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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I h6.by al6m uidB pdrly of p.ouiy tlDl I d .r.npl film th. contr.clos Lic.ns. kw for lh. lollowi.S ..en (se.7011.5 ,Bsin@ .d Prcfdioo Cod.): tuy Cily or CoEly which r.qniG s Fni to coisltod. alts. inPfove &nolisl' or Epai u, <br />roduc Fbr ro tu is&c.. .&o reqoic ftc arplicor lor such p.ron ro 6L ! s'Bn d $!n@l ihal lE or slE b li.6.d BEUltlr r <br />ro rhc ptuvisiotu of rh. Conr.c|6! Licc.cd kw (Ct!pl6 9, Comddcins pit Scdon ?000 of Divtsio! ! of ln Buird md <br />Pofcsiom cod.) or $at h. o. 3h. is cropl lhucton ed lh. basi5 fo. llE dl.g.d q@ption. Ary viohdon ofs.dion 7031.5 by sy <br />alplicel fo. a p@il lubjcts lh. applicanl lo s civil p@lly of iot DoE ll'm fiv. hutr&.d dou6 ($500). <br />-1. <br />a oMd of $c ptupdn or ny cnployG wifi sas6 a rh.ir elc @mp@snion. will do 0E e* Md Ihc slr*r@ n @l <br />i o<kd oro,rs.d tu. sL (Sc.704,1, BlsinB ed PrcfBi@r Cldc Tnc cotndclor'3 LicG. L6w aod nol a+'ply lo &oMdol <br />rhc ptnpdry who hil& or inFoB fid&{ r.d who rb6 3rct w* hicclf o, t@lf or rhrcueh hi! o. h6 om mdord. <br />providcd rlrat su.h imFovoErs m ml inrqn d oror..d fo. Fh. l[ tws. tlE tuildins o. iiprov@l i] $ld *irhin on. ]a <br />ofconpkrion, rhc olm.r Builda wiU lErc ll). h{rd.r olFovi'B ord lE or 3lE did ml build or ii4roE t. FoFty t . dE Brp6. of <br />I. s oM6 oathc propdly, m .rclsivcly contradin8 s,nh lic6*d contradoG ro o.srtud llE p.oj6i (Sd. 7044, BGiK <br />.nd nDfsbr Codc: Thc Conlru.to,'s Li.cE. Law do6 nol apply to a owna o f prop.ny wlD buil& or inprcrBlhdd.. <br />Md who onr&crs aor sucl Fojrls wnh a Co dcro(s) licd*d p6@n ro $c conl..clois Li.dc llw). <br />_l @ d.mpt undd S@rion . B. & P.C. fo. lhb ,!@! <br />NORKFRS' COIII'ENSA'NON <br />DECIASAIIAN <br />I h6cby .,Im lnds p6shy ofpqjury o.. ol the followits d.cl.ralions: <br />-l <br />havc &d will mirtain a Ccnihd. of Congl ro S.lf-ltuuE tor srlG! omp6$lion, 6 Fleid.d for by SElion 3?00 of lh. <br />L!h.r Codc for th. Faolfus olln. md( for whi.h lh. p6hil b isu.d. <br />_lhaleandvillnainraiiwo.r'compo3lrioniBqanc.,srcqoralbySdionl?00ofth.tborCodc,lorlh.pofo,l@aof <br />conFG.rion i6urm.c ffi.r ed policy nunbs rc: <br />o14 I-vqwcq-l r.l Da)q l t1 <br />-l <br />e.rii rhd itr rh. p..tomec of thc wort for phth rhis pcrnn i! i$u.d. I ilDll nor oploy ay p6s. in any mmM <br />s E rc t .om. snbjer ro rt wort6' omF.!.rioa hws oacsliami& d .sE lh.l it I slbuld b€.ot€ subti..l lo llE <br />work6' corp.Nalioi provi.ioN olselion ! 700 oaln bbor Co&, I sh.ll, tonhB-ilh omply silh $osc ptuvbioa,, <br />WARNINC, Failurc ro su. *0&6'tul. and sh.ll subjst m mpk,yq Io si'ninal poEhB @d <br />cosr ol compqssrio.. deage a prolided tor lh. <br />o.,", '- I I K I <br />!!ct A8a!a! <br />I h€rcby afrrnr undcr pcnalty o I pdjury rirt I d licdsd undd provilio. ol Chaptq 9 (cornrocing with Satio! ?000) or Division 3 <br />of rtu tsGins d Prolstuns Codc. dd mv licase ir ia full foEc and cltel <br />-C..?-o _f lcoS )t D <br />ss <br />calllarcuoNrrNj)luc-dc[lcr <br />I hmby arm undd Fnalty oa psjury that lho. is s omlrudion ladinE og6cy for lh. psfommcc ol rhc *ork for wnich lhis pconn is <br />issudl (s6 3097. civ. c.) <br />A}II,ICAULDECI,ASAIIO! <br />I hdtby alfti undd Frlry of pdj6y oe ol tic following &.hrario6: <br />D.molhion Pmtu-Asb6r6 Noin.dion F.d6.l LellaioB CInb a0, Pan6) <br />-R.qut <br />d ttrtoof Nolificlrim <br />-l <br />.diry lhlr rl'€ f€dtr t tcsuldioB r.suding 6bd6 rdolal ac @r @pliGbL io rtn pm.id <br />-l <br />cdliry rhar I hlvc rdd this ,pplt.r srsl. lhar fi. ltovr i.fomario! i5 cor*1. I 6eE ro 6mply s n oU cily 6d count, <br />ordin.ncB md Skrc tiss Eld ion, ed hd.by .ulhonzc qr.stlari!6 ofrhb Ciry and Coonly ro dls uIEn lh. <br />lt <br />4- <br />s t( <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 Ranqe <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 I <br />FINAL //Pbz .&tsl <br />Notes, Remarks, Etc./ tv, <br />M! <br />8 <br />c <br />abov. maiion.d p6p.dy aor <br />r-------T------