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MECHANICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS (r\\ NtiR tl ILI iIt I)1.:L( ,\R,\ ()N
<br />I lErcby lmrm undcr p.nlhy of IEiury lhal I m .rcmlr 6om llE C,nlBcros Ltcn* Lia for lh. followi.8 rcsn (Se.70,t.5
<br />Blsincs and kofcssion Codc): Ant Ciry or Colir, ehich rcqlirs a lDnl ro @niro.t olrq. inpmrc. dcmllsh or E|,!n e:i
<br />sElcruc. rir. ro ns i5suec, al6 rclluiE. rh. applicar for ruch Fmil ro 6h r siS*d sltrlcnEnt lhor lr or shc L! licen{d plsua
<br />ro rlE pmvhioN of rhc Contrrcror's Liccn*d Law (Chrprcr 9. Commcn.ing sirh Se.ioo 7000 of Divhion 3 oflhc Busincss and
<br />Prcfcsstuns Codc) or thrl h. o, shc h cropt rhcrcfron rnd rhc barh for rhc lucged cxcnq,lion. ant vioblionofSclion ?011.5 by !n,
<br />{pli.a for a pcmtir iubjcc rh. .rplicanl lo a civil pcnal'y or.ol mm thm fiv. hufldrcd dolla* (t500).
<br />,1. .s owrcr of lh. ImFrrt, or my chplo)Es wirh *!ges * rhct sle comp€n$tion. sill do lne sot old $. n4lw t ret
<br />i enH or oflcrcd for slc (S6.7OU. B8inc* and Phf.ssio.s Cod.: Thc Conra.tor* Lkcns l:w docs not q,!ly lo m o*ncr of
<br />rhe pmpcny who brildg or inpmB dEmr !d eho d(E sh *r,k himFlf or ncrslf or ltm!8h hh or ln own cnplolci.
<br />rori.lcd rhat su.h inqmEmnrs @ mr hrcnded or off.Et for sk. lf. iosl€. rhc tiiiHing or idprftmm h sld qdl n om )rr
<br />ofotrpLrioc rl* olrrcr Boittr sill Mr rhc t{rdd of,r"!in8 rhar nc or dr dil mr hild q inqEB dc lop.ny 16r rtr prpos or
<br />_1. nr .sB of rhc t opcny, dn .iclusiv.ly conb&ring sirh li.cn*d .o.lrEIoR r. onsrMr tl* ,,mj.!t (56. 7044, Bu\ierc
<br />ad horcssbn Codcr Thc ContEctols Lic€nsc tiw docs nol npply to an own( oflropcny wh. builds or imp.orcs th.r.on.
<br />dnd wh. convdcrs for .!ch pmjcck with r Conh.b(s) li.cn*d pDBu.r ro lhc Conrrdols Li.cns L!*).
<br />-l
<br />umcxcmfl un<lcr S6rhn- B. & P.C. tor rhh Eason
<br />W(TRXERS'CO PFNSATTON
<br />IIICI,A8AIION
<br />I hcr.by lffirm !.dcr,.nslry of pcrjury onc olth€ folbwiq dccLr ions:
<br />_l harc .td will mi.rdn tr CanilEtrr. of Congr to Sdf-lcE for srlGl conpcnsdion, B povidcd for by S.crion 3700 ol rlE
<br />L!b.r Codc. for rh. perfolrl1lM ol rhc sok for which rhc pernh B isu.d,
<br />-l haw and will mlinlain wortd' .onFns.liotr insune, s EqliEd by S..lion l?00 oflh. tjlor Codc. fo. dE Ffqlrc of
<br />lh. mtt fs vtbt lhj. Fmn is L!$ed. My sort6 or4.Nlion inseM 6icr &d lDlkt nuhbcr el
<br />..*. 'S,lalr Frrrl
<br />2t l1(7 5
<br />-l
<br />c.nify rhut in rhc pcrlormtrcc ol lh€ work lor which lhis pcrmil k issued. I shall noi cnplo, an, Fho( in,ny mnmr
<br />s s
<br />'o
<br />tEcoe slbj(r to rhc sol}6r @n{Enqrion h$ of CrlitoEi& and .8m rhd if I snould h.ronrc subjd lo lhc
<br />*ortsl comiEnsli,n pmrisn,nr of Sc.rioo l?00 ol rhc Llbor Gne. I shnll, fonhwith mnDly wirh tho$ pmvisions..
<br />WARNIN(;: Fiilurc tu *curr workcr' conrr.nsariotr covctuBc is unli*ful. nnd shall subjr{l cm0lo)tr lo aininrl tcuxis dd
<br />.ivil i.cc up ro onc hutrdBl rnousu.d doll,tr ($lOO o, comptn\rrt,n. d4Egcs d\ ptuvidcd fn rh.
<br />ser ion 1076 ql rhc lfhor C.dc. inr.rcd rnd
<br />-,., -{lroltq, A
<br />I ucEJs]iLct NrS,ilrots
<br />l)l (1 ,\RA IroN
<br />I hcrhy afiirmundcr prnllty oI Fljurr rhar I rm licened lndcr pmvtbn orChatrcr 9 (.onnrftii8 wnh S.clirr 7m0) ofDivisn,n l
<br />ot rhL Bu{i cs*mJ Pmicssions Codc. d ryliccnsc ir in full ltre and clllct.
<br />t0tlqbu
<br />C
<br />I h.ehy rliirn undcr FnrkyofFrjuryrhol rhcre h r con(ruclion lcndi.s aEcnc, rd rh. pdronmncc ollhc aort lor qhich lhis I,.tnril is
<br />i\\ucd (S.. :1097. Ci!. C )
<br />AITLICANLIJEjjLABTIIAN
<br />I lmhydltDundcr |En!lryor ri.rjury onc otrhc lbllosinx dcclxBrtb
<br />D.nx,lin,n P.nnir*Aib.{.s Noriicdlion Fcdcfll Rc8uhrnrs ( r[t 40, Prn6)
<br />Rcquncd lIrr$ of Notifi carion
<br />I.cdilyrhar lhc rcd.r,lrcgulalioN rcEdin8 NtE(.s rcmov0llrc not 0!rliclhlc ro lhh rmFr
<br />)Cl ccniry rh&r I have rcln rhn amli.arion dnd srarc rnar rh. ah,v. inrrmu{idr is.oRcl.I r8rc l. conrrlyq harrcirya.dcolnry
<br />ordinrnccs and shlc t-'rs elr ro buildinS conshcriotr alrd lErcby duh..ie rcpr*nr{rivci ot lhii Ciry &d Counly lo cntcr upotr tic
<br />lbovc mmiodd pmFrry
<br />Arplkdl or Ag..l Si8ui
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<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 i Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Fire Damper
<br />Openings
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.f/rz-/ts i\3$
<br />Final Test
<br />Meter Release
<br />FINAL l/lX/r,t AKd
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Furnace
<br />Grease Duct
<br />lnstallation
<br />krdcii Nam.
<br />-
<br />"*, <Jaol rt
<br />I
<br />I
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