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MECHANICAL.INSPECTOR RECORD OWNTR BUILDER DEL(:ANATrcN I h6.by dIm $dd Fulty of pdjury $d I m .x.E r lion rhc co r.doB Licce LN for rhc tollo$i.e .!@. (Sn.7031.5 Bqin6! d'd Prolaion Co&)r An, Cily or Coud, shich r.quir€ ! Frnil lo co.!rod, dl6. nntNvc. d.holifi or E .n Dy ' sl[clurc Fior ro ft nswc. 6I$ r.q!i6 lhc lpplkot ror luch Fn ro fi|. ! siBn.d 8ln.lml lhd lE or 3h. i! licoi.d plEdi ro rhc !.!vnioB of lh. Conh.rof! Lic..*n l*v (Cll.rr6 9. C.mdcinq $,irh S.crion 7000 of Divtion I ol rh. Burtidr ud Prcf*ioro co&) or rhar hG or rh. i! .r.npr $ftnod od rhc b..i! ror rh. .llq.d ddprion. Aiy violdiotr ols.flioi ?ol Lt by e, ' dpplicMl ao ponil subjcl3 rhc .ppli.dl lo r civil p.ulty o I nol Eorc rhrn fiv. hon&.d dollm (ltoo) - -1, a omd ofItu pm!.ny, or my cdFloyg sirt v.g6 s th.n ek smFrsalion. $ill do lh. Nolt sd lh. enf,16 i! rcl iitod.d or ofl6.d hr slc (5€.7044, BGins dd Prol*ioN Codc Th. Comrldois Ltce Lrq &6 ..t .9ply ro an osn6 of ih. p6p<t, wlb buil& or iiFlr6 rh@.. .6d who rh6 sh ulrt hitu.lf or lE*lr or rtmlBh hL or hd os. oploltd. Drcvid.d lhll !u.n imFovamE @ mt hlaxLd or oftdd for sL. ll fioN*., llE hildiry or imFosE is sld $ithh onc yr ofoopldioi. tlE olrG B{iE will h.rt rh. hr.(kr otFlvina rhi h. orstu did nor hrild or itnFnrr th. prr)pc1y tor rhc pu,po!. of L B o"nd of rh. pr.rary, o .r.hn.ly .onr&rins wilh licd.<t co'nradoa h .otr{ru<1 rh. !roj..l (sc 7{}t4, t}LciK and P,otosnn Codc: l hc Contnclois l-i..nsc l,sw do6 nol.pply 'o an owr6 oi prop.ny s h. build! or nnpror6lh(sn.ed sho 6nrrnl! for 3kh projcrr *irh 6 Co.!relo4!) lic4.<l puEuor ro rh. c..lr6nor's Lk.N bw) Ian.xcn und6 S(tion .8 &PC forrhGr.Mn t!.aaEE8s:l:oufENrAIIa! DEqdSAEqB I heby amo onds p@ahy olpqjury oi. oarh. lollowiiS d..ladnrN: -l h!v. Ed will minllb . C6riaE.r. of ao66r ro Sdf-lNN for worta omFNrio.. a F.vid.d for by S6rion l?00 of th. L.bor Codc. for rfi. Ffomo.c oalh. *orl hr shi.h 0E psmi b isu.d - I hlvr &d \$ill mlinldiD wort6 comp.Ndtior idor c.. a r.llon.{ by S.{ion ]70o of lh. ljbor ( ode lor lh. p6f.muc. oa $. ert for s hich lhi! Fnit is isu.d. My $0116 .o,npdsd ion iBurdc. catrir e p.li() numlEr6.: PolicyNumb6: I cenify lhat in rhc pcrlon.rnce oiine \!rI lbr \hich rhir rc.inil h issoRl.l shrllnol dnpl.r.ny. l{son rn in) nrinncr $ Nro b.com. !uhj(' 'o 'h. \.rrds composrnrn h(!.f( alit mri. and asrd rhd rII shold lBon. srbj.d 'o 'ltr$o*4' .onrp.ruarion t)l o\ isions o I SNI ion I7c{ ol rh. Latrn ( odc. I shll. fod[s irl c.nl}nr $ irn rls* r,u isnns $ARNIN(; l:3'lur.l(' $.tr'. so,kdi n cov@$ h u.lawful. ed 3n.ll suli(r !n oryhDo lo oimi.al taahiG ud civil fin6 up ro on. nund,.l rh.Nlnd dolh.00.000). in lddition ro lh. cGl oa.oop.@rion, don.Nd.3 provid.d ao. th. "*Jhcrohn fvla, i.Z'tol I hc,ebyamnnukl.r poallr o l priry rlml I n lild*l und.r ri o\ isnm of ( n.prs ,) (connncncirs \ irh S(l iu 7(r(r0) of Dn istun l of lh. Busind and Prea6sio6 ( od., od nv lica$ i5 in arll for.. dl .lTd L'7-O tozA 121 f(aen -J]vac t tJ c I hdby !flim u r poahy o|Fjury lhd I isu.d(S(. 1097. Civ. C.). is..oNd.lion kndint !86c, for theFfonrancc ollhc $orl llr \hich this pcnil i! l-tllJ( t!l_DE!L!!!.!llOr lhcr{,r nlJntr,utrdc' pctrrlrr- olfoj ) oncol lh( lall(Nin! d.cli.iii,!,s l)cnrn i()n 1,.' riis sl*n\s Norilicdriur l,rtl.'rlR.!tr ilnn* (Itrlu.1o. P rn) Rcqtrtrcd 1.fl cror'N.rlllc i(nr l.ql'lyrhar rhc fcdqol r.lularFns rcEddins aslstos rono\0la,e tro! $fl'c.hl. ro Iht p,ot(r th€ oboE inloflmrion is cotrel. I !3G to conply s ilh illCir! rtrd<'ounty APPROVALS DATE ID/SIG.COMMENTS Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork 6"K-t7 v.v4t Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar A\ Rough Mech.P-q-t-7 o-\4ID Final Test U Meter Release FINAL 2-t6"ly v.w1d -'"*"^ "' *:';z';/;;; ;* -Notes, Remarks, Etc. I-t