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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />lvletal 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 />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Meler Release <br />FINAL I Uu llilV te- <br />Notes, Remarks, Etc. <br />OWNER BT,ILDER DELCARATION <br />I herby amrn undcr Fnahy of p.rjlry lhlt I m .xcnfl ton lnc Contracto6 Lien* tiw lor lh. follo{ing adsn (Se.7031.5 <br />Busincss 0rd Profcasion cod.): Aiy cir, or Cou y which rcquircs r p.mh lo @.i1ru.1. tI6. itlprcve. .kmlbh or EIEi lnv <br />sio.ln, Fi.r ro irs i$usre. lle reluirc! rh. rrplkal for such Fmil lo 6k a sagft{ sltl.mnl thdl lE or sh. i! lienkd PlrM.l <br />ro rh. pmvisions ol rlE ContBiols Lic.n*d Llq (Chrflcr 9, CommEinS *ilh Sccrior 7000 of Division I of thc auii.c.r .nd <br />Pblcisions Codc) or thll hc or rhc is eieq)l lhftfton ud lhc boris for lhc lllcged crcnflion tuy viohtion of S*lio. ?031 J bv uv <br />apolic{ fo, a pcmir subiels thc opplictnl to a civil p.nshy of mt mE lhln tirc hxodt i dollss (s500) <br />,1. $ owmr ol lhc Fopcnr. or ny .,plo,$s wilh w.8q !s rlEir $k omp.Bslior, wi[ d.' lh. wdt .ri ilr *rud@ ir 6r <br />inrcnd.d oroffftd fn slc asa.?044. Blsims. sd Prctcsiioos Codc Thc Co ado/3 LicciE Lrw d*s tul arDlv lo !n owncr of <br />rhc pmFny who tuildr q i'tlprcB ilE6( ud *ho d,a skh hrk himscll or h.R.lf or ltmld his or hcr own cmrlov.c.. <br />provirled rhar suci imPloEDnB c mr iddicd ororcrcd for sL.If. hosffi. dE hildinB or nt{,n,wm.r Li sld t hino*t@ <br />ofotrptxio.. tli Owmr Builll.r will lEw llE bo.d.r of rrcvhe oEr h or dE dA ftll hild r iqrcE {E l,oFl, 6, tu purpos of <br />-1. <br />!r owncr of lhc Imrcny. !n ex.lurikly onlE line wilh litcns.n contr&roF ro onslrucl ltE Imj$l (Scc 70a:1. 6u\inc$ <br />.nd ProlRsio Codcr ThcCoolmtoasLiccn$ Llw dtus nol ltplyro anosnu oflrcFny *ho builds or improw.lh.t.on. <br />and who ontels aor such p.oj€Bwirh r C.nlmlons) liccn*rl ruir@r to rh. conreloas LieNc kw). <br />I rcxcmrr undcr Sccr ll. & P C. nniht ic$otr. <br />]dOf,f,EBS:COMTEIIAI TN <br />DECI4BAIIITN <br />I lrrchy afarn undcr p.nolly of P.rjuy ooc of lhc folowir8 dcchr.tions <br />-l <br />hlr dd siu dirhi. a Cdif..rc of Conenl to Sclilo{rc for mrt6 @n0.neion. s previH for bv S..lion 37m of lh. <br />tibor Cod., for rtu Frfolffi of lh. vorl for which lhe lEmi k Lsrcd. <br />-l <br />h!!e aod *ill eainlah wort.s cofuFtr\lrion insuhmc. as rcqliEn by S<tion .r7fi1 of $c bhor Codc. lor thc Pcrtbrmncc of <br />ihc work ror whhh lhis p.mit ir nn&{i. My wortcm coq,cnslion inslmrc. cuicr and policy nuhb.r el <br />l..nify$ar in lhc pcrformft. oalh. work fm snich lhis lcrmn ir is.ucd,I shlllnol c,r{,hy 4., Fsn in ant Mer <br />s' s h tEdnr rubirr b $c *oi(sl coopcnsdrion ln8 olca <br />*o eB conr.os,lbn Fmvnioas ofs*rion.l70ooflhc hbor <br />$grc rhsr il I should ti..onE iub].cr t, rh. <br />i(f hvirh conuly wilh rho€ nnrvisio.! <br />WARNINC: Fuilurc to su. workcs' omliNarion @vcsd is 'ful, 3nd 3h,ll subirl an .n{,lo}tr lo oioiml |EMllics lnd <br />ro rL md of.omtEnslion. damg.. as pmliled for th..ivil finds rp t, om hundrcd lhousnd dollus (!lm.0o0). in .ddn <br />Sarim.1076 orrhc uhor (oilc. inlcrcn znd urflys <br />, hcEhy atfu'n !ndc, pc.,xyofFiury lhdl I rit ( I (mmmminS *ilh Sftri,o 7m0) of Diviiion l <br />of tu Busircss und Pmf.siions codc. ud m, <br />tf,ndcis Addc*. <br />- <br />ATPI ICAN DF(II ARATION <br />I hc,rty limund.r Iktrrlry uif.rjuryonc ofrht rolbsnrg dc.l,nriotrr <br />Dtm'liri.n P.flnfs AstEsros Norifi.arioi FcdcmlRcsuhrinN (lillc 10. Pd6) <br />Rcquncd Lcrr.r.l Nor''li.rrhn <br />I ccni,yrIN lhcLdcn,l s Bmlal m noi ,rdiabk h thh poj.cr <br />I a['e rod,mply *ith eU Cnrrnd Counry <br />onli',iN.rrn.lSrJrcl-rw! <br />Pmil.c nam(pri ):- <br />ltfr <br />Hood <br />lnstallation <br />Final Test <br />CONSI'RI]C'I'(IN I FNI'IN(i AGENCY <br />I hcrch, antr'n trnd$ Nnrxy of Frjury rho! rh.rc isaco {ru.rionh irslgcicy rorhcrrlomumc o, rhc sor* lor whicirr'k Nirtrh is <br />tsu.discc :l(n? Civ C ). <br />trnJs . NJn'c <br />- <br />I <br />-T <br />t-