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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace I 7l^^ lr /C<nntn t K1_
<br />Compressor L 4
<br />Ivlisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh Ductwork b/.u lt P GluofL -t6-7
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F. D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.4 l'vol ur 6rvt>rfx 't.K7 -Final Tesl
<br />FINAL ilttltr{rh4ptD lez.---
<br />Aotes, Remarks, Etc.
<br />'M lktuk"/|l,. Vt4{A^t
<br />d4
<br />A/0 ilmaatqn h>rrtLr,lL I,tlar4t v rt tL f vtt !,-w^\," 'tYiot/h*np vLrl P.Itrnl ru bzt*,tL/+ e2-6.rrwbl
<br />OWNER BUILDER DALCARAIION
<br />I hscby .firn undcr Fnalry of leiury thar I m cxcmpr 6!n rhc ConhcroB Lt.nsc kw lor rh. followinS EMn (Sc.r0:11.5
<br />Brsin.ss ud Prcltision Codc)r Any Ciry or Coury which rcqlics a lcrml lo.onsldd. .h.r. ihnrow. demlnh or EIEi My
<br />srocrurc. pri, to irr iisuec, alrc rcquiE rh. q'plhml for su.h pcrmil to fih ! sigtud slalcmir lhol lf, or ihc is li@ns.d pu^uut
<br />to rh€ Fovisions of r,E Conlrrcrd\ Lien$d tiw (Ch!,,lcr 9, Cohmmioe warh S6ion 7000 of Divisrn I of lhc Busincss .nd
<br />Pmlcsrionr C6dc) hr $ir tE or she ii erc,ll)l th.rcfron 0r.l rhc b&ih tor ihc alk8.d cx.mplion. Any viobfion of Sftrhn 701L5 by any
<br />opplica.l ior r p.mil suhjels lnc .pplkanllo!civilFnallrofnol mrclh.n filc hondeddollaB (t500).
<br />-1.
<br />ar os.cr ofrnc pmFny. or my cnplorys {irh w&Ucs us rhch $lc.rmpcns,rion, {ill &, $. wnt md lhc slrrturc n tul
<br />i.ord dofrcr.d for sL (58.7044. aurims,.d Prufcssi,,.sCridc Th. C. raclols Licns Llw &Es ml appl, ro u oeft.or
<br />thc Dmpcny wtr t{ildc or itrr0oB rltMn. anrl whd d@r $ch tr& hinrclr o. tusclr or 0muah his or hcr own e'q,loyN3.
<br />providcd thd such impmwmnts N ml hlended or olM for slc. li lrEs. rlr 1 illins or nrfrehnE is sh wilhin m. ru
<br />ol corpkrioll. rhc Owrcr Bdlrr eill h,rc th. hndm orE.vane rh,l h€ or sh. dil ml hild m itFmE thc ltolEly ,or llt P!q.s df
<br />_1, arow.cr.lrhc Imrcny. sn.xclusiwlyconrBctins wirh li..nsd .od rocros ro onsrtucr rh. Imjer (Scc,7&.4. Btr$@$
<br />un Pr!ftsbn Cod.: Th. ConrEcror's Licc.* Llw docs mr lmly ro an oorft of prcpcny *ho buil& or improvcs ltcr€on.
<br />and who onr@r. fo. su.i pojsts with . C.itmcro(9 li.cncd plRun.l lo lh6 Conlmclor's LiccnFc L.{)
<br />I r .rcn,ti uill.' S(li,ni . B. & I).( nn rh s r.iul
<br />SAXr!&T:(aMTEIIAIION
<br />I'ICI.ABAIII]N
<br />I hcBby antm undcr p.nnlryofpcrj!ryoneofttu followine dcclntrlions:
<br />I hrv. irld will minrdin a Ccnificlk ol Conscnl ro S.lf.InsuE for qorkes cohpcngliln. $ Imrided ror by S.clion 3?0o of lnc
<br />tlbor Codc. fo. rhc p€,i'mnc. of lh. ml* lor which lh€ !.mt ir issu.n
<br />-l
<br />hav. snd will minlaitr wortcG compensation nNurrrcc. !s rctuted l,y Sc.rioo 1700 6fihc Labor Cod.. for lh. Frformrcc of
<br />lhc wort lbr which lhh p.rmil is nscd My workcs o'npcnslliotr inslrucc c!rh, ard p6licy ru6&r ucl
<br />PoltyNorb.i Erptu
<br />-l..niay
<br />lhll in th€ pcrformftc oflhe *ort for whth rnis perml is Lru.d. I rhall ml cir{ oy any FMn h lny manmr
<br />$ as ro becom rubjd to rhc vor*cB omp.ns.lion lass ol Crlilomia, !.d a8r rhd if I sholld li.om subje o (E
<br />*ortc6 onTxnrNrion pmvhi..s of s.clion 3700 ofrlE t h.r Cod., ! nElL fonhwirh str{,ly wilh rh.* poriritB..
<br />WARNING: Fdil!rc ro $cuc workea' @qxisrion cow6E. ir unl|wtul. ind shall subjNl s cmploFr lo diminrl F@ltB and
<br />civil lincs lti ro oE hlndrcd rhouend dolba ($100.000). i. lddirio. b tlE cGl of omFturlion, d.tuBcs as ,mvidcd fo. tl*
<br />Seclion 3076 .f rhc t hor C6dq intcrcn and .iromy\ L*.
<br />rrel:Ntl:tlcoNt&lclf)B
<br />DIiCLAXTUAT
<br />Ihcr.byrfinnundcrpcnallyo, pcrltry rhd Ir lircn{rltrndcr!x,vi\n,nol(hrPrd9rcom.tncilre$ilhSccriotr7{XX))orDni\i,n:l
<br />ol rhc Busircs i.d Pmlt$ion!Codc. fri nry liccns i\ in tullnrcu{l.rlrcl
<br />CO flAUI:UANTENDING.{GEII:T
<br />I ficEby orlm lnds Fnahy of l).d!ry rh.r rhce is . oinerhi hidiiB ,gcrcy ior ttE Frfoffi of lic wk for shhh lhh pqnn b
<br />isiu.J ls.c.1097. Civ. C.t.
<br />Ltfllca.NfDEc!$all0!
<br />I hor$, dlim hd$ ptnalr, of r,.rrry onc orrhc rulhwii8 d.clmrhns:
<br />Dc.ulitnn PcnnnsAsbc{os Notili.ation ljcdcrulRcsulutions ('fill.40. PDn6)
<br />-Rcquircd
<br />Lencr ol Norilctrri,r
<br />-l
<br />cc.rif, rhd ltc feddal rcE]lhtioB esdding $h.sros rcmlal @ nor amliclbL b fiis Imj.{
<br />-l
<br />c.nify lhrr I harc cad lhG .pplic{ion ud shlc ln{ dE sboE inforrErion is oNl. I agre lo @tply whh .ll Cily .nd Counly
<br />oidiones lnd srarc L,qs rhlirg ro building coBnacdo.. old h.rcby aurlDna Epr.rc.rariEs of rhis cny dd cout, !o cnre DF. tE
<br />aboE ftnrhEd pm& y fo inrD.crion prpor'
<br />Amli.anr or Agc.r Si8ndurc:
<br />Vents
<br />Hood
<br />Meter Release
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