy of pciory one of lh€ folloqing ddLotionsr
<br />I hrv. rnluilltrrirn h i Cenillculc .l Constrl k) Scll ltrsur c lrt qo.kcN onilcr\rri{nr, \ t,ovidcdtrb,Scclbr.17(x)oilht
<br />ll}xr Codr- for rhc p.rformrnc. ofrhr wo& f{tr sh'ch rht t^..nnir n i\sucd
<br />I h,v. r.d will m,inuin wortcN compcnsatioa insurancc, as rciuncd hrS.clion 3700.frhc tlhor Codc. for rhc l)crlomrcc of
<br />lh. wor* fttr vhich rhis l.mil is issEi My worlcB co'ry.nsd ion inslEie cariet !d policy nnmb.r a.l
<br />a)rrlt E," )
<br />t4'qLllrs a
<br />_l ccnafy rhlr in rhc pcrformm of lhc work for whLh rhis pcrmil is issu.d,I shlll not en{,hyanyll.iion in tny mnmt
<br />$ ns io trmm subFct ro rhc wortcd ohpcn$rion lows of Crliaomia. and asdc rh,r if I should bc.om subi{l lo ttf,
<br />wo*cB .onF.sation povhions of Sc.lion l7m of thc L.hor Code. I duu. tbnh*irh .omply wnn Ihoe povnions..
<br />WARNING: Failnn lo sm *orkcs mmp.nslion .ovcagc is !tr1o{iul- lnd shlll rtrbF.r rn ..{,loyf ro dininrl iEulti.s and
<br />.ivil fin* !p ro orc hudrcd lhousnd dollors (SIoo.O(i). in addilion lo rh. orl otcomp..srion, d.mecs as pmlidct for lh.
<br />a 3l)
<br />ucElslDioNrtaqa,x. DECI,AIAIIIIN
<br />I h.nb, antn undcr Fn rofpctjurylhal I m lie.st undcr 0nrisionoIChatrr9(conlnxncin8 with Sdion 7l)OO) ofDirisioi:l
<br />or {hc au\irc3s dnd Pn,rc$ions Codc, ond my liccnsc is nr tull rbre and c,Ifr
<br />IDl115b
<br />*6r
<br />calSIBlC INII;NIUNG:ICEN(I
<br />Ihcrcbyrllttrrundcrpcn0lr)olNr.,rrlhxrrhcrch!.-n$tucri,nlcndinat8.n.yror'h.Frfonmrceofrhcworkri,rshichrhisFnniris
<br />nsDd (S.c .1097, Civ. C.)
<br />A.TTLI(ANLDIICLASATq!
<br />IlrE$ytrfinru.ncr pcnalry ofrErj!r, o0c orrhc aolk,wins dcclrarn,n\:
<br />Dcnmlirnr Pcnnirs A\hcdo\ Norifi..rion lr.dcrnlRcsuldions (Iillc 10. !'M6)
<br />Rcquircd trncr of Norifi .ariotr
<br />l.cdilithd rhc lcdc rll rcgu lal ions rcsu.dins *h.sx^ r.flr)lal urd ndrrmli.dblcro rhis tmjccr
<br />-[lccnifyrhar I hlve r.ad rht appli..ri.n md s,r.rhrt r ivc inro.nNFn $ omcl Iasrerofl]nDl,w hdll(lr
<br />ordiwEcs alld Sr,rc tiws rel,riry to 6! ildi E|f.sc ariv.s of rhk City and Cou.ty
<br />lhovc mntn,ncd pnp€ny for
<br />X/:o lw
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Ir/isc. 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 Ranqe
<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 />Rouqh Mech.7/e4/M 'ibqa
<br />Final Test
<br />Meter Release
<br />FINAL 4/L7/ tv ,(\rq
<br />Notes, Remarks, Etc.I
<br />1-
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<br />t-=-
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