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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS <br />appliances <br />Eva porative Cooler <br />Furnace <br />Compressor <br />Misc. 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 Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />perFire Dam <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />64rrllkRough Mech.4/4/t/,[?-, <br />Final Test <br />Meter Release <br />f-7/lll|tYA-FINAL 4/4 /t4 /ny' <br />Notes, Remarks, Etc. <br />OWNER BUILDER DELCANATrcN <br />I hftby afiim und6 Fnslry of pdju,y rhll I s .rcmpl fiom thc Corrrcroo Li.€.* kp lor thc follo*ing rc&. (S< 70l l 5 <br />BGin6s ed Prolsio. Cod.): Any Ciry or Counry *hich icqutB, Fmit to mn$tuct. ai6. inprov.. danolih or r+dn .nry <br />slrucluc, prior ro ils iseuMc., slso rcqunG rh. applicel for such p.mir lo 61. a si8ncd nardcnt rhal h. or sh. b licoa.d t$uar <br />to rh. provisioB oldE Conlracrdi LiGns.d lrs (Chaprd 9. Coeocin! wirh Sdrion ,000 ofDivision I ofth. Busin* dd <br />Prcfsions Cod.) or $ar hc or shc ie dmpt lh@6om dd lh. baii5 tor rh. allcScd dop{ion. Ary violalion of Sdion 701 I 5 b, any <br />applka for r p.mil ubj6kllE applicor lo, civil pdrllyofnot soEth& filc huddrd dolss ($5@). <br />-1. <br />s omd of rh€ propdty. or ny dplolte wirh w.s6 s rh.ir elc conpc arion. willdo $.$trI6d ihc arurm i5 ml <br />idod.d or ofia.d ld $lc (Sa,?oaa, BuinGs &d Plolsioa Codc Th. conlraclol s Lic@. rlw do6 Dol qd, b e or,c of <br />lhc FnFiy wl$ hil& or irFoc lndon, drd who dG $ct wd{ fiims.lf or h.Mlf or ltnusrt his or hd om @ployc. <br />Fovidal thd r!.h irpmlffi @mt Lnod.doroltdld aor sL.I( hosda. rh.t ild'ne or ioF$Ercd iE sk *nnin on. ra <br />olcof,pldion, lh. ()*n r Bnilda wil narc lhc hrd6 ofproli.g thd lE oi ih. did Doi build or inFov. th. pmpsly for tlE purpos of <br />-1. <br />6 0*T6 ofrh. proFty, d .xclusi!.ly conlro.ling with licm.d conrmtoB lo oistrud rtt Dftjccl (S(, 7044. Bc.ns <br />Md AnE sin Cod.: Th. Conlr.clol s Li.s. Law <,oc nor apply rc d om6 o aprcp.ny $ ho builds or inprorcs lha@n. <br />ud who ot Bcrs lor such pojdls wirh . Conrsclo(, lic@.d p6!d lo th. Cod4crors Lt.@ Lis). <br />_l @ cxonpl @da S6tion- B. & P.C. lbr rhi! 160{. <br />lroa6E85:-c0ltrDNrtArlaN <br />DECLASAUON <br />I n6!ry arm lodd Ftalty ofFj'ry o@ otth! to[osi.s dc.lantioa: <br />-l <br />h8vc ed will ruinrain a Cdificat. of Cocdl ro S€lflBurc for erlm conrp.neiion, a Fovidcd for b, Selion 3rO0 oatn <br />kbor Cod.. lor thc pdtol:lec of lh. s tor r,t)ich lh€ p6hit b isucd. <br />_l hav. &d will nairtain wotk.tr' coopsalion iNu&cc. 6 rcqui!.d by Sdlion l70O oflh. Labor Codc. aor lh. ldfomdc. of <br />thc sorl fo, *hi.h $i5 pdon b i$u.d. My w*6 coeFladio! ire{@c. cam6 ad lolicy numbq Ec <br />,,,,.,,b1yrJ4 <br />{-7 <br />-l <br />cdliry 0'al in lh. Flolr@.. of the sork for which lhh ,.mi is i!su.d. I rhdl nol @ploy @y pden in &y nr nd <br />s B to bdom. subjd io rn eo*6' omFosion bE oacaliaodi,. ed agr thd if I should b.coN subj.tl lo lh. <br />*ork6' comp.Mlion provisiotu oasetion l?00 oflh. tibor Codc I shall. lonhwilh @mpty Eith lhos povi!io6.. <br />WARNTNGT Failrc lo su. wort@' composrio. .ov@8. i5 unhstul. md snrll subjal & oployd lo 6imii.l podns ud <br />civil fh6 up ro on. hun(H rhoumd dollm ($100.000). in .ddilion lo rhc cosr ol codp.Nlio.. dmagd 6 prorldcd tur rhc <br />UCINSEDIONIIACrc.BlllcraElllo! <br />I hcoby amrd uods poalr, ofncrjurylhat I m liccN€d udcr po\isio olChaptd I (co,nmocing \ith Scqion 7000)ofDirision l <br />of lheBusins d Proa6io6Codc. od mylicdsc is in fullforcc. cfGcl <br />?lgssrL <br />bre"nolr.r <br />co!$au(1raNtflDllc I;!cI <br />I hcEb, arrn und6 pcnalryofpcrjorylh.l lhee is. Nnsrrucrion lendng aemcy lor thepsfom cc olln€ xork fot which rha poiil i5 <br />issu€d (S&. 1097, Civ. C.). <br />ATTLICANI.DEqIAAAIIO! <br />I h6tby alhn uidd pd6hy ofpajury oic of rb. fouowing ddl@riors: <br />D@olition P@neA.b6to! Notilicalio! F.d@l lcgllaiioB Onk 40. P!n6) <br />-R.quirEd <br />L.lls of Nodncldon <br />-l <br />cdiry lnd th. t dsal rcgul.lioG r.Srding sbdos rmovrl s. nol applic.blc to lhis poj61. <br />I cdi& thar I hNc Md $is fica!o!c inforulio. ir corel.I rgBloonplywilh all Cnysnd Cou y <br />( dd hs.by aurhori4 rcpr6autivB oao! Ciry dd Couly to al* upon tlEodiraocB ed Stlrc Llwr rhlitB <br />abovc monioo.d propdy lb, <br />Appuc&r or Aed Skllllc <br />ad1 <br />{ <br />II <br />I <br />Metal Fire Place <br />Cod€. imcrd and lnorncy r lG <br />T------ <br />-r----- <br />I