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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDEII DELCARATION <br />I h@by a,tm undE p.Mny oa pdjury rh.d I d ddpr 6Dm lnc Comhclo6 Li..ru. Llw lorrhc fouosilg l!@r (Se.7011,5 <br />BGiids eld Prof*ion codc): Any cty o, counry which r.qui6 a p6,ni ro coinruct. snq. inprove daDolirh or r@.t uy <br />srruc16., prior ro iE i$udc., al$ (qunB $. rpplicet lor such p.nDit to fi|. a sign d sramt rhfl h. or !h. ii li.G.d pGu&r <br />lo rh. pnvisioa of lh. co.rr4tol! Liensd Lrw (cn pl6 9, coom.ncine wllh S6riotr 7000 of Division I ol rh. BBin6 dd <br />PrcfBio$ Cod.J o( lha hc o, lhc i! d.m9i th6.tom &d th. b8b for lh. all.g.d .xanFior. An, liolalion of Sc.lio! 7011.5 by &y <br />appli@l for a pdnil subjdls th. .pplicad lo a .ivil pmtty olnol norc lho fivc tun(H doll6 (t500). <br />-1, <br />s oMd olrh. plopdry. o, hy ddor6 with wag6 4 lh.t slc @np..$rio!. win do $. wk snd tlE slnd@ b nol <br />irtoi.d o, oftr.d fo, srl. (Sc.7044. Buin6 sd PrcfdioN Cod.: Ih. Cod rcrd ! Lic@ L{w do6 rcr @ply ro o ow,q of <br />lhe ptopqry who hil& or inpro!6 th@i. dd wno do6 sch srrL hios.lf or h6clf or th6u8t hi. or hd oM dployd, <br />pblid.d thd such imp.orqds e mt inad.d oroli,ld lor $L. lf. hoNM. fi. hoiltins m iBFoloEn is eld withi! o.c )@ <br />of@fiplcbn rh. O*rd Build. wi( hrv. lh. htrd@ ofFoviig lha h. or si. did mr boild ot un!rcve lhc ptoFry aor th. Pl po$ or <br />L s oMd ofrh. F!p6tr. m .rclNivcly conrmclins *irh licdB.d contktoN to coirltuct fic roj6t (Sc. 7044. Bum6 <br />and P$tusion Codq The Conkrctols Licme tt{ do6 nor.pplyro u oMq ofprop.n, who builds or ihpBv6 rhaon, <br />and qho conrBcrs for sucn Fojds wirh ! Conticbn, licdts d purudr ro thc con!6ct.l3 Li.@ te) <br />-l <br />m cxftpr ud6 S6rion-. B. & P.C. lor rhis tten. <br />Drt€: OF.er: <br />]UABEEE!:CAI4fj!!AIjq! <br />DECT,ARATTON <br />I h@by amm undo p6rly ofFjury on. ofllE following ddlrrrioB: <br />-l <br />bar. dd will mainrain a Cdific . ofconsr ro Sclllsur. aor work.B coNp.nslion, a Fovid.d for by Seion 1700 o I lh. <br />t bor Codq forlt pqfonecc of ln wo* for which lt pd'it is isu.d <br />Inav.a *'ill mointain rvork.ra codpmarion iBuraocc 6 r.<tuted by S.clion 1700 of th. t bor Code, lor lhc p<fomMc€ ol <br />L, <br />isucd. My worl.u comptralion insudcc coio dd {Dlicy .omb6 e.: <br />bor <br />s s 3\o r?to (t <br />-l <br />c.dify thrr in th. prfom c. of the eork for whict thn p.mil is i*ucd. l shlll nor dnploy oy pqen i. e|nMnd <br />$ 6 ro b..o6c lubjd lo fic erk6' coDp.a!6rion laE oacdilomia, md rge $rr if I should beom rubjel to fic <br />worta' onposlioi prclisioB ofsclion 1700 olrlE t bo. Cod., I slDll forlhwilh conPly with lho$ ,rovisio6,. <br />w iNlNC F ,lure lo sue \orleR' co l. ed slEll subjel m dployd to oinind FEhi. ed <br />rh. cos oi coEp.MrDn._JlrqrR e po'idcd ro, rh.vri\*Slt(Dt,wl;q-- <br />u(IlSELCO[rlACtQtr <br />DEOIAAIIOX D <br />I lmby afllm undd patdy of pojury ttal I d licotsol u!d6 povi.ion olchaptr 9 (comMcirs wilh scclioi 7000) ot Divnion 3 <br />of thc B@iia ed ProfBio6 co&. ad nr li.ae ! in tull hc ed clt r eSDlt <br />0 uffit <br />I <br />( (rNSlRr ( r()N l t:NDl\(:,r(:EN( \' <br />I ncrcby amnn undd po,lry o f p.rjury thd $q. is a codtu.1iof, lmdins agocy for rhc psfolr@.c of rh. rvork lor shich lhis p6nn b <br />isstr.n (s( 1097, Civ C.) <br />ATIIICAtrLDECBAAIIO! <br />I holby atrm udr paalry of pfjury onc ofd'c following dccleiioB: <br />D@olilioD P@ir..A.b6ror Noriicdion F.d@l Rc8uLlioB (Iirlc 40, Prn6) <br />-R.quircd <br />1116 ol No{ificdiotr <br />-l <br />c61ily tnot th. lcddal regularioB lcsadins 6b6tos lonov.l e ior appltabL to Ui! p@jel <br />I .cnify rllal I halc rcod rlis applicatio rh. abovc inlon.arion is coft.l. I asrd ro conply wnh anv <br />ordinancG dd Slal€ lr\us rclar ad h@by a[h.riz. r.F.nalivB of lhis Cny dd Co <br />above ndrioned propcny for <br />\( <br />pliances <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. <br />Final Test <br />Meter Release --\FINAL / 2- lt -Ft {4(\z-) I <br />Notes, Remarks, Etc. <br />I <br />? <br />& <br />I