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MECHANICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR-ANON I hncby rrm uidE Frny of Fjur' lht I e .rdpl frlm lh. ColnEct.c l,icGe It* fo, th. followh, r.sn {Se.?041 .5 BBin* .td Pol6sor C.d.)r Any Cny or Cou y snicn r.quiE . pdf,ir lo onntud. rhs. inprev., danolilh or ,ip.ir oy $tucr@, rbr to h3 isn c.. .ko E!ut6lh. +?licd for such FnI lo frlc ! !i8i.d cd.ffil lh.l lE or.h. ! li.d.d P@&l ro rh. lrovtioN of $c Cotlrnto-! Lico.cd t s lchlpId 9, Comhdcins wnh S<tion 7000 of Diviii l ol lhc Buits ed Pref6ioB Co&) or {ut lE or !h. t .rmpl lha.from bd rh. bGs for lh. tll.*.d .\mFbr Aty violrrFtr of Sdb.. 701I 5 by,.y ap9li..nr for d pnril subjds rh. sppl'cad lo 3 ovn pdrltJ nf.or mr. rhd fir. hurdrcd doUE ltSlro) l. s oM. oarh. FFty. or hy .mploF. $ilh wlsd s lh.n $t cobposlhn, will & lh. vort !d $. ni.lc ! ml i, aiGd d otr6.d for eL tsd.?044. Bsin6 &d Prcft.lioN Cod. Tt ConlrE ld 3 Li.@ k* do6 lot eply l. d oM6 ol rhc r.oFdty wli hil(b or if,r66 tlEa ,i who {h6 Mfi sr* hins.lfo. h@lf or lhmuBb hi. or hs oM dplo}t€, provid.d rh.l &cn imrmrqGnr & mr i[6dd or of6.d lor sl I( rh$'6. llE hlildi'B or irprcGcn !t sld Pita oi. ]6 oforpldia rlE (,*16 Boiltd viI hlE $. hndd ofFDvins rhi h. o, !h. did Nt hild or inFl* tlt FoFty ftr tlE F Fror l. s o*n6 ol th. Fopary. m.tcl8iv.lyconr.di,s with licG.d cofin.1oE 'o.otrntu(1 lh. F.j..r (S( ?044. BEBS &d hofsid Codc: Th. Conr6dort Licos. Lrw &6 .ol sppl, lo & oqnd ofpro!fiy qho bxil& or imptov6 lhdon. rnd st 6nrds ao uch pmjers {ilh a Conr6cro(s) lictucd puEomr ro rfic Coiiradoir Li.E& trv) I &n.r.mpr unds Satnrn B & P( tu rhis r.a$n. uoasEac.(au8[NrArla! DECLARATION I h6.by amrn unda Fnany of psiury oft oflhc follos i.s dehraiiom: I h.!c mi $ill 'ndinra'n. ( difical. oi(..!at ro Sclt-lostr. tor \orrss'coflnq$ ion.6 Drevid.d lor hys<rnln:r'r(r0.lrh. Iltx,r (i.t.- lir rh. psfonnan.. I f rn. s orl lor $ni.h r hc psrnr s i$u.d Ih:v.&d$illmtri.iI\orle.omFBatio.iB!,u..sr.+tdbyStrlhr1700oflh.LlborCod.,forlh.psfomMc.ol rh. rcrt for whkh lhis p6iir is isunl My wortd- smp.iEdiof, ifturMe @id &d tslicy .ombd c: I c.nit rhd in Ihc psf.mncc of rh. sort hr {hich lhk Fnir is i*u.d. I rhlll ml dploy uy p($n in tnt mME e.rrob.$o.,obj-ttofi.so *' cohFrEdion bs r.f C.liaomi!. dd asr6 lhd if I 3l$old b6omc rubjd to lh. sorld' Nnpoerio. poviriom of sEiion ll?00 olrh. L.&r cod.. I slEll, hflh$ nh (omply wirh lfiok 9rovbio6. WARNING F.ilurc ro suc $orL6'co6!.tqlion.orras. s unl.NtuL ed 3htll subjct e drlola lo oni l FEhi6 ed civil fin6 ut lo on. nunrtr.d lnousd dolls ($100,@l)), in.ddirion io rh. con olconp.etion. &nagB d proid.d lor lh. SEtion 1076 ofth. Lsbor Co&, inl6.n ed dlofty s ad lll.Irlf,u(l,Nll(rcB UEC=!AA!!.(A .l rh.llrsinssand llolssion\cdc. md n[ lirfli.. s,n rL'll ir.c dnl .ai(r (onln.tor ll)lsj4lclllrd,rlDllclliErll I hdeb!.mnn u"ds pcnihy ol tc|Uryrlrd rh6. k a.o.srtudi.n lo ins.sflc) turhcporomM...irh.norl lot \ h,ch rhn Fnrir ir ksu.i(s..:roer.Cn.( ) AIIUI NLDIi(I,ASAII9! Ihs.tl} allimunds poahy oapdju, on. of'hc loll \intdcl0rartunv D6olirtr)n Pnnrirs-AstEsr.s Notification licdsalRetularrns(Iirl.{(i. Ptu161 Reqtrr.d t.cus of Noxfi cari{m I .dlify rhd th. f€d@l raulario Escding sb€ros rmolal e. ml lpplicnbk lo tht prcjcd. I .aif, rhal I ha\ c r6d lhis lpplicd ion sd nal.lhal tlE dn\. inromdion ir .on..l I .grc lo ospl:/ shh lll Cily md Cou.ly ordituncd r'd Srarc l-a\rs Eldi.! to b(ilding cotrslrudiotr rn h@b'l lulhoiz! EFtrlnivd ollhir Cily .nd Couly lo olc uF. fi. .borc 'Erioncd porEry foi iGpdlion purD€6 ppli.mr or A86t SiSnaturcl Ponir*.arc(Iriio Appliances [\/etal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rouqh Ductwork Toilet Room / Clothes Dryer Residential Ranqe Other Hood 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 FINAL h4/-r4 br€/dt Notes, Remarks, Etc Vents L