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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNER BUILDER DSLCARATION <br />I hdcby a,Im uidd paalty of p6ju.y rh.l I @ qmo io6 th. cortE.loa Lic@ t w aor ln followif,B te$n ise.7031.5 <br />BBii6s ,rd Prcf6io! Cod.)r Any Cily or Coualy which rcqui6 r Fni to mE{rud. ahd. imptuv.. ddrcllh o. r.r6t My <br />lrrudue prior to ire i$@cq .l$ Equn6 rh. .pplicet aor such p6nir lo lilc a li8ltcd 3t!rc!Mt Ih.l h. or sh. b li.@!cd pucu.lt <br />to thc FovisioB of $c Co Eclor.! Lk.oed t w (Ch!fld 9. Como.in! $ith Sc.lion ?000 of Divisior 3 of lh. BBin* ad <br />PDlNioB Codc) or thsl h. or !h. i! .x@pt lhn frcn &d tlE b.5is for lh. sllc8ed adpfion- Any violalior ofsdlion 701 1.5 b, uy <br />applicel for ! p.mil $bjel3 rh. ,pplicsl to a civil p.,rly of not noE thd fiv. hun&.d doll6 (5500). <br />L a osM offi. popdry. o. oy @plor6 *ilh wrg6 6 rhcir $L comp.n$rion, wil d. th. *st dn rh. nide a rcl <br />idad.d or or6cd for sL (Se.7044, Buits ed PrcasioN Cod!: Tt€ Conlr doCs Lica* L.w do6 not eply lo M oMa ot <br />rh. Fopdr, who hikh or i@.oB thdF,'. md who do6 scl s* hituclf or h$lf or ll'euah I'n tr td om dplorG. <br />provid.d lh,r cu.h impmvad r @ ml inlad.d or oirdld for sL. I[ now6. llE buildiq or irrmmatl is eld wihio otc r@ <br />oa@ophrioGll!. One BliLk MU hrE ltE h(k otFoing rhd h. orlhc drd mt hiH or imFow dE FoFty lor th. pr!!o& of <br />I. 6 om6 olrhc FoFry. e ddBiv.l, conradins vth lico!.d coor,.cEa ro coislruct tlE pmj*l {s6. 7044. BiBinc <br />ed Eoftssion Cod.: Tb. Conkaclois Licasc Law do6 not ,pply to e ownd olprcFny who buil& or inprcv6 lhd@n, <br />ud {ho oir6.ls for 3uch plojds $itlt a colnE ro(, lkaEd plBud ro rh. Conrarois Lic@ Law) <br />I e crmfl lndo s<tion . B. & P.C, for rhis ren. <br />IAtSEStlCO!4rldtAIIO! <br />DECI.AEAIION <br />I ha.ny aflim lndd paaly ofpijury oE ofrh. followhB d..L.aros: <br />I h.v. &d will uiil.h ! CEtifEar. ofconsl ro S.lf-lsurc for workd ompoadior. a Fovid.d for by Sotion 3700 ol$. <br />Labo. Codc. aor lh. p6fomucc oau. wort ao. snicn lt. p@Dn i! i5.u.d. <br />*hdlcandsillnai ain worl6 .onpcGarion iNdnc., a rcquncd by S6rio. 3?00 oa '.t bor Co&, forrh. psfom8cc of <br />sort for whi.h rhis p.mi i! is.d. My worl6 conDoaaion iBlm.c c@d ad Ftcy .unbd @: <br />Lt <br />lbqc.74 o <br />-l <br />c.nily that in rhe pqlomsrcc of lh€ mrk for whjch this p6dil i! issucd. I shrll .or oplo, a!, p.coo io &, mend <br />e a lo b..om. subj61ro thc wo,l6'conp.erioi las olc.lifom,& od asr rh ial should bcofr.subjar lorlt <br />wort6'coop.GalionprevbioroofsaiionlT00oftlELrbo.Codc.ln'ullfonnwinenplywilhlhosprcvtioc.. <br />wARNtNc: [ailo. lo s@ sorl6'onpsdion ovra*. is urlrwtul. &d 3hr]l subj.cl d ddo]q lo Einindl pd.hi6 snd <br />ii lddirioi lo ll'. c6l of comp€Ntio,. d.mg6 .s provid.d lor lhc <br />s <br />DECIAAAI]AN <br />In@byartrn.drpoan,oapsj"ryrharItunliGr*lund{povisioioachaptc9(commd.inr\ilhSelion70001oaDniion.r <br />of lheBusin€ssad hofBionsCode, &d hyli.dse is in lull rorce od clT(r. <br />za .<,.c/o 7oro77 <br />!,!r5laucl!attE!DtNi_&c!!ll <br />I hcrcby riljm und$ Fnahyorpqjuryrhir rh5e s r.onsrn,cton lendin! rrm., lor nr p.Tlonrancc olihc\orl fo. \lhirh lhis p.lnril is <br />issr(l(Ss 3097. ('ir C ). <br />AIf,LI(A]IL!ECLIB4II!)! <br />I ngd,y aftnn uod6 p€nalt' ofpcrjury oneoathe a.lnnvins !(lmltuns: <br />Dcmohion llnrirs Asb.srosNorificarnrn rcldal Rcruhltuns (lirl.40, Pan6l <br />R.\uncd blto or Noriilcalion <br />I cElilt thal nE f.d.rol rcSulal iotu r€aardin8 Gbcios rdrov.l tre nol alplicablc lo lht p,ojc.l. <br />I coiay lhar I hav. rad rhi! applicarion ud 3ral. thd Uc rlDv. inaomltion is .ordl. I ag.e lo comply with all cily dd county <br />odiaancd ud Slal. Lass rchl to biiildinB co8rtuclio( &d hd.by alnhorik r.prenari!6 ofthi. City ed Cour, ro <br />abov. ndlioD.d pmp.ny lor <br />Applic&r or Asot Sisnauel r-'Z---.--Y <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Compressor <br />Misc. E quipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Rough 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 />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />/ <br />7/2-e,/h r'fr +7.a) <br />ID/SIG. <br />Furnace <br />Smoke Detectors lnstalled <br />Meter Release <br />FINAL <br />Notes, Refiarks, Etc. <br />T