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APPROVALS DATE tD/stG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />ft/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh 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 />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release
<br />FINAL 'il<1ts4 -.{,lll4,'d tf{o h Ar'z
<br />Notes, Remarks, Elc.4laa(aaa bb.P,.,
<br />,Q1{-. tt a_<tzst"-t
<br />OWNEI EUILDEN DELCARATION
<br />I rErcby rffirn undcr Fn.h, of rciurt rl'.r I m crcm nom rlr Co raloa Lic.n* kw tor lh. folhwi.S E Fn (Se.?011.,
<br />Busi.cs lnd Prof.ssion Code): Any Ciry or Counr, which EquiE. a pcmil ro coNlrucl. dLr, improk. demlirt or qBn dy
<br />sru.rw. priir ro ir3 i!ruo@. .l$ RquiFr rh. .ppltor fm sucn Fmjr ro 6lc ! si8*d $arcmir thd lE d rhc h licn$d pumul
<br />ro thc Eovnions of a Conrr{.lot. Liccncd t w lchlprer 9. Comnercing silh S.clion 7000 of Division I of lhe Ausincs and
<br />Phfcssio.s Codc) o, rhd h..r shc h cxomti llrrct om d.d E 6&sls tor rlE 3lk8.n cx.trV,lion. Aoy ,iohtion of Scrbn 70.1t.5 by &ny
<br />opplicoor for a Fftir subj(ts lhc ll)Pli.antro acililp.n.lryofnot mrcrhln nv. [ondcd doll&s (5500)
<br />-1.
<br />&r o-ftr ol th. pmp.nr. or ny enploter wnh wa*cr $ rlEn $b .onp.n$lion, sill do l,E wort ad lhc srnt|ft ir tur
<br />ifl.dol ar o[er.d fo. elc (Sr.7044. Busims a.d P,of.sio.s Codc Thc Conrrcrois liccne (jw doc. oor dpl'I,
<br />'o
<br />d owncr of
<br />rhc trop.ny sno hnildr or iqm!.s th.mn. ltd wlb d6 Mh w* hinrclf o. hcrslf or rlmugh his or h.r ow..mpbyccs.
<br />rmvid.d rhar s&h inrmwft.rr @ er hr.nd.d o.oftEn 16r sh. I( toreE lhc buildin3 or itrEmwn nsE*nhinoftJdr
<br />ofc.n{rldior thc o'xn$ BuilLr uill hllr lhc blrdd of I'lvitrB oEl l8 or stu dn mi hoild or i,qms It ImtEny for lh.IUrFxof
<br />-1.
<br />as osncr or lhc pmpcny. !m cxclusivcl, conrMlins sith licensd conr.!ck,* h .on{dcr rlE !roi{ (Sc. 7044. Blnrcrs
<br />L,i Pn,r6\iriCod.r-rh.Co6k.ctor's t-iccn{ tjw docs nor rytlyto anoqncrof!'n,pcn!*ho build\ ori'ryovcs lh$.on.
<br />!trd who onrrucls for slch pmjds wirh !Conrtucrods) liccnsd plExdm ro lhc cofidors Li.cns Lrw).
<br />I amcrcmDt und.r Sauon . B. & P.C. ror lhn rca\on
<br />D.l.: O*n..
<br />llrarES$!)llfENsa.rlaN
<br />DECI.A8AIXA
<br />I hcrcby sfllrm!.dc. pcnallyof pcriuryoft of rhc fdb*im dccLBrions:
<br />-l
<br />hlvc n will nEinrain ! C.nilic,rc ofconsnr to sclalnsurc 16r workcn con{..salioo. as pmvidcd for by sc.li{,n 1700 oirhc
<br />La|(tr CoJc. for lhe l,cnbrm0rcc o I lhc qolt nn whicfi thc Frmil h hslcd
<br />co p.ns inn insunncc. a\ dq n.d hysc.rnn l?0oofrtu L.horCodc. for rhc Frr.rna(c dt
<br />'conlrn\rrio. in\nran.. .micr dM Fni.ynrmbcr irc:
<br />t 1
<br />I ccnili lhat inrh. pcrlnrnurccoflh. wort lor whichlhis pennn k issu.d.l rh'u nor.nploy lny r.6on in 0nymlnnc.
<br />s !s ro bcqrm suhjccr lo rhc so!t.^'conpcn\ t,n lnws orclliromE.ftl a8rcc rnal ifI snouB heom {ubjd t,rla
<br />krkcr'conFnstiontntl\ionsolSdrbnlT(x)otrhcLihorCo<lu.lsh,ll.fonhqirhomplysithrhosPm(nionr.
<br />IVARNING: FailuE ro suE *orkcs coryEnslirn covcEgc is utrlawf!|. a.d \hau lnbitr e .q,lo)tr ro aiminol lrMhics snd
<br />.ivil timr up b onc hund.cd lk)usud dollors ($loo.ftx),. in co'npc6r.tion, dlnagcs !s providcd tur th.
<br />{r-tl.
<br />UCINIIILCONISNIAA
<br />IIEIIABAIIgN
<br />I hcrhy rlltr unds,'.n.llyoloerjurr lial I !m liccnEt u.d.r rmlnnrn olCh,rrd 9 (.om.Emin8 sirh Scdion Tlr(l)) olDivnn,n:l
<br />or rhc Busincq\ani Ptur.ssions(id., dnd nry liccnsc is infulltuNUdcliccr
<br />-J0 c-3 8Ll e
<br />ralutsl.J-llQ!-Iliulllli li!)(r
<br />I hcrcl,y rlftarundcr p.nrlry
<br />i$ucJ (Scc.3(x)?. Civ. C.)
<br />ofFrJUryrhlr rhdc i\ r.on{dcr*r lcndirB +cncy nn thc Fnnrromc ofrhc sork ftn shf,h rhh
<br />IITL,IIANLDEILIBAII9.Ii
<br />I lrNhy llltirD u ndcr pctrally ofpcrlny onc ofrhc t{'llo*ins dcclirlrnn's:
<br />Dcnfulirnn, Pcr.rir\ A\hnos N.rillc!ri n frdcralR.guldion\ ('lirlc lo. Pfia,
<br />-R.quncd
<br />Gttcr ol Nolill.rli,{'
<br />I c.dilirh,t tu icdcr.l rcEU llr io ns Esdd ils o$Esros rcfr,vrl arc norlPplicrbl.r, rhas [orccl
<br />)|(-nnr ,n. , t* .,o ,nh ap icarion !d $arc rlur rh. rhrc int,rntroun is .{rNr I as,a h compry sirh arr c y 'id counry
<br />odiMtr.cs lod Srurc ti*s rclat ing b buildingc.iitucr Md hcrcby0trrhori2c eprcscnralilcs oflth Cn, ud Counlyro
<br />atx,rc nEnri,'ncd pnrp.n, r(, in\F.rio.
<br />IAfplicrnl or &cor Sismr!rc:I
<br />5 LD^tSt
<br />-.,o^i-t{-l Y
<br />MECHANICAL-INSPECTOR RECORD
<br />1{
<br />P-.,***lp,,Oj4
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