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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE COMMENTS <br />Appliances <br />Metal Fire Place <br />Evap 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 /n\ <br />Toilet Room / Clothes Dryer 5.v-t*vll4l) <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 />FINAL /nb/tk ('trzt>rt+-/62-,-/u <br />Owrd-B!ildr D.cldtion <br />I h6.byrmrm under pd hy ol p.rjury lh.t l.md.mF lomtn Co.l6.ro Lic.n* ttw aor $. lollovins r.&n (s4 7031,5 BcinBs <br />&d Proa6rio. Cod.): Aly Ciry or Coorr, *hich r.quir6 ! pcml ro 66riu.r. !lrd. inpolt. d.mlish or Eplt rny srDclu.. Fior ro il! <br />i$u!n.c. lLo rcquiG lh. .prlio'n for 3uch p.mn b fiI. t riSncn lt.r@nt thrl n or sh. is lic.Gd p@@t lo 0E povisios of thc <br />Conkdoli LieB.d L.w(ChlFo9, Coftn.rci(g wnh Setion 7000 of DivB'o. I o t tn. Bue'n.!! lnd Prot63ioN Cod.) or thtt h. or. <br />3hc n .x.Dfl rn*n'on .nd rl* bei! for rlrc lllq.d .&dprion .Any viollrion of Setion 7011.5 by ,ny lppliclnr lor ! pmil lubjcft $c <br />+plicanl lo. civil p.dry ofmr mrc lhm nv. hu.dr.d.lolLa (1500). <br />__l, 6 ownn 01lh. pFpcny. or m, cnployB *hh wrga a rh.t el. coBp.tuarion. will do lh. work dd lt. nrudw i3 .ol inrddd <br />or oreEd for s l. ( s.c 7044, Bulm.rs lnd P,oL$ion! Cod. Th. Conlncro* Lic.ns. Llw do6 not .pDly ro !n oMd ol rh. pop.ny <br />*ho buil.Lr or imDo\s rha6n, dd *h. dod such sork hituclaor hdlfor rtmush his or h6 ow. Gmploy6. provid.d rh.r euch <br />improv.r.nt e. mt ht.nd.d or offd.d lor sl.. I I how.na. lh. buildin! o. ifpbv.ncnt ie sold wnhin bnc ycar orcodplaion, $c <br />(rncFBuild.r will tuv. th. burdci olprovi.B th.r hc or ih. ,ol build or nrpDv. for lh. plrpo* of r!h). <br />_1. a ownnolrh. popcny. @.rclori!.1, conmdins whh lic.acd contr..roa ro $Nlrucl rh. pruj*r ( Sft. ?04{, Bain6i.nd <br />tuoaesion cod.: Th. contr<ioa! L.c6. Lrw do6 nor .pply lo & o*B of propsry wto builds or iDpov6 rtqotr . and who <br />comrcrs for such p@j.cls wilh a Co !cro(, lrc.ns.d puBunt ro th. Contmdo.3 LEn!. kw ) <br />I @ cx.mpt n.d( s<rion ,8. & P C.forfib rcaoi <br />WORXERS COMPENSATION DECLARATION <br />I hq.by aflim und.r pcmhy ofpsjury orc oa thc lollowiry d(l*.lioN: <br />_l hw. .nd e ill oainl.h ! C!nif'@r. of CoB.rt ro S.lf.l Gur. for @r!.rc' cotrr.nsrion, a provd.d lor !y Sdion ITOO of $. <br />hbor Codc. fo. th. p.rfomm. of thc wdl for *hi.h thc p.dir i3 i$ucd. <br />I lnv. lnl snl ,ainlam wort.rs @mp.n$lEn rsoflne. c ..q!n.d by S.cIion lT0o ol th. ljbor Cod., lor th. p.rforronc. ofln <br />.omD.narirn inrumn@ ffin lnd policy nuhh.r ecfu r2"..._ <br />r:C (oVlo t7a 8tz4 tt?6'i.*ai""*ffi[roq oircs; / rf ,- <br />I c.niaylh.l in lh. p.rformnc. oarh. wolk aor qhich lhk p.nnir is irsu.d.l shnll no'.nDloy ant p.Ron in.., ma.n.r so 6 ro <br />b.crmcslbJdl rornewoil.R omp.nslon L*iof Calilorn,,nd rsr.e r <br />compctulrion povisions of S*rioo l?00 of lhc t"::,ff <br />WARNINC Fail!6to !..ur. wo,[.6 @mp.n!.t,on cov.ris. rt uihwful. $d slEll subjd !n.mploy.r to criminalp.NltB and civil <br />fh6 up lo onc fiurt.d rhoMd dolls ( I100,000).i!.ddnio! to th. cGt of conp.Ntio,t dro!96 a prcvid.d for rhc Sdioo 10?6 of <br />lh. L,bor Cod., inleGl .nd.nom.r's fd <br />ueElsE!-qoxlBAcroatulclA <br />I ho.by.mrd undq pcnthyofpdjury tn3l I am lic.nscd u.dd pmvkion ofChaprE 9lco,m.tr.inA with S.dion ?000) ofDivision I ol <br />Cod., rnd my lic.cc is in foll forc. ud.ltel <br />Ll z- <br />ca!s!B!rcr!9!_t!i!!!rc_acExtri <br />I hcrebr.flnm ondd pcn.kyof!. urr lhar th.Bk acoBrtucrion lcndins lgcn.y aorrhc polomanc.otrhr*or[ fffsh'chrht podil is <br />nsucd (Scc. 11097, Civ C.). <br />AEEIC6IIIL-SEOJA I!q{ <br />D.molnion Pmtu'A.h6lor Norificlion F.<tc6l R.aularionr (Tnk 40. Pm 6) <br />R.quircd lrtd oaNori,icirion <br />--l ccnify rhd rhl lidml r*ul.l ion! r.B-di.e ab6roi roolal !r. no! appliclbLlo thii proj.cl <br />l..nio rhat I hrv.,eadlnisapplicarion6ndstare lhattheahovc inlonmrion iscor.d I asrec lo comply wnh all Cny ond Colnly <br />ordinaeG rnd Sraie lrls rclal in8 lo bu ilding Epc.nl.iivB of this Cny a.d Comiy ro .nt.r lpon fi. <br />S,I, <br />M \W P5i \Permil,lnspeclion F r06 <br />tD/srG. <br />Meter Release <br />D.r.: ____ _,olxnd. <br />5- <br />l.ndc,\ 4'lJ'.s.