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MECHANICAL-INSPECTOR RECORD <br />DATE tD/stG.COMMENTS <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 4"1q"1 YMI-\I \ <br />U <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />6-L't"t1Rough Mech.v-u*t\ <br />Final Test <br />Meter Release <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCARATTON <br />I hdcby aflim u(td poaty of pdjuy thal I m q.mfl fron t Contn.roB Ucens. Ls* aor th. follo{i,8 r.en (Sa.7oll.t <br />BBiis and Proleioi Codc): Any Ciry o. Cooiry whcn rcqutE ! Finit lo on$tuct altd, iEprov., ddrolish or rq.i &y <br />sttucruc. prior ro irs i$u@., ,to r.qutd lhc appLicmt for $ch pd n to fih . sigol sld.ffil rnal h. or sh. b lim.d P@ot <br />lo rhe povisioN of t Conlrlclr! Licn*d Lrw (Cluprs 9. con'ndcins wirh sdiion ?000 of Divsion I of thc BNiDs ad I <br />Pofsions Codc) or lhrl h. m lhc i! dchd rha.ftom ed ln h6i! for lh. allcg.d.xo!pli@ Ary violalior ofsdion 70ll.t b, e, <br />applicet lor a pdh subjdrs thc 6ppli@r ro a .ivil pciahy ol lor mc rte r,ec nun&.d doud (5500). <br />-1. <br />6 oM6 of thc ,rolEry, o, o, @plow6 wnh wa86 s lh.t sL comFaalio'! trill do $. @rt dd fi. qrulr b nol <br />inr..d.d or otrccd for rsl. (58.7044. B6ine ed ProfdioG Cod.: Th. Conl[clors Lk.@ L!* do6 rct tpply lo & ouq or <br />lh. popdy who hddr or impmvB rlEor &d wbo d6 sch srt limsllor nGllor thrcush hi3 or hd oM mPloyc <br />prolid.rl rhar such inDro!€6l! e rcr nllad€d orolIdld fo. s"l. l( howwd.lh. hoilding o. ioprc\@l b eld wilhi. on. y@ <br />ofo'trpkion rn 0*16 Buildr. wil h6E rh. buda ofFovhs dld h. or dE did mt bold or inPllrc lh. PloFty lbr dr porFs of <br />-1. <br />s oM6 ol rh. ,ropay. m 6cl6iv.!y codGcling w n ficasd cotidclo6 to co!5fiu.r th. Fpj.( (Se. 7044. B{si6 <br />r.d P,otosi)I aod.: Thc Com,.clofs Lic.N Lav do6 nor apply 10 & opn6 of piopsty who buil& or imprev6 lh<@n, <br />aid who 6iract3 fo. such Foj613 with a CoDrra.ro(, li.a5!d p$u: ro tb. Conlr.clors Lic6. te). <br />-l <br />d cxdpr udd S6rio,! _. & & P,C. lor tlis raon <br />D.re or.s: <br />l4onsEBSca!48lNEAEON <br />DO TAEAIION <br />I ha.Sy allim undd pdal! olDcjury orc ollh. followi4 dcl&alioEl <br />I hav. $d will tuinlain . Cdrilical. ol CoMr to S.lf-lcuc for wortd @frr.olalio., 6 provid.d for by SElion 3?00 olth. <br />rttr Codc aor thc pdtonnscc otlhc sort Ior which lh. poni is isrocd. <br />I have ud will nainhin workdl conp.B6rio! insueca s equir.d by S..lion l?00 ofth. tlbor Cod!, lor thc pdfomdc. of <br />thc wort lor whtb rhit pdnit ir isu.d. My wort6 comp.@rion iNuMc€ cmi6 dd policy nuobo e.: <br />-l <br />cdiry lhar in the psfomd.e ofthc worl fo, which Os ponn is isu.d. I shlll ool dplo, dy FMn in my amd <br />e s lo teoo. subj6t to thc @ri@'omp.G.rior las orcalirohit" dd asc rhd ill should b<om subjet lo thc <br />wo*6 comFMtion prcvilioN olstnion l?00 ofth. Lrlor Cod.. I sh.ll, fonhn ilh.ooply wilh lnoe FovilioN.. <br />WARNTNG: F.ilur.lo K{. Rork6' omp.,sdion covcraEc is !ih*a!1. md shall subjdl d Gnplorr lo ciointl FBlis dd <br />civil fin6 up lo otrc hudr.d lhoutud dolls ($100.000). in addnion to ltc con of compqslion. danag6 a provid.d for th. <br />Serion 3076 oatnc bbor Codq i!ta61ud alloftyt f6. <br />ADDllst- <br />UcENEDIO!:tf,ACrOf, <br />DEqa&um[ <br />I hdlty .ftm undq p6sty of pdFy ttar I d lier!.d @dd F!!!io. of Chal6 9 (omtriig wilh sdb. 70@) olDivkion l <br />of rhc BNi,B ed PrcfdioB co&, ed ny lk.e i! in tull forc ad .fcl <br />Lic.e Cbs:-Lic6. Nuab6 <br />D .i Cotrtncto.: <br />COIIIAICIIONIENDAGIGENII <br />I hfrhy aflm 6dd Fi.lty olFjlry lhn th6c ir . oodturb! k dilg r8.n y for lhc Ffomm. of tlE wo,t &. {'lljch thh pcEi b <br />i$ucd (Sc. 3097, Civ. C.). <br />aItllcall.lEcldSarla! <br />Iha$yatrrEuldrD.rattyofrdj!.yorcof tn.fouosirsdels iom: <br />D.noltio! P@il$Alb€los Nolificdion Fcdd&l R.guhlioN (Thlc 40. Pal6) <br />-R.quircd <br />L.rld of Noti6.dio, <br />-l <br />cdiry th.r lh€ f.ddrl rcsuhtioB ,cgdding ab6to3 ldoval &. nor .pplicabL lo lhis pmi*r <br />-l <br />.diry thd I hav. qd lhie rpplic.tion sd slal. th.r th. atov. inlomltion is coftcl I rgG lo conpt wnh dl City ..d Coonly <br />ordnsk6 ed Sutc t wr GbrinS ro building coNrrucriotr ald h6cby surhorie,cF6otrliv6 of lli! Cily ed Coulylo 616 upon t <br />abov. Mtioncd propdy for iBp.dior purpG6. <br />Apolic&t or Agdr SiEoalure: <br />r.EtzEtIS.illtill <br />APPROVALS <br />/r\ <br />u \\-/ <br />/\ <br />FINAL <br />I