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APPROVALS DATE ID/SIG,COMMENTS Appliances Ir4elal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer a. .ls,l"4@;lt-n-/9 ,.iltoz Residential Range Other 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 ,t J-.* -/FINAL AYle-o vr.-7\nr-M) Notes, Remarks, Etc.Irl tl I O\&N ER BUILDER DEI.CANAIION I fid.bry srtrm undd p6.lty of pdjury lhlI I d cxmo ion lh. Cohltacros Liccns. t2w for$. fotlowing !!en (5€.7011.5 Bcin6s ed Prof*ion cod.)r Ary Ciry or Co@ly which (qriB a p6nn to coisltud. allo, i6prcv., &inol,sh or rAqi ey 3itucluc Fio. lo iri isoe., aLo r.quir6 lbc .pplicel lor ruch p.mn lo frb ! sign.d $dci@l thtl lE or slE ii li.6a€d pa$ut lo 1te pmvisioN ot th. Contr0clol. Lie.sd t w (Cta!l6 9, Com.ncing win Sadon ?000 ol DivLion 3 of lh. Buirc$ ed PrcrNio.s Cod.) orthll lE or!t. i5 q.n r thccliw od lh. baiir for lhc all.s.d darplion. A!, violrrion ofs{lion 7011.5 by dy ,9pli@l for rp.mn subjdllrh. applica b a.ivil !@ltyof "or mrc$u liv. tundr.d doum(1500). I. d oMn of fic propaty. or 6y .Eplor6 wro erg6 s th{ solc cohpqBaion. {ill do lh. vc,t ad rh. *ldft i! sl itrdt(H or o0aql tor eL (Se ?044. BNi.d sd Prcf6iod code Th. conlE.lois Lic@ kw do6 nol @ply lo e osG oa rh. FDpsry wto hoil& or imF!6 fio6l! lld who dG sch srt him.lf or h*lf or lhDush hi! or ha om .mPlord. provid.d d $.h inFovalE rls c ml inlad.d ddldd 6r sL. li to*c. rh. t idine or inp.&dE !t $ts vi'nii oi. t a otconphrn'(d8ordoB!iE6silh.th.hddofFtrvngth,h.orsltdilmlbuildo.nnFowth.FoFryforlh.Bdpo*ot -1, s oMs oathc pmpsty. m aclui!.ly conf&ri.s with licftql .onrrdos lo coisrucl th. projdr (S( 704,4, SBiIB and Prckrbn Cod.: Th. Conloclor'! Lic.tuc Law do6 nol apply b 6 .*n6 oaprcFny eho builds o. inprov6 thmn. dd who oitids hr su.h plojei! wnh a Co Bdo(, lic@.d puRuan lo rhc (o.rr.croi3 Lic@ Law). -t M.xdfl undd Scdon-, B. & P.C for lhis r€$n. D.lq o,trE: lroSsEE!:coMlDNiaIo!uEclAlalla! I hdcby 6IIm undr padry ofpBjury of,. ofh. hllowin8 d..laalioB: -l hav. dd$ill mainhin r C.nifical.oacoNnl lo S.lf-lcuc lor mltdl .onPd30tion, 6 Pmvidcd lor by S.ction 1700 oflh. Lsbor Cod., for lh€ pqfode.. olrh. *o.t fo, trtrich $. p@il is i$u.d. -l have 6d vill oainhin workcn comp.Briion imuranc.. 6 requir.d by S.clion 1700 of rn. Lobor aode, for lhc pqlbmec. oi rhc worL lor which thb p@il is iasu.d. My wo,k6, comp.nsotion ituure.c cani ed policy numbs e.: Policy N@ba:-Elpt6l I csirylhar io rhc p6tomoc. ofih. {ort atr wfiicfi rhis pcmil is i$uel.l stall not mploy uy pd$n in any neno e s to b..oo. cubjdl to llE *!rk6' conlqsalion laws otcalilomi& Md tgK rhd if I should bdom. subjd !o ttc sort6' conpasriotr proviiioN of Sdion 1700 of$. Lrbor Codc. I shrll. ionhwilh comply wnh lho* ptoBiod.. WARNINC: Failu. lo sm work6' comp.Nlion civil no6 up ro orc t@dcd rhousd dolls ($100 Serion 30?6 of thc Lator Codc, id6.{ ed lnorEy , i5 unhwful, ard shrll srbjel & aplord lo diinal pdahi6 dd in lddilion lo lh. @31 ol compcNiion. ddag6 a prcvidcd for fi. Drre_ Appliont: I h.rcby alrm !.d6 p.i.lty oapEjury thd I m lica6.d ofchlpld 9 (comacins rvith Sdlio, 7000) ot Divisio. l ol the B6ins md Pols@E Cod., md ny licd* b in tull forc.6d c,Id o--L \12\ I hcr.ly amm undd p6all, of pejury lhal th6c is . coNlruclion lddins srnc, aor rh. PsfomMc€ ollhe so.t for whi.h rhis lEmit is issucd (sfr.1097. civ c ) ASEICANI.DECI.dMITO! I ha$yaIftn!od6 pqalty ofpqjlryon of th. following dd@liois: D@olirion Pmirs-Asberos Nolificarion Fcdfrl R.sllariois (Tirl. 40, Prn6) -R.quircd taraof Noificdion -l cdiry that fic f€dcral rcrll.tioB rcesd!8 6b6los roDval m nol spplicabL lo thi. prcjd. -l cqri& rhsl I hav. rad rhis dprlicdion 6d !tar. rhar rh. abotc i.aomation is corel. I asc lo conply wl1n tll Chy dd Coul, ordimce md Shr ties relnliry t ildins codtucrion. ard hcreby sulhoriz. rcFMtalir6 ot this Cily an<! Coult lo dlq uPon lh. .bov. mmlion.d popdy for pplicdl or ABo' sign.rurcl II MECHANICAL.INSPECTOR RECORD Hood f-------T------ --l--