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MECHANICAL-INSPECTOR RECOHD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Eva porative Cooler <br />Furnace <br />Com ressor <br />entIrrlisc. E UI <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rou h Ductwork <br />Vents A\ <br />Loilet Room / Clothes Dryer -7-17-tK t-w1d <br />Residential Ban e <br />Other <br />Hood <br />e I HoodT <br />e ll HoodT <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Dro Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />FINAL -t) <br />Notes Remarks, Etc I UI <br />OId]\'ER BTIILDET DELCARAIION <br />I hcEbyamrh! cr pcn lry of Fdury tnal I m cxcrpr fion rtE Conhcton Li..n$ Lls for rlE folowin! l6n (S&.70]t.5 <br />Busircss aod Pr.fcssion C.dc): A.y Cily o. Counly whi.h EquiEs ! tEmn to o$ttu. arto. inpror. dcmtish or Epu! uy <br />srocrlrc. prbr lo irs itruft. aho rquiEs rh. spplkant for such Fmn lo [k a ligtud stdcmnt rh{ h. or sh. h tiensn plNs.r <br />lo llE pmvlrions ofdr Co.trucrors Lien*d b* (c1Bplcr 9. Comnciig with Seior TOOO of Diehio.I of ltE Eusincss.rd <br />Pmfcsions Codc) or rhd h. or shc is cxo.pr rhcrefroh and lh. brsir for rhc athged crcmprion. Any v,okljoo otsdtionTOll.5 by lny <br />appliconl 16r r Frmir subjects rhc oppli.anr |o acivilpcnatryornot mE than fivc hndrcd dotls! ($5OO). <br />-1. <br />as owrc! of lh. pslEny, or ny emplor8s wnh waBcs s rh.n eh onpeBdkJn. pilt do rhc *mk Md th. strurm ii rcrjnlcndcd or oflcrcd ror slc (Se.7(x4. Busirss lnd Pmtc$io* Codc: Th. q)nta.xr,r Lir@ Ljw d@s mr +r y to m owni 0frh. I,oIEny who hiild, or iryrcws lhretr and v,n d6 $ch vo* hi6.cta or hcr$lf or tnmueh his o h.r osn chrlorcr\. <br />pmridcd tn.r act inVmEmnGm ml htcnd.dorofi.ftd fd et t( horcE, dE hritdi.g q in$oEril h$u wirhnoft )rsoloiloLliotr rhc ol,no Bualhr eill IEE llE bdfttcn ol ltroenE th.l he or stE dn ml hlh or iml,mE rtr pmFry to. tr p!.F$ of <br />-1. <br />ai ouncr of thc pmpeny, m exclusivcly conrrcr ins wilh licnscrl .onrd.hr ro conntud th. Imjcc! (Se. ?Oi4, B$mcs\ <br />and Eorisshn Codc: Thc ConIrc.lols Li.ensc t!* docs nor lpplylo 0n owncr ofpropcny who blitds or nnnrovcs llcr$n..nd who contrsds for sn.h pojccr, wilh a Co Bcro(, ticcnscd pusu0n! b rh. Cont@rols Lic..sc rjw). <br />I rDcrcnr[ und.r Sc.r <br />W(}NKF[S' COMPENSATION <br />DTIdAAIION <br />I h€rcby .rfi.m unde, p€nahy oa pdrury om oarh. tolto,inS del,ni6n. <br />Lr6i, (-r c. rnrrhclr.rfonn{n(c.lilr *.lk t' which lhclf,nnir tr n(nt <br />will nmi ,in wo c6 compcnsarir,n in\unrcc. o\ rcquncd hysc.rioi ITOOofthc Lnhor cGl., for d. <br />Mt wolkch @lrltrnssrion iNurMc. coicr ad plicy numtcr urc: <br />q.l <br />WARNNC rriturc ro sm *or*c* compcnstion ..!chac is !tr10wtut. lnd sialr subFr m cmp <br />civil fincs W ro om hundEd thouqnd dottds (glo0.o0o). in &tdiln,n to lhc cost or.o6pcnsario.. <br />lorr lo aininal Fmki$ snd <br />daro8cs ar Frovidcn for rhc <br />Sdion ]{16 of rlE Llhor Codc. inr.rcn od tormy s fes** -J'lt'16 <br />^*-., <br />LI(',ENSliD C(rN',t R^( ,l0R <br />DICLAIAIIQN <br />ol lh. Lltrnnr\smd Prolt$io.\Codc. od r licrtr{ is full nn(mdcflicr <br />IsZl(bl-r.lr.tY <br />(I(INSIRIJCTIoN t A.NI)IN(; A(:T'NCY <br />Ihcrubyriirmu.rpcnalry.rFrjuryrn lhcrc hrconsroction knding B.ncy lbl rhc pcdunurc. oirhcwork n whjchlhkp.r6ir h <br />is\ucd rscc 1097. Civ. C ). <br />A}}I ICANT DECI .1!IATIO{ <br />I lrntyrnnmutrJcr Nnrhy or!.rjury oic.l rhc hrkJwi'rs ncchrnrir)i\: <br />Dcnmlirn,nPcnnir\ A\hc{o\ Norilic0riorRd.rut RcgutalioNftirtrt0. ld6) <br />Rrotncd l.xn n, N..fi.,i.n <br />-r <br />ce,lify ltu rh. fcdcol rcgulalions EBrding $b.sr6s,emvatm nor ll)pti."bt ro <br />'hir <br />nmi{r <br />-l <br />.enify lhd I h!v. ead rhn ap,rication dn sht. rhal rlE !ho!c inror@rion L\ .ocr. I asrc lo $mplt sth rI Cn, ard Couiry <br />ordinn.ccs and shrc li*s E ildlnS c.i\rMIiotr &d h.rchraurbnrc rcFcsnlatiws olrhis Cn, ann Couflly ro cnlcr ulnn rhcrh)rc trr rioncd t0Fnytu ir <br />Appli.atrr or Asc.r Sisnrtu \ l\.\z <br />Meter Release <br />tll->ha'I <br />n <br />-l <br />&nify rhll in lhc prrortuncc oftnc work lor qhkh rhii l).rmir is isslcd. I shrtl nol chptoyrny pcr$n h on! mm*ts as to h.or subjccr to thc mrksl mmr.nsurion hws oic ilonh. ud a8rcc rhol ifl shoutd lr.om subicd lo thcwortm comFnsarion ,rmvisions of Sdrion ]7m of thc tihor Cqlc,I shalt. forthwith c.mnly wirh rh6* Drolisions. <br />L.ndn\ Addr6\ <br />_L