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MECHANICAL-INSPECTOR RECORD DATE ID/SIG. Appliances Metal Fire Place Evap Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release FINAL .fAt/lt lh.Y'/ O*na'AuiB6 Dcluaion I h6cby .fim uda Fn.lty of Frju.y thfl I m .x6p fm lh. C@r.d6' Lic.e Liw fd rh. followins l!a6 (.4 70! 1.5 BGind &d Prcfdid CodO: A.y City u C@f,ly *hich Equir.! E pdin to 6sm4 .ll(. impov., d.mlish d rcFir oy iruclurq priq to itt is@e, ,ro Equi6 th. +plicer fn rGh Fnn ro ,il. . risEd nsrllthr lhr h. d 3h. ii li@.d porudt to 0!c prcviti@ of $c Cotr&tdt Lictu.d tr* (Ctapr6 9, Cqhtu ing with s6n@ 7oo0 of Dvition , 016. BEif,q ed PrcraiN cod.) d ln.r h. q rhc i! cxmpt thftfrm Md $. b6t la lt! tllcs.d qcfrptd An, violdi@ ol Sado. 701 I 5 by 3y opplicdt fd . Fhn subldt, Ih. .ppli@r to . civil p.n.lry of Id lffi rhe fiv. hun lt d &U4 (l5m). _1, B oMe of dic FoFny, or my GnD,oy6 wilh w.ae E ln.ir rc|. .dpaE d6. *ill do 0t. wort dd rh. tlwctu. t no. inhd.tt d o6c.cd fd !.1. ( Sc ,oaa, Bqinq ed Prcfeis Cod.: Thc coiE&i6'! Lic6s L.* dG nol .prly ro 6 lMd of rh. Fo?.riy who buil& d imFov6 $.@n. Md *ho do6 rlch qdt hiell q h@lf 6 tlmugh hi! c hd oM mployd. Fotid.d dal sEh amprcv.l6ti @ nor i Gnd.d d ordd f {lc lf, hoea6. $G bgildiDs tr improvtur n $b wi6in onc }d of cmpl.do\ lh. oM6-Buil<!.r wiU h.v. $. t{rd.n ot p.ovin8 !n.r h. q !h! nor build d impov. fd {t pu.po. of 5.1.) _1, s (Mr of dE FoF,ry, d dcluiv.ly 6n8ri.a wirh li65.d @F&t6E to cdE*t llt. Plojct ( sa 7044, Bqine Dd Pref6ie Cod.r Tt C@relor! Lic.M L:* do6.or.rply ro e ou6 ofFopdy *ho buil& d imFov6 rh6@, ad wno @r&l3 fo. i@h psj@u with 6 csrtuto(, li6'€d pBMt ro th. Contri.rot Li@s L!w.) _l m .rdpr 6<Lr scri@ .B.&P.C fa$i!!!.s WOBXERS COMPf, NSATION DECLAf,ATION I h6.b, amm uftLr p.n.lry of Frjury o. of lhc foll@in! &dEdim nllin a C.nificarc of Coler ro SclfiNE fd wdr@' comp.tu i6. a Fovid.d fc by Scrio l?m of6. p.rf@c. oatn. wo* ad ehich th. Fhn k islcd od eilldilt in wstc'!' qrFn tiolr idulaE, B Eqrtld by 561,@ 3700 of lli. r$6cod..lathc FfcltllE of tlc which dft D6nn n inucd My sqr.r'' cmF !.ri6 iuuMe qi6 ad dicy i6!.i e:$me- E"r\ "^*,oqA- o/C/t'tt ,T l/0 /7--3/- U- (Thk !cti6 i..d .or bG c@da.d if 'n. Fhn i! rd otu hudrcd dolla ll l0ol d ,*) that in th. Ff@ue oa $. *ort for whi.h tli. Fmil I sh.ll nd .mploy ey p6e in ay ndns s a @ er !o $. wqk6 ' .eFBalie lawi of cdifdi&f I sholld b.cm subj.d b th. wort.6' cmp.nlatio prcviions ol Sccrio. 37Oo of $. L.bd Cod., I l],,LA4L wARltlNG: Failur€ b ieur. *0*6'strll subjc.t & @ploy.r ro crimind Fn.i 6 Md civil fin6 !p to dc hundrcd thMd dolld (Sl m,ooo).in $. L.br Cod., inr#r sd :trh.y's f6 c61 of@mpnBa o. d.f,lA6 a prcvid.n an tn. Sction 1076 oa LICENSED CONTRACTORS DECI, RATION I n.r.by afim !nd.r Fn.lly of Fiury l,\3l I 6 licm.d @dd of Cn!,tr 9 (ffidcin8 *iti Serion 7000) of Divisio 3 of rh. Buif,Gs &d PblBiN C.U.. ud ry li@rc i5 ir flll fG. I hdby .fim 6di FBlq of Fjo., dr.l tn@ ir . iaucd (56 lorr, Civ. C.). ln th. pcrfome.. of th. vort for whi.h rhir p.mn it APILICAIIT'S Df, CI-,/IRATIOII Dcmolirid Pmin-Alhdc Norili.5ri6 F.ddJ R.Sulrid (Tid. 40. P.n 5) _ i.quirld llld of Noriiqnm Gra.dii8 ab6r6 lftm.l @ nol rrDti.lbl. [o tht Fojdt k cd6t I aEr+ to c@ply vio all City ud Cowry athsia r.pr6al.tir6 ollhn Cny d Counly locnl.rupon lh. abov. midoncd proFfiy fq 4-r8-oz- APPROVALS COMMENTS Other LicagCl&:_ -------T------ :[-----l------ ------T----- I = L