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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DET DELCARATION
<br />I h.Eby .rrm utuLr p.nally of IE jury ltal I m .x.nFl fiDo llE ConrrmroF Ltens kw for thc folb*in8 lwf 64.70:11.5
<br />Blsimss ad Pmfesion Code): A.y Cny ot Courlt uhkh Eqlies . FnDr lo.onnEd. alts. in!'mw. dcmlhh or rnrn dy
<br />sm.lrB, prbr ro irs hsldcc. aho requnB rhc lprlicul for sEh lErmil lo filc s si8rcd slal€mnl thtl lE or ihc b lic.n{d l,usu !
<br />ro,hc prcvisions of$. Conlreloas Liccnsd l,w (Cfiaptr 9, Comcncine wirh Section 7l)OO ol Divishn 3 oflhc Busincsi dd
<br />PmfcssionsCod.) orllEt hc orshc is ci€mpl rhcrcioddd rh. basn lor rhc ullcgcn cxcq,ltn. Any viol ionofsetion70ll.t br rny
<br />apoli.lir tor ! ,.mir subjdls rhc oorli.aor ro a .ival p.ralt, ol oor mrc rhln fiv. hudrcd dolla6 {t500),
<br />,1, as own.r of tlE FDFny. or ny.q,toy&s wnh *sg* * rh.n $le onlEr!.riotr wil &r dE so* .,n dE rtud@ is mr
<br />irrdncd or otu aor slc (Se.704.1. BBih$ .nd PefslioB tuc Th. C,nlmcloas Lie.s L.s &ri d am,ly to d ovrcr of
<br />lhc poltriy who hiills G inrpoB rltetr !d Btb dc tufi sd himclr o. h.r*llor tlmqh tk d hE own .opkrrds.
<br />pbvid.d rhal $ch inDormnrs @ ml t'lcndcd orofrcEd for sL. lf. hoqq. tlE t{ildirS or i,prcrcmnl is sld snhin orc t@
<br />of.omphtion. rhe Oem, Aliko will h{k 0r hdc. of p,sving th,lhcor snc did mt t iU or iqmve Ur IiF Ety for th. lurlxB of
<br />-1,
<br />as owner ot ftc popcnr. ffi crcluriwly conlrdin8 *ilh licorrd conlmclo6 lo con$tucr rlE prolrl (se. 7oir4, Au$rc$
<br />and PDftssih C{dc: Thc Coihcroa s Lie.* Llw d@s mr omly to an owncr ol [mFcny vho blilds or in Dw3 th.ron,
<br />dnd {ho @or@B lor $cn f,ot{s wirh s C,nhcro(, ltcnEn I'lFuor ro rh. Cooll-aci 's Lic..s Lw).
<br />Lm crcmD! undcr seron . A. & P.C. for rhN rca\c.
<br />iry(lr(ins' coMPENSATl(rN
<br />IIECI.AXAIION
<br />I hcchy .flirn under p.nrlry .f ,djury om of ltE folk,winS d..lamlions:
<br />-lhlvca
<br />tr ill roinrlin a Ccn iu.nr. of con$trr tu s.li lnsurc ao! Eolkcn coryEnsrio., a\ Jrevid.d tnr bt sstion :l7tn oi rh.
<br />tibor c'odc. ,or llE lrrlbrmuE ol rhc *ork fo! qhi(h rhc F.n'i i\ nsucd
<br />_l htrlc lnd *illmainrain woilcN compcnsarion ihuranc., as r.qunld by Scctnrn 3?00oflle khorCodc.lo,lh. p.afo umcof
<br />whth rhis pcnnir is ksuL{ My workfts nr$nNc clFi.r ntrd F,lic, nufrbcr a.l
<br />l.cdiarrhar inrhcrcrlornEnccoflhcwort *hich rhh Dcrh h niucd, I rh,ll nor cmploy lny ttc6on in any @ntu,
<br />so sIo trcom slhrcrr ro rhc wolkd{ onwniirion laqi olc.lia6mia, ahd aBN lhBl ifI should t com suhirr lo.l*
<br />workcs'comtcnsalionpn,vistn{ofSc.rionlT0Ootrh.LuhtrC(dc,lsh.ll.nrnhrithconrlysi
<br />WAnNINC Faiturc lo wurc *rrkc6 conFosarhn
<br />.ivil fincs ut ro onc hutrdrcn lhousnd dollss ($l dtrms* a. pr6rid.d hx !h.iljfr
<br />ucl:! DtoNtMl)a
<br />DICLAAAUOI
<br />4- (O (1c 1) I
<br />I]O!$f,ICUQ!IDNDINGSGE!.q
<br />I hcrcby aoirm undcr Fnllr, of pcrju,y lhd th.rc h a .o.s!rudbn b.dirg agcmy for ltF FrforNrc of lfic hrk for {hhh rhk p.rnir k
<br />issucd (S(. 1097. Civ. C.).
<br />AEUlANfDrcIrlSU!.)ti
<br />I lrrchrunhrundcr pcn{ky olprrjury onc ofrhe rollosins dccllBrn,n\.
<br />frcnxnirt,i Pcrnrils A\b.{o{ Norifi.arioi Fcdcrrl R.SuldidF (Tirlc,l0. Pina)
<br />R.qrircd larrf of N.rifi.di n
<br />-l
<br />ccnify rhal rhc ltdcrl rcsrhlb!\
<br />I ccn'lirh r lhrl. rcrdrhi( nDpl i\.onc.r I n!rcc t,.ondt wirh dllCiryrnd Coutrry
<br />o inunc€s und Surc Llwr
<br />8h)!c nE.rioncd pmFny
<br />L.,rt
<br />,:.JWffi-
<br />Appliances
<br />lvletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />l\4isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh 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 />Rough Mech.
<br />Final Tesl
<br />Meter Release
<br />FINAL 4ttr>hfi\^^roAl ar4 )
<br />Notes, Remarks, Etc a I l t\
<br />l)rt.:- Ovncr:
<br />I hcEby lirtrn undcr penalty of F..jury !ha! I am liensd undcr lovision ofch,pls , (mftmin8 *ilh Scdion 7000) of Divition 3
<br />or $. Busircs md Pmfcssions Codc. !d my lkcns k in liill foc ed cll.d.
<br />L.ndrl A.ldF$:
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