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MECHANICAL-INSPECTOR REGORD <br />DATE ID/SIG.COMME'G.OWNBR BUILDER DELCARAI'ION <br />I h6.by arm undd podly of pdjury fi.r I m qonfl fioo lhc ConlracloR Lirmr kw for th. fouosins lqsi (s6.?011.5 <br />Bcirs ed Proftslio. co&): A!, Cily or Couly shtt..qoi6 a pcmi ro cornrud, dte, iiprolc datolbh o q{iiey <br />slructue Fior ro ils isumq dso rcquiG lhc applicet tor such pc n b tue 6 siged fid@ar rhal nc oi !h. n !i@d pB@r <br />to rh. ,,mvisioB of rn Conrncld! Li€ns.d L.w (C'n,prd 9. Connmcing wilh Setion ?000 of Divisioa I of th. Bcin* od <br />PDlaioB Cod.) or lhar h. or sh€ G dmfl rh6.tom ed lh. bais lor th. all.scd .imFion. Any viohion oasdion ?03 L5 by &y <br />applicer for a pd,lir subjcls lh. .ppli@r lo a .ivil poahy oaror moe tl@ liv. tu.dr.d douas (t500) <br />-1, <br />a omd of lhc Fopdrn or Dy mplota vith *aB6 s lh.ir sl€ codps8 lio'! triU do tlE ei{ r.d tlE slrEt@ b ml <br />i.l|ad.d or olta.d for slc (Se.70{4. BBinB dd Proia3ioN Cod.: Tt. CoilEclorr Li.dc Llw do6 lol aprly lo & ownd of <br />rhc rDpdty vho hiil& or iDli.c rE@I\ ard uno dE ech mrt tim.lf or fid.llor lhrcugh htu or ha om oPLyE. <br />prlvid.d rhd iu.h inpmvocnls @ ml hls'd.d oroffs.d for elc. tl howd, $. hlildiie or impmGrar b $ld wilhin ob. t@ <br />ofcorpl.tio,'. $. oMd Blitla vil h.* tlE hrda ofprovins $a h€ or she did ml build or inlfo< ihc FDFIy aor rhc puF* or <br />-1. <br />s o\1@ olthc FoFiy, @ dcluiv.ly contadin8 wth licd.d contracloE lo coisrucl lh. poj..l (S( ?o44. aEi.6 <br />ad Profi3rion Codc: Th. cont.dol! LiccG. L.w do6 nor apply to oownd ofp..peny wno builG or imprcv6 th6@n, <br />ud who ontmcls for suct pmicrs wilh o ConlEcto(s) li.6scd pB@t to lh. Conlr..rol! Lic.e tra). <br />I d..xerpl rndd Satio, .lt.&P.C forthis r.e, <br />O.ner,_ <br />!98r8$:CAM$!!AUO! <br />DEIIdSAIIa! <br />I hc.eby am.mund6 Fnahy ofpfjlryoncolrhc tollorviry dal-a'iotrs: <br />_l havc rnd sill n,inl,i. a cfiifi.,re o l Co6dn ro s.la-l6urc for $orkcc con,pen*rion.6 providcd lor by Sdlio..1700 olrh. <br />l-ahor Codr. lor the pslomdcc of rhe *orl for Nhich rhc Dmir G issud. <br />X h,vc aid will nri.tain workcis .o,rpeNariotr i6ur.n.e, s reqrncd by Sd ion 1700 oi rte libor Cod€. tot lhe !olome.. of <br />is issud My rortm compwrion iNuruc€ cstrid rd policy numbs ac <br />L + <br />0 l I <br />-l <br />c€rli8 thal in rhc pslolrmc of rh. so for which rhis p6nit i! iscd. I shall oor @ploy sy pr$n in rny men6 <br />$ a ro b..omc slbjd lo lh. sortd' comFsslio. l.ws oaclliaomil md rgre lhal if I sbould b.con subjd to lhc <br />woi(6' conpoEalion povisioB oasetiof, 1700 oalhc Lrbo. Cod., I shall. fonfi{ilh omply wilh tho* pbvi3io6.. <br />WARNINC Failurc ro *u. ert6' conposlrio. ovqas€ it ul.wtul ed snrll srbjan e dploF to qiniMl pdalti= dd <br />.ivil fin6uphon huodrcd rhousr.d doll6I$100.000), in addirioi o $. cosl or conp.srion, deD's6 a providcd lor rh. <br />er [\o/\ <br />DDCIABAIIA! <br />I holny .rr@ uldq Fnaty of Fjury ttn I u li@s.d unds Fo!i!io! of Ch.prc 9 (otlfucins vnh sdtioo ?000) of Divnio, 3 <br />of fic BGi6.!d PrcfBioc cod., dd or licae is i! fidl foN rld.ffcl. <br />(h-o q <br />N <br />^",:U/tq/ I <br />gollrBL)cuQN.LrNDM[xi1 <br />I h6&yarmu a p€nalry of psjuy rh.I rhs. it a consrruction krdinB !€try for thc pcfomdcc ofrlE @rt aor wnicn this pqrlil n <br />isu.d {Sc, 1097, Civ. C.). <br />-l <br />cdiry lhal I havc ,ad $i5 appliorion ed slarc fid rhe &bovc infonndion is cor.cr. I alrc 1o comply wi$ all Cny md Counly <br />ordinm€s md St.rc tls Elalilts lo buildn8 consr dior md h6*t unorizc Ep(Mr.tiv6 oh!'is Cny od Co!.ry to 016 uFn IIE <br />rhov. <br />'n.ntion.d <br />prcFny ror imp€clion <br />Applicanl or Aa.nl SiaDatu.x <br />Pdniie im. (pino:l<*c0 l"e /\ <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 />Hood <br />Type I Hood <br />Type ll 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.2/-7//A r 7Lt1h*/l-'.27 , <br />Final Test <br />FINAL 1lt0 h q hM Cr2/ <br />Notes, Remarks, Etc <br />-+ <br />APPROVALS <br />Meter Release <br />c-"-..Y- <br />l,.ndeis Ad&N: <br />- <br />"p.,,c,r-nioiiirffiI hqlby afrm undd Doahy ot pqiury onc otthe follo$ins d(ldarions: <br />D€noli(ion Pdnire^sb.sroi Nolincalion F.d@l Rcsllaliotu (Till€ 40, Pan6) <br />-Rcrlntcd <br />L.lrd of Notificalion <br />-l <br />cdtiry that the fcdsll rcsolatioB r.!&dios 6b6los .doval e ,or lpplicrble to this prcjcl. <br />".," "ll/ q/ry <br />=