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APPROVALS DATE tD/stG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative 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 />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL v-7t-t6 t t"tt4{)
<br />Notes, Remarks, Etc.
<br />MECHANICAL-INSPECTOR RECORD
<br />OWNER AUI|-DER DELCARATION
<br />I hcreby lmm utrrld pcmlry of fdury rhar I d cxctr'pr 6Dn In Co .ffr* Lkcne kD aor lhe followi.g Nrsn (Se.ro.rl.5
<br />Burincsr dd Pofc$ion Cotlc)r Any Cny or Coumy whth cqlirB a Fmn ro c.nrmcr, ,llcr, iq,,ovc. &molisfi or rctEn ony
<br />sr.!.rw, prtu lo iri is.!ee, lho rqlircs lhc {pplicaor fdr rlch p.mir ro nb ! li8rcd siarcm th.l lE or shc is liansn pursel
<br />to rhc provhions of rhc Contrsdols Liccn$d Ls* (Clq,tcr 9, Co'trmeming *irn Ssction 7000 of Division I olrhc Burinc$ &d
<br />PDfcssiois Codc) or rh.r lE or shc is .rcmfl rtftarom and rhc b&sn tor th. allcs.d cxcnqion. Any riohrion of Sdioo ?03 L5 b, lny
<br />applker lor ! pcml subjets ihc trltlic,nr lo r civilpcutyof@r @rc rh@ fivc nundrd dollas (S500).
<br />-t.
<br />as owH rl rhc pol'nn d my cmpLyei eirh wagca ei rh.ir slc conFnelion. *il do tlE m* .,n dE suutm is ml
<br />inre !d or ofi.rcd fo. sL (Se.?044. auriresr .nd Prefc$ions Cadc TIE ConrE rd'r Lirn* k* dB or !0Dly lo {n ovM of
<br />thc rtnFny qls hoilds or i'qNB dictur. od wtb d6 tuh hrt hidrclf or hcmclto,lhrcugh hi! o,lE oen.r{,loF.s,
<br />provthd rh{ s!.h inprEEffi@ mi h..n t dtrotu rorslc,lf. hoBb, ilE boildin3 or rrpreEmr ir sld within om F
<br />of@nphrior ltE O*B Buiti* wi! hlw tlE hidc. 6f pbring ln,l h. d lnc dil rcl boild or inprcw ilE pDpgly lor tlE plrpor ol
<br />l. ds owNi of rhe r.p.ny, m .x.lx\iv.ly coniE.rins wirh licc.cd conrh.roE ro 6nmcr dE pRric.l (Ss. lO+4. Bu\incs
<br />!"d tttrlixsion Codc: Thc Conrracrols Liccnsc La$ d@s not optly lo ao owncr of pol*ny {ho builds 6r inpnrv.s
<br />'hecon.0nd who on'mds for srch lolrk *iln u C!.h.ro,{r) lt.n*n l)usuonr ro rh. Conrm.rols Lk trs L!w).
<br />I ancx.nrfl undcr sNrion ,3.&PC lorrhisrca$n.
<br />Itrtr O$ .r
<br />YAatrEALC9MEINSAITON
<br />DECT,ITBAtrAN
<br />I hcrcby !filrn u.dcr pcnallyofpcrjuryonc ofrhc rollosin8 dslaarions:
<br />l-rhir(itr|. turthctErlni,run.dolrh.\orkturuh.hrhc|Innr isn$.d
<br />{r havc and *ill nri.lai. rorkcn comtcnsllioo in$rorcc. ss rcqliEn hy Sdio.lrtro nf rh. tibo, Co<tc. tor rh. pcrlollr4c ol
<br />whrh'5rnur nnsud Mvtrrlch' o,mEn.rr.{'rrsurJtr.c.mEr slp'li ynun'h" r(
<br />Amr,-,t*z)'
<br />c 2l
<br />-,
<br />ccnilyrhat nr tnc,)crlo n.trccoflhcwo lbr *hich rhn ncrmil is hsucd.I shull
<br />"or
<br />chploy any F^on in any madncr
<br />e s ro bccom slbjcd to lfic *orim cohpcN!! ion lau\ o{ C,litomid, ann asE. rh,l it I s}buld h.com $bF!l b th.
<br />wodcr comrnsorion lx,visionr ofSccrion l7(Dotrhc LobrCodc,I \hall. lonhwirh contly wnh rh.* prorhions..
<br />WARNIN(;: Flilur. ro scurc workcrs comFnsdiotr .ovcras! is utrltrwtul ond shall suhicr an cmlloycr ro siorioul Fnllri* a.J
<br />n{rion. drroscs ^ pr.vidcd aoi rhe
<br />G /9
<br />lherchyaft x crEnrlllolrcrjuryrhrrlnnrlisnsdurdcrnrovisi('norChrrrd9lronnrf,,Rii[wilhsc.ri, r7(xxrol'oivisi, 3
<br />ol rhc Bu\i'rcs rtrrl l,oli\sion\ Codc. d trry li.cn\c ir iri Irlltu(a ,ricllcct
<br />?s
<br />€e
<br />Ih.L-byaflnrundrrtcillryolFturyrurh.rci\r..n{n.ri(,ki{liigrBctrcyhrrhclcrionnrN.olrhcsorknr*hichrhisp-rniri\
<br />i$uc 1s.. .t{)07. (:i! c )
<br />I .fiiry rhrr rh. lcioll mguldrions Eg.rdiDe dstEsor rcmoial trE nor sp koblc to thh pmj.{1.
<br />rhc ati)!. inturnhtn,n k..r(r I .8rN ro coqry wnh oll Cnyafrl Counly
<br />.borc mtrli,rcd p0ptny for impcct
<br />Aptlkr r or AEL S€ndurc
<br />aurholtc,cprescniurilc\ of rhis
<br />Dotc
<br />";Wf."*-
<br />f ---f------
<br />f-------T------
<br />tt
<br />Lcndcas AddtN:
<br />-
<br />rppr rr:iiiiiiirilrror
<br />I ret y altinn undcr p.nally of !.rjury om of lhc iollNing ddldral ions:
<br />Dcnrlilion Pcnnils-Asbcsos Nolificllion ltdcEl Rceulaiions (Tnt 40. Pan6)
<br />-Rcqoircd
<br />l.rr., of No'if$rion
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