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MECHANICAL-INSPECTOR RECORD
<br />---,!-OWNER BUTLDEX DELCARATION
<br />, nftby lmtm unds pcn.ly ot pcq!ry thar I e cicnq,l nbd rh. Co.r&bu Lhens lw for the followi.S M$n (Se.?031,,
<br />Btrsin6i ard P.ofcssion Conc)r Any Cny or Counly snich Equn$ s lrfui ro .onimc1, an9, i$poe, .t @,ish or EI,on dy
<br />slfu.nE. Irior ro ils is$.mc, abo rsquircs tlE qdtanr for such Fdil ro lik a ri8rcd salc@.t thd no or shc ir liccn*l rumanl
<br />ro rlE Flvislons of rlE Conrmtor's Li.e.Ed kw (Charrto 9, Conmming *iln S.ction 7000 of Divhion I of llE Busio.ss and
<br />Pmf.$ions Codc) or rhar hc d.hc as ex.trp rhcFlmo ud d. ba\iq ior lh. olh8cd c&mflion. Any viohlionofselion ?olt.l by my
<br />applicer tor . pcmil ebick lhc lpplicant lo s civil prmlly of not mrc Ihln five hundrcd dolt$ (t50o).
<br />I. trs owNr of thc Fop.ny. or ny cmtloy€ci wirh woscs !s rhct sk c.np.nsdrion, wil do tlt rcrt ad llf snxlw i\ 6r
<br />inrcndcn or ofcrcd for $lc (se.7044, Burim$ ,nd Prolc$ioor C(i.: Th. coarrcdois Ltlnsc Lr* &6 .nr dlllly b nn owrcr of
<br />$c pmFnr eho blilds or nlpmv6 thcon. aid *ho des suh sork himslfor hc^cltoi rhouBh hn ot h.t own cmnhltes.
<br />l(,lidcd rhor sn.h imprc(mds @ mr inr.idcd or oltc,.d tn ek l[ noscki rh. hoihhg or inpmrcmnl is $ld wilhitr otrc,ru
<br />oaoq'hlion. fic Owmr Buil+r will hlt 0E burdcn of pmvin8 thd lr or sh. dil mr tfuild or d,Ima rhc pmFiy lor ItE puqDc of
<br />-1.
<br />!sownd olrhcl)rcp.ny. amcxclu.irl,.onmcting eirh l iccn*d .ontracioB t conslocl llE tmjRl (Se. ?044. Bunms!
<br />ard Abfe{siroCodc: Thc Conrmcrols Li.cnsc Lr* dms mr rpply r. owncr of!,rcpcnyvho blilds or inDmw3 6crcon.
<br />and vno mntrrcrs for sch pFitli anh r Co.rturo(s) lien*d pus@r ro rh. Conlrlclor's Li.cnsc L{*).
<br />I mcrc'nd undcr S(rion . B. & P.C. lo.lhts rc@..
<br />trOBKEBIIIQ!'IINSA.IION
<br />DEC| ASArllA
<br />I h.eby rffiro undc. pco,hy of pcrjury om of lhc tollowing delarulions:
<br />lhrv.n willtrBinrrin iCcniicarcolcons roSclflns{ciorworkcn $nt.nsnin,n, a\ !6vidcdrorbySc.tknrlT00.ith.
<br />btl, c()dr, nn rhc J).rlnrmmcc ol rlrcp. ior which rhc pcrnrir i. issucd.
<br />-l h.re and *ill f,ainhii wortcB corl.nrlrion insuBnce,.! Equind hy Sdlion 3?00 of lh.lrbor Code.lo. thc l!.ni)lrurcc of
<br />rhc $o* for *tich rhh pcmn is i.$cd. My wort6 onp.neiioo iosmk trtr aid IElty nlhh.r e:
<br />t ccnilr (hdr inrhcr.rro.numcolrhc work for whthtnispcflnn is hslcd.l {h!ll.or cnFloya.yI(mn inanynunncr
<br />$ as ro bccom subjcct to rhc {o,lss @n!$srk,n hwr o{ Clliao ia. lnd agmc thll ifI should bc<om suti*' ro thc
<br />wolkgl onu.nslion pmvhtuns ol Stcr io. l70O of rhc Lrk, Codc. I shnll. fonh*ilh comtly wilh lho* Prclisionr..
<br />WARNINC| FaihE ro *c@ uokcrs smpcnsliotr .oRa8c is unlow Nd shall sublccr M cmtbrlr ro dinirdl Fnullis &d
<br />ciril nnes uI r. onc hlndrcd rhou\.nd dol,rB lslfl).(x)o). nr lddir codncnsarn,n, d!ro3cs ns 0rovacd for rhc
<br />SNri,r :1076 olrhc lihtr C()dc, i'n$c{ rtrd rr
<br />IIECLIEAIIoN
<br />I h.rhy,0irm und.r r.n,lrrofledur! lnllI ur liensn undcr arerisnnr ol Chrprcr 9 (co rmn( in8 sith Scdion ru)O) .a Oivnion :r
<br />of rhL Busim\\xnd Pr.f.{sn,ns Cod., ri nry ll.cnsc r r lullhrcc ltlclf(1.
<br />o/
<br />Drlc:
<br />IANSIBIJCII9NIENI]IIG.&AEN}
<br />IhcrchytrinnrlndcrFnulryolFrjlryrhrrrhcrnr.on\l.ri)nLndin!lScncrrorrhcpcrforronccoirhcMtkturwhiclr{hiipcnnnis
<br />is{Dd (Scc.1097. Civ. C.)
<br />afflls NfDlictdSrua!
<br />I lrrhy r,[m !odcr pcn!lr, ol r.rl0ry otrd ol thc inllowi'ig rtc.lxrrrr \:
<br />Dc x'lir,on Pcirnire sh.sos Notili.dion l'cdcralRcBuldions (lillc 40. Pdan
<br />-R.quncd
<br />hrrcrol Norirr rion
<br />cmHl u! nol arpliclbh lo rhh proJccr
<br />rh6w i.fnmrnrn ic corNr. I agr lo somp lyBirh all Ciry !nd Counry
<br />! and counryb cnrcr uPon rhcrDrhornr rclf clcnrrrivcs of rhis Cir
<br />APPROVALS DATE lD/Slc..COMMENTS
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lvlisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough 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 />Hough Mech.
<br />Final Test
<br />Meter Release )?v)FINAL 4 V L,t'l
<br />Notes, Remarks, Etc.lt 0\
<br />to -t 2/-t8
<br />II
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<br />:r7Por,t2
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