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o\rNER Bt [_DER Dtat,(.\lta I ,(r\ <br />I hcGby arm und6 paElry of pdjury rnll I m cx6fl &on th. corr'sdos Lic.* Liw ror rh. folloviis r4!di (I*.7031 .s <br />BBiis .rld Ptufdio! Cod.)r Atry Ciry o. Co$ly which r.qun6 c pEtll lo coi.l c1, aho, imPrcv., (Ll@lbh or Ellrn Mv <br />rtrucluc Fior to i6 suee .ho ilquiE lhc lpplicel lor $ch pdh lo frL a 3i8o.d st.rffil lhli h. or sh. i! tico!.d Pu6urn <br />lo lh. Fovilio@ of $. Co.lr..lor's Li.dFd t w (Chr 6 9, Colmmdng wilh Scdion 7000 ol Divisior I of lhc a6i.* ed <br />Pmfsions Cod!) or rh.I lE or ihc is ddpl rhftiof, dd thc b€sis lor th. dLg.d .r6ption- Any violalion of S61io. ?01 L5 by ey <br />lppli.er for . pmt sobj6l3 rh. .pplicol ro s civil pouty of no! noG lt& fiv. hun&d doll$ (1500). <br />l. s oM6 of$. FoFny. or n, mplotB wht w.gd s lh.ir $L e,npos.liotr will do lhc utrl ed th. slrudu. it @r <br />idodd or olId.d tor eL (Sc.7044. B6in* ed Prot*io6 Codq Tic Cortraarols Licre Lw do6 mt apPl, to d o$rs or <br />rhc FDl,oly who toit& or in .ov6 $qot! dd who do6 $ch wrt hif,i.lf or h.slaor lhmush ht or hd or@ @phrt6. <br />providcd l,16l rBh ihFovdmls G ml ids'd.d or ofdd for $,.. ll howffi, lh buildiic or in,'!rc@t b $ld wiltin onc yd <br />oaconpldion, thcoma BlildE will hlw tt h!d6 ofF.lriig lhn lEorCE.ld ml boild or hrow lh. pllFly for dc purpo$oa <br />l. 6 omq ofth. propsly. m crclNiv.ly co r.clinS wi1n licenrcd co rado6 to @Grocl rlE prcjel (S4 7044, Bcms <br />dd Pl!fisi, Cod.: Thc Com6dols Lic.G lrw do6 nor 4'ply ro o ownd of prop.ny wto buikb or inprov€ th4o,r. <br />d who oitr0.rs for such Fojcls wilh ! CooE cto(s) licosd !uB@l lo UE Conrldoas Li.tuc Lrw). <br />I m cicmpl nndd Setion- B. & P.C. for lhi! ren <br />D g Oan.r' <br />voaf,a88lo!4IflsallqN <br />DECTTAEAIION <br />I hdcby amm uida pcilty ofpsiury on. of6. rollowi,r dc.lnrliou; <br />-l <br />t!v. lnd will Einlain . C.nifidc of Const to S.lf-lrour. ftr worl6 cooF.sdio& G Fovidcd for by Sdion l7O0 of ltE <br />tabor Cldc f6 th. Ffomm. of lh. wort for which lh. Fmit b isu.d. <br />I h.v. <br />"nd <br />sill m0inlain vork6 codp.66lion icum.ca s rcquied by Selion !700 oa$. L,b.r Cod€. for thc Dslonnecc ot <br />lhc wort tor which ltis p€mil is issu€d. My ohpctaalion iBlmc. di6 dd polic, nMbd d.: <br />-l <br />cdi& thar ii fic pofotll1,e of lh.for rvnich rhi! pmi ir issurd, I shall nol chploy any p€6on in any n'Mn.r <br />$ s ro beamc ,ubjer to ttu mlk6' compcnsrion ls!: olcaliaomi4 aftl rsre lhd il I should beomc aubjdl lo lht <br />sorl(6's'np.nslio.pbvtioreoas€clion3T00ofthcbborCodolslull.hnhsthonplywithlho*prcvisioN <br />wARxlNGr Failurc td suc wort6' comFMion ov€m8c is unhNaul. and 3hall tubj*t e @plor6 io simital paaltiG 8nd <br />.jvil tmd !p lo orc hundr.d lhoNn.l dollm (1100.000). if, oddilion lo lh. co3| ofconp.betion. d.n!8s a proridcd for lhc <br />n", </zt/tl <br />llcElsEDlrrNtB^cIl)$ <br />Df,q.AAAII(2! <br />I h€rcby am,n und6 porlty ol perjuy lhal I M h€8\r und.r rovision of( h,fld 9(conrmdcins with S.dio. 7(xxl) olDilisio.:r <br />of the Businsmd Pmf€sioNCode. a.d mylicore is i" tulltore dclttr <br />Totq r1 <br />"""5j2q/tK '/a <br />COISIBICTOIIIEIDNC.ACEIII <br />I t@by .rm urd6 pdulty ot pdjury lhfl lhe ! a 6n!{tu lion kndiag tg@y for lh. psfotuc of th. Mtl for wticn lhL Fmit i5 <br />isu.d (se. 1097. Civ. C.) <br />Atttlc NfoEcldBArIo! <br />I h6.!y alhi unds D.nalry olD.rjlry on. of rhc follo\vine de lddrioc: <br />Dcnohion Pmire^sb€rN Norificarion f€deal R*ularions (I illc 40. Pai6) <br />R.qu ted L.llcr of Nolifi.alion <br />I cdit thsl lhc lcdsal Esularioos Eg&dins abGros rdolal N nor rpplicabL ro thie pmjet <br />-l <br />cenify that I hav. rad On rppliorion Ed ial. thal O. lboie inlomation is corr€cl. I lsrc lo oDrl, wnh aU cily 8nd county <br />ordind.6 &d $arc Lrvs rchiig ro tuildinc colslocliol! ud h(cby ,urhotuc rcprsrslivG olrhis cny &d colnry ro atq !r.n dk <br />abo!. ndrioo.d popory fd i8pdl <br />Applicanr or Atmr Si!nifitre <br />APPROVALS DATE ID/SIG.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 Range <br />Other <br />Type I Hood <br />Type Il Hood <br />Grease Duct <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 /r\\ <br />FINAL a-tTlB h.wil| <br />Notes, Remarks, Etc <br />P'hhe*re(p n,): ,//.t- <br />".,., S/zq/t{ <br />MECHANICAL.INSPECTOR RECORD <br />Hood <br />Setion 1076 of th. hbor Codc ir 6es d allomy s f6. <br />-------T------ <br />I <br />=