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MECHANICAL-INSPECTOH RECORD
<br />OWNER AUILDT'R Dt]l,CA!IATION
<br />I hcrhy rr'lirnr und$ |tntrlry ot $rjurt rhd I im cxcnrfl lninr lhc On ru.ttri Li.cn\c Lrs itr rh. li'$i'rs tcJ$d ls( 7011 I
<br />B!!ic* rtrd I'>(L\sim Cric) Any Ciry or Counry trhich rtqun.\ r Fhnir lo.ntr{rud. rlrcr. imP(nc, dc k)litlr,tr ^Ftr ri)
<br />snkrurc. Driorio irs hsurnc.d$rcqui--.\rhcxrtli.mrforsu.hNrtrrirrolll.r\i-!ncd{atmnrrhnrhc.rrhc(liccn\cdlu6uar:
<br />t, rhr pn,visios ot rlr Cotrrfucrtr s Li.cns.d L'w l(.llaprcr 9. (inntrric'nt sirh Scdion 7(Xn oi Divi\ion .l of rhc Bu\nt\s ,nti
<br />rpnliqfri(trrF-i,nir\ubJ..hrh.lptlicrtrriotrciilpcnalryofnolnrr.rhufirchundrL{dolllr\(l5oo
<br />L as owmr oftlE psFtry. or m, enployes wnh vager I iEt ek conp.nslrion. will do rlE wk anl tlE stnxtw b ,bl
<br />inrc .d orofrcrcd for elc 156,1)44. Au.im$ ed Pmfcssio.s Codc: Thc C,nradofs Lken* bw dms ml opdy ro dovMof
<br />{he tmFny who t!ir& d irproEs thq@tr srd whb d(Ec Mh urt hinsclaor hcr*lf or rhrcrBh his or lEr own.nPl6y..s.
<br />rrclidcd rhar ikh iqNwmnt! m ml inlcrxLd oroff.Ed aorsalc.I( hoEE, rh. hoildin8 or i,pmeft bsBwnhinomrtu
<br />of 6rpbIhn. th. OwBr Blit d wil hlt dE hfthn of piovinS fill lr or she dt ml hoild or inIrcE trc pmFly fn 0E Fitlne of
<br />-1,
<br />!s oqtur oarlE trr.ar. m.rdusiv.ly .onlE-lin8 viln fiai*d onmdos
<br />'o
<br />con{Ect ttr Imir| (Se. 7044. Butircs
<br />a PDissb. Codc: Th. Co.rm.roar Liccnsc tlw dcr nol apply lo sno$ns ot O,opcrr, vho buildsor imPrclcs lh*.on.
<br />snd sho conlers to, rkh roj(h wilh. ConlddonI licci*d pusulm ro lh. C. ncrtr r Lkcnt kP)
<br />-l
<br />anrcicnrpr Lnd.r S&ri0 l, & P.C. tur rhn rcn{,n
<br />IIOATE&S:I;OITIEMAIIAN
<br />DECI,AXAIX}N
<br />I h.rcby lffirm und* pcnrlr, of lnjury onc of rh. folk,wiry d$laEtnrni:
<br />-lhavc$d*illfluinuinrCcnificai.ofcon*trtl.scif.ltr\urcla.so.ltcF.oD.n\drn[,sslrnidcdLrhys.crt,n]?(xJoirhcuhtr Crle. lnr rhc rcrlbnun.r,l rh. work ritr which rh- |{nnir is issucd
<br />-l hlr a.d uill naintrin workers compcnsation insumncc. as (tlitd by S..rion l7m of thc t2hor Gdc. for rhe p.rfomEre of
<br />rhc wort ,6r whih rhis pcmn is issucd. My *ortc^ co'n ..uio. iorurtmc .aEhr ad lDli:y rumbcr dl
<br />L{T -!
<br />^,5:816
<br />-I.cniryrhdr
<br />in lhc rcrformtra oflhc wort tu whrch lhh pcnnit h issucd. I sholl not employ!.y l'.aon jn ony murct
<br />s os ro tEom subjccr ro rlE so&dr onp.nsdio. lass or Cslifonia ,nd ,3d rhd it I should hccom subj.fl lo rrE
<br />worksl .orfcnsarion pioririonsofScclion 3100 oflhe L,hor Codc.l ah,ll. ronhwilh.omtly wilh lho* Phviiions.
<br />WARNINC: I. lurc lo s.urc wo,kcB .o pcnsri.n .ovc.rgc is utrlowtuL lnd stall rubjc.r an .mrlorr lo riminal ltM[n1 and
<br />h onc hudrcd rhoosnd d.llarr (Slln.(fi)). in addirion lo thc cosl of.omrcn$rtun. ddmScs 6s Prolacd aot
<br />'hcSNrnrn 110T6 ol lhc Llhr Oxlc. inlcrc\r uid ultonrcy i tacs
<br />c ,, Av.A44r
<br />I hcrcb, rrnrm ui.ls r.n,lryorpctury rhnl I ir lienln uMcr rrovhiooorChtrpr( 9 (.onnrcncir8 !irh sccri..7fix) urDririon l
<br />ol rhc ltusitrcs\lnd Pn,rc*n,n1cudc. myli..tr{ i\ ir rulllnru.lnlcris.-l
<br />- G-rlE2 ts -l
<br />,.,.,,"(-ZlK- --.-...".
<br />SASBIJCIIQNUIDIM.AGDNCT
<br />I hercby trlnnnrnd.r lEn,hyoiFerjury thst lhcrc is a ornsrtucrt,i hndin!.8cNy lor lhc Pctlotrutuc ofrhc work ior*hich lhh lErmit is
<br />issucd (Ss.1097, Civ. C).
<br />AfILICTTNLDtrCI MIIQI!
<br />I lrtby nflnn xnd$ tlcnolly.l p.rjury onc of rhc li,U{,*ihE rlc.larari(rN:
<br />Dc.dinnr Pcrnrih Astrsro\ N.tli.n!n,n Fcd$rl Rqul.tionsII itlc,10. ffi6l
<br />_RcquncJ b(cr olNorillcition
<br />-l
<br />ccnify thar rlE tcd.dl eBuhlions rcBuding astrshs rcmv rc nor 4Dli..bh lo lht Fmltt.'
<br />2.n,,^
<br />l,f,nrr*'""a
<br />!r I h.vc rcad rhir .pplicarion lrd sr.rc rtur rhc .bv. infordlbn is coft.l. I aCx* ro .om/y wilh !I Cny and Coury
<br />rion.andh.(by&r}trrizrrcpre$ 4tivcsofr,rnCiryahdCounlytocntcruponrhc
<br />Nhov. m iomd pmp.ny ftr
<br />Appli.Mr o, Agcfl SigMrurcl
<br />APPROVALS DATE tD/slG.
<br />Appliances
<br />It/etal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Z*ta-ya-br-Smoke Detectors lnstalled
<br />Rouoh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />t$/Rouqh Mech.
<br />LFinal Test mtu{W'-
<br />Meter Release /1 tuffi-FINAL 'ft ,tl-v/
<br />Notes, Remarks, Etc.I
<br />t /'/o'\-
<br />COMMENTS
<br />D4, /' l-
<br />Grease Duct
<br />^.,oK --C -8
<br />tt
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