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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />[\4isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents ,A <br />Toilet Room / Clothes D ryer 6-27-l(X4{1Ll <br />Residential Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Fire Damper <br />Openings <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 7'A-lN YALTL\ <br />Notes, Remarks, Etc.\i <br />OWNER BUILDER DELC}NATION <br />t hcEby affm und.r pcMlry of F,jury th l m.x€nfl nom thc Conmdos Liens Liw for rlE tollo{ilg eabn (56,7011,5 <br />Busincs ard P.ofc$io. Code)i Any Cily o. Cou y which rcquircs r t6mir ro @.slrucr. .116. imtmvc, dcmlhh o. EFt ey <br />srructE. Fior lo irs is3udc. obo Equn s lhc .pplicm for $ch pcmi lo lih , sig.cn st'lcrnt lh8r h. o. she b lkm$d pulset , <br />m rhc Jmvi.io.s ot rlr Conrcrofs Lkcn*d L!* (Cnlplr 9. ColtmminB $irh S*rbn ?000 of Dirisio. I orfi€ Dusin€ss and <br />Pmfcssions Codc) or ihsr hc or sh. i! cr.mpl llE@aromand rh.ls!i! to. rhc alhg.n cxcnDlion. Aiy viohlio! ol S.dni 70J 1.5 b'sny. <br />q,plkrnl for ! permil subj.{ls llrc .fi,lica.t lo a .ivil p.nally of not mE tho ,iv. hudEd dollos (9500). <br />_1. !r owmr ot rhc pmp€ny, or my coplortes with s!3es !s rhct sk coq,cnsrrion, will do rlE *orl and rhc srtur@ h n,r <br />i.rcnd or oflcr.d for elc (se.7044. A8in.sr dd fofc$ions Codc: Thc ConrEcrr'r Li.en\c Las docr .or arply Io an own r of <br />rhc,nollrly slF t{il(Ilor irp$B lh.Nn. arld rt des rNh wo* hin*lror hersllor thmugh hh or hcr ow. enrl,loyccs. <br />lrnvidcd rhdr slch nrymkmnrs m nor i cfrhr! or otlcEd lor slc lf. fiok6, rhc hikliag o. irpolc,E h eld *ithin onc tcr <br />ol corpLribn, riic owna Build.r will hnw <br />'h. <br />btrd.n .f oovins rhd hc 6r shc dA bl hild or iq,ow rh. rhpca, 16r th. lqns ot <br />-1. <br />as owmr of thc pmp.ny. rd cxclusivcly conlrncling wnh t(ns.d .ontreloB lo con(rucl ltr !,Djccl (Se. ,1X4, Busincs <br />{nd ftDlesbn Codc I The C.orElors Li.cns. Llw des nor aplly ro atr orner oI propcny who buildr or ihprevct !h.rcon. <br />rnd qho ontmdr for such pmiEh vid r Conhc'o(s) liccncd pu^Mr ro lla C.ni@roC. Licn* trw). <br />-l <br />omcxcmpr und$ SErio <br />l)al€: O*ne.: <br />IdORKERS' COMPB{SATION <br />DICIdIAIO! <br />I hcrcby affirn lndcr pcnahy of psj!ry orc of lh. folk sinS d€clud bns: <br />-l <br />harc ond will oinl.in a Ccnifrr'. of Con*nr lo Sclf- lnsm f.r so*di @npcB.lhn. as I'Evi& fo, by Setion 3700 of th. <br />l.Ibor Codc. for rh. ltrfomkc of rhe qo* t6, *hth rhc p6mir ir isslcd <br />_l hat and will mainhin *.rkcr' compcncotiofl insunncc. as rcqukn by SBt ion l?00 of lhc Llbor C.dc. lbr lhc lErfontuncc of <br />rlE hrk tor which lhn pemrit is isi,cd. My vortcG mnlllnsrion i.smmc cuicr !d polky numbcr a.: <br />-l <br />ceniry rhal in lhc pcrfo,romc ol rh. *o aor vhich lhh rcrmir h hsu.n- I shrll n.r employ any pcs.n ii Lny @4t <br />b .s ro tr.oN subjNt tu rh. workc$ conFnsdion l,wsofcdlilonia and dsEe rh.l irl sh.uld hc..m \ubj.cr to <br />'h.No.*6' .\,np.n$r ion F,vhbns of sriiDn l70O .r rhc Lnhn C.dc. I shall, tonhwirh d,mply wirh rh.s povhionr. <br />WARNINC: Friltrrc t) {curc $o'[cr\ <br />rivil li c\ trp b nic hrndr.d rhor\a.d <br />tr covcra8. is unhslnl. lnd shrll \uhjmr an cDrdoycr b .nrni'ul lrx rics rtrJ <br />ll in ldd bn ro rhc .od oa coqr: un,., dtr'tuscs d\ providcd ror rh. <br />s.rrirr:r)760lrh.l xhtr (ixlc, i, rrr(rnd <br />[p-Ltr.o1 <br />I lEEhy lfun @dc. p.ully of Frjury <br />irsed (sc. l(97. civ. c. ), <br />.onno.rk n lcndin8 .gcmy lor thc F.formre or llE wo for {hth lhn Femit is <br />AEUIANIDLELII{III}N <br />I nr$y innundc. !.nfln, oftErlury onc ofrhc lbllowing d(k.dbns <br />Dcnolirn Pcrnits Asbcsros Notifc{io Fcdcral Rquliriotrs ('l irlc.10- Pan6) <br />R.qunni b(cr of Norill.drk,n <br />ion is .orNr. I as& m 6m y wnh dll Cnr and Counry <br />rcprcse rrivcs ofrhh City md Counryto cnlg lllonrl". <br />".,. 6 Lc^\v <br />Grease Duct <br />PijlicyNu.rhcr Ext)trcs <br />- <br />I h.Ehy lrtrm und.r Fn lly of F jury thd I m limsd uod6 Fovirion of C'lEpt . 9 (6,lmEina wnh Sclbn ?000) of Divht'n l <br />of lhe 8ulirc$ ar(l Pret *io$ Code. atid my liccn* is in tull toe .!d clr(l. <br />D.t : <br />v *k\t <br />ffitl <br />ttt---+--- <br />: