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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporalive Cooler <br />Furnace <br />Compressor <br />Misc" Equlpment <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 />Iype I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />o penings <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 I <br />FINAL -an 7/l'( -'t^, <br />Notes, Remarks, Etc. 1 <br />-) <br />OWNER BUILDER DEI,ICARATION <br />I h@by lrm undd poDlly of pdjury ltol I @ .x.opt fron 0r. Conlm.loB Lic@ kw for th. aollowioe r.en (Sd ?01 I 5 <br />B$iid !d Polerioi Cod.): Any City or Cou y which r.qunB ! pqmn ro on$tuct, alta. improvc, ddnolbh o, rp6i ey <br />iloclurc prior to its i!t!dc.. llso rcqu!6 rhc a?plicor lor such pdnil to filc a sisncd 3talmat rhd hc o, shc i! li.@d p@dl <br />lo thc Fovi3ioN of lh. Conlra.lor's Licr!.d t w (Chrprd 9. Connd.ing wnh S..lion ?000 of Divkion I ol !h. Buri,* and <br />Prcl6ions Cod.) or rh.t h. or shc L! dmfl fic.fioh ed rh. beb for th. au.s€d qdprion- Any viol ion ofscdion 701 L5 by oy <br />spplic.it for. prEn llbjdc rll. rpplicam lo.civilp.!.Iyofnot Eorc $u 6vc hrdn{ dolls (1500). <br />-1. <br />a oma of rhc p(oFry. or h, nplorB wirh w.s6 a th.n $E.ohpob8lion. *ill<b th.wt &d thc ntd@ i ml <br />inlo{od or ofcrcd aor eL (Sc,7044. BNin* dd ProlBioc Cod.: Th€ C.nlracrols Li.a* Llw do6 nol lpply ro m oMo of <br />ln FoFly wlb hilA d inqro\€ lhG( dd alb do€ su.n sd. hihs.lf or h@ltor fircu8h nis or h6 oM 6nploy6. <br />Fovid.d th such inprovdMls @ et i d&dorolH for sl..li fiordd.ltcbuildins or inFolqdn iietd wnh[onc ys <br />ofconpktioq lh. o\{nd Buildc "iI hav€ th. hrdo oaFovin8 ord h. or ln. did @l tuild or irqow li. FoFly aor lh. p{qns of <br />_1. a ow olthe Fopsry, M scluiv.ly conlrscriq wirt licoscd ronlndos ro onslru.r thc Foj..1 (Sd. ?044. tlau6 <br />and PloGsrbn Cod.iTt. contrclor'r Lic.ns. k* do6 nor.pply ro M ov.o o atrop.ny *ho b!il& or ihprovB itdon, <br />dd *ho oiftcts torsu.h projel!{hh. Coddcro(s) lhsMd p6@r ro rhcCoffiador's Lic€e trw) <br />-l <br />@ .xmpl @d!. sdion-. a- & P.c. lor rhi! r.&., <br />D.re ornd: <br />]laaf,!8l:coMffllArotr <br />DECT.Af,AIION <br />I hd.by .mm undd p.n.ly ofpnjt y oi. of$c hllovii8 delelioal <br />_l hav. ud will dinloio . C€rrific.t. of CoMl ro S.ll-lNUr. for *ort6s coftp.Garion. a Fovidcd for by S..lio, 3700 oflh. <br />L{bor Codq forlt pslom$c.of th.mr} for which rhc Fht t i!s!.d. <br />,-l have and will minllin wo 6 conp.realion iNuranc.. c r.quncd by Salion 1700 ofth. Llbor Cod., for lh. pqfommc of <br />lhc \ork lor vhich this pmnil is isued M, sortd ompa!+ion ilsumcc 6iq od Dolicy rumbs EAIf.r..-( fllEvett*.4 /r/rtt1 <br />-l <br />cdliry lhll in lh. pdfolrw. of lh. woIk for which tbi! Fmil is i.$.d, I shlll nol 6ploy ey p.Bn in any Mnd <br />e N rc b.com. subj*l ro lh. {0*6' @opoaarion la$ oicalironi& ed asc thlr if I should b.conc subjd ro rh. <br />worie'omFsionp6vi5ioNoascriooST00ofthcttborCodclshall,fonhwirhcoEplywihtospFltioc,. <br />W RNINC: Flilure lo Ku. *0116 comp<tralion cor@B. is unl.wful. and shall subjd o oplols to siniEl Fahi6 and <br />civil 6n6 up to onc hun&dl lhou*nd dollm ($100.000), in.ddnion to rhe cost ofcompdsrlioa. damas.s 6 lrorid€d for rhc <br />inr(61&d altorEy s fG. <br />z IY <br />DEC|4EAIIO! <br />I t@by afim und6 pallty of pajlry rhd I m lic's.d undd Flyisio. otch!fld 9 (@ill1ftiis vith sttion 7000) ol Divhion 3 <br />of lh. Buin6 ud PofBioE Cod., .d Dy lic@ ir b tull fore rnd.fic.t. <br />io 3og <br />r r(C. <br />qq!$alcro!-LEtDllcJcEBcr <br />I h@by aIIm und( po6lty of pdjuly tllar ln6. k a @ndrudion kndirg agacy for lhc psfolrmc. of thc m* tu whi.h rhis Fhir is <br />b$cd (sd. 309?. Civ. C.). <br />A.EP'I(AILDEOAAAII(D <br />I hdlby rtrrm undd p6ahy olpsjury on€ ofln€ ao,lowin8 decl@iioml <br />Doolilion Pmit3-Alb6loi Norilicdion F.ddd Rcsulrrions (TnL 40. Parr6) <br />R.qun.d L.lld of Nolilic.lior <br />y' cdi4 rhd rh. a.dmlrcsuhtoB Esadrnr 6!6103 r do\ rl a. nor rpp''cablc ro rhis prcJdl <br />Y I cdrfy rhd I havc @J lh6 applr.hon ad stsr. ihd rh€ rbove inloflnalion is con .1 I aSra lo corply wirh all Ciry and Counry <br />ordi.mc6 &d Sl3rc ljw Elllinx ro buildina .urh.riz. rcF.gldiv6 of rfii5 Citt md Counly lo dl6 upon lh. <br />abov. ocnlioned propdy for i*pc.lion <br />Appli.anl or Axml Sianrlur.:I <br />C.-- <br />Lq I( <br />'EZn <br />,",*""*n,' 1bo poToq{l k I <br />Lendd s Nm.l <br />Smoke Detectors lnstalled