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M ECHANICAL-INSPECTOR RECORD
<br />i lEEby .fm un& pc.lny of Fjuy 6n I e q@Pr for t[l Coorlldo6' Lic.@ kw for rhc bUoeire !!&n (c,?031.5 Bui!.33
<br />ald Prctusioo Co&): Any Cny or CoEly whi.h r.qui.6 . p6En to 6BtM, .Is, inFovrr dd.lnh or r.?& ey sEu.tE , Fior to il5
<br />irsue., aho rcquiB tbc !!pli..d fo.$ch Fotlo fl. ! 3is.d sar@an dar t o. !t! i5lic@5.d pEsr&r t tb. povilioa oftb.
<br />conE .rois L!eo!.d lrw (6!p6 ,, Com@ils ei6 Sdio! 7000 ofDivisiod 3 or &. BEin6r ed Proftsiio6 Cr&) or tbll h. o.
<br />ih. i! rt dpr rbd.t d .nd tL bGis for th. !I.g.d Mltior -Any violnion of Sdior 7031.5 by dy .pplican for a p@n subjcrs th!
<br />.ppliMt to . civn F.ty of et @E tt& 6v. tundr.d &l]!! ($J00).
<br />_i, E oqc of lh. FDFly, or ry dployc wilh w.€6 s thcir soL .oEp6salioo, will do rh. sod. ed tb. sEudur. it mr i,rod.d
<br />or o66ca f.r r.L ( 56.7044, EuiD* ed lrcfqioa C.&:lt C.ltdor's Li@. Llw do6 tul spply to e o'e of l!. p6pdy
<br />who buil& or iaprovB t[aa!, .rd who do6 iu.[ wort hjelt o. hr*laor through hir or ba ou @ploy..., pNvid.d llar 3!.h
<br />iEFov@.lrs e mi iordd.d or ofrold fo. saL. If, Lowdd, tL. boildile o. ioprcl@at i5 eld winin o@ yd of @oplaion, rL.
<br />Ovu-Bdldd will hlvc th. hrida ofprovilg lh, L. or sL. tut bund or i'!Fo@ for th. pspo* ofs.L).
<br />_I, a o*G of lh. FoFry, u qcluivcly @ ra.lile wil lic@.d @trrdoB !o 6!stru!r tn! !.oj6r ( SE. ?044, Bui.* .!d
<br />P'otulion Co&: 'I1B Colr.dor! Ls@ rry &6 lot .p9t, lo 6 orc ofF.Fty who hril& or ibFoB r!!e , &d wto
<br />@!tr'd! fo. sh !rcjEt! win . co,rco(3) Ii.a..d E)llEr ro o. colhdor3 Lic@ kw.).
<br />_I 6 qdF ud!. S€1i@
<br />-8.
<br />& P.C. fo. tiir t!eE.
<br />WORKERS COM}ENSATION DECLAR TION
<br />I bs*y aFm udd p63ty of pdju.y oe of thc foloeing d..l@doa:
<br />I hav. .nd will 6.irnaiD r C6dlior. ofco.san io sGlll,fu. for world' @6p@!.rio., B Fovid.d for hy setbn 3700 of6.
<br />Llhor cod., for tl. FfolE,e of ti. wo* brw|i.h th. pc6n is i$u.d.
<br />I h&. ud eill @i ri! wo*@' @Bp@s.riotr itse.r a cqliEd by setion 3?00 of &. Ehor cod., for th. Ffo@e of lh.
<br />wo* 6r whi.h lhi! F6n is i!!!cd My wo*a @6pasdio! i,s!m@ 6i6 erl pol,cy .Mbr rci
<br />ra
<br />N-b., 7600o0 lgo2, ll,gti.:ti.'o""a@ oit*)
<br />_I .drify rhlt i! tL paforE,@ olthc mrL for whi.b a[i! F6n i! isu.4 I .h.ll er c@loy ey F$a i! Dy !:r.!G e a to
<br />bcD. $bjd to &. m*6 ' @op@!riio! las of c.li6nia &d .sra tnrt if I slould tao@ rubjEl l! l\!. wo*d'
<br />@qo*lioa ptuvisios ol Sdtion 3700 oft!. l$or Cod., I shrI, 6nlwit[ @oply with th.$ !iovi!ioa..
<br />WARNING; Failu. to seur. wo 6' crr6..!ioD @v6.s. i5 ul3wtul, ed sbll $bjcd & @!1016 to eioilrl podnd sd civil
<br />fn6 up io oe hEdr.d thoG&d do[G (1100,000),i! addnion lo th. @n of@Bp@etea .lrE s6 a Fovid.d br th. s{tior 3076 of
<br />tt Lbo! Cod., i.lEEt rrd atlotu y\ f6.
<br />l,lcB!@glNlEAcr0BtDEcLa8allq
<br />I hqtty .fIrE uldr p@rlry ofFjury lb,t I @ Iicdr.d udE FDvLion ofcbrp.d 9 (@@6.iis eith Serio! ?000) of Divni.a 3 of
<br />tt BNiE$ Ed &o&.sioc Codc, ild By li.d. ir itr 6rU forc &d cffdi
<br />Bc kss
<br />?-/4/ PLt----T-----
<br />qONSIBIqIAIi.EBDAG.ACEIq
<br />I Lalhy rffn6 uldd p6rby ofFjlry th.t tta !' ! o!tl!&!nD &ldjqg .g@y br 6. FbrEl@ ofth. *or for ebi:! t[ir FDn i.
<br />iu.d (Se. 3097, Civ. C.).
<br />APPLICANT'S DECLANATION
<br />D@olib! PaEneAb.do! N.dfclti.n F.d.r.l R.guLriod GitL 40, Plir 6)
<br />R.quird L.nd of No.ifi c.li.tr
<br />_l .Etify tbn t!. fcda.l rcgulalioE lcgudi.g ab6t6 @val & mt .IplicabL & tLs Fojct.
<br />I caify rhn I b.v. Ed rht lpplic.rio! &d s1.r. thlr thc lbow i,fodation is con.q. I aere io conply vitb all City ud Coury
<br />ordile6 &d sldc ks r.lni!8 to hjlding @BrocrioD, ald h@by suthorn r.!r66t!tiv6 ofthis city &d codty lo 6tE upoalh.
<br />abov. Dariorcd FoFry for
<br />APPROVALS DATE COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evap Cooler
<br />Furnace
<br />ComP,ressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Rough Ductwork
<br />Vents;
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Greas;e Duct
<br />Fire Damper
<br />Openilngs
<br />lnstallation
<br />F.D. Drop Test
<br />AbovE Hard Lid
<br />Above T-Bar
<br />1r 2Rough Mech.3 h)llt /1,ur-t'IFinal Test
<br />Meter Release
<br />FINAL 4/tr/ls,/rk
<br />-lnspectionForms 03.31.06
<br />L uA//,
<br />Smoke Detectors lnstalled
<br />Drl.: OlE_
<br />'//z/t-
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<br />I
<br />I
<br />ID/SIG.
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