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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCANAIION <br />I h6€ty amm undd poaty of pojdy thd I m .rmfl ton rh. CodEcloR LicG. t w for rh. lollowios r.eo (s.t.7031 .5 <br />BBiiB a"d Prcfeion cod.): Any Ciy or Coudy whict r.quir6 a Fnn ro .ondNcl. 0116. inpiov.. dmlish or r+6n m, <br />3lrlduc Fior to ns issuec.. rtso rcquiG rnG epli.anl for such Ffrn to fib a 3isncd o6l thal lE or !h. is licm.d puBu&n <br />lo rh. Fovirhc of lh. Corrtuto. s Lictu d ftw (ClBpra 9. Comoci.S wilt Sdio. ?000 ol Dilision 3 of ln BEif,s ud <br />Prol*ioc Cod.) o.lh.l hc o. si. i! ddpl lbGrcGom ed lh. b.!i! for lhc dlcs.d cidplion. Ary viohion ofsdlior 703l.5 by any <br />lpplicanr tor . tGnit subjels rh. sppli.@l to a civil p@hy of @r moE lho fiv. tu rcd dollm (t500). <br />l. s oMd ofd. prop.rty, or ny dploys wilh wagd 6 ltuit $1. mnpcisaioi, will do th. vott &d th. slntl@ b nol <br />inrod..t or olls.d for sL (Se.7044. B6i!B dd Profeios Codq Th. C.rirrclm s Lic@ L.w &6 tul lpPt lo e osd of <br />rh.Fopqry who hliLh o. ilDpro6 th@,L od sno do6 rGh wrt hims.lf or h@lf or lhrcurh hb or hd oM.Eploy6, <br />provid.d lh.r uuch inForEMrs @ rcl hrqxkd ororsd 6r sL lf.lnM. dr txilditts or in'Fo!@n n eh wilhin oE ta <br />olco,trpkrio( rhc OM6 Builds will hlv€ llE budd otFovitrg lhd h. or shc did @r blild or irDploE 0E Flpsry ao. lh€ lurDo* of <br />-1. <br />6 oMa of$. pdp.iry. d qdBiv.l, corn adine shh li.a$d comrlcloc lo aNldcl lh. projc.l (S*. ?044. BcoB <br />ard Pr!&33i@ Cod.: Tn. Coiulcloas Lic@. Law doB nol lpply ro e ownd ofpmpqry vho builds ot isprov6 thddf,, <br />md who conrruc f.r iuch FojEls wilh , Conracro(s) licds.d puau lo $c Co.rador's L(.@ l!w). <br />I mcxcmpt ud.r Selion-. A. & P.C. tor lhie r6on <br />WORKERS'COMPENSATION <br />DECIASAIIO!Ihdby.ltrmu s pcalty otpajw on ofrh. touowinB dBbiarioB: <br />-l <br />h!v. ed eill oaifisin a Ccnificarc olconsll lo S.ll-tBuc hr ert6 coopas.lioo a Fovidrd lor by Sclion ]700 ofthc <br />kbor C.de for rh. Ffotuc of rhc worr for s'hkh lh. FD b isu.d. <br />-lh&.edvillroi ain so{6 coopclsadon isu&c.. s r.qsir.d by S.dion 3 700 olllt L5bor Cod€. for lhc p6hr@cc of <br />$c wo ( for which rhir D.rmir is isu.d. My worl6'. ia0nn.. caid ed polict nunbd uc: <br />_l cdiry thar ii thc Ffo'j@ci of lhc sorl lor etict lhi. Fnil is i$o.d. I shru nol oploy &y psen in a.y D@n <br />$ d lo bdorc subjer ro rh. M*d' con!€Ear ion lNs ol C.lilodi., dd asE rh.r if I should b6oo. .objer io $. <br />wolt6 comFsrion povisioN of Sdion 1700 otlh€ t hor Cod.,I slEll. fonhwln comply wirh <br />'hos Fovitioru. <br />WARNINC: Failu. to soc wort6' @npo.ario. co!.6gc is unbsful, &d shdll subjel d dploF lo diDjnal Fdtt ,nd <br />.ivil fu6 !p ro oi. h@dr.d thoMd d.lle (1100.000). ii lddiriod r. $. cGr or ohp.erio!! drme6 6 p'oridal ro' rh. <br />Scrion 3076 oattc Llbd CorL, inr..Bl &d dromry.3 86.*-e{Ze16--r " V.r""- A"errlt.> <br />rJrliNMcoDl!^clla <br />D[Clda r.IoN <br />I hscby atfirm unds r€,alry ol r.rjury rhhr I an li..Bel undd pmvision olCh.ttd 9llannmcncios with S..lion 7000).fDn kidn I <br />ol thc 0$ins md Pmi6sn'ns Codc. ud my license is h finl lorce od ell(r <br />L <br />CO!{STRUCTTON I rnlDllic AGENCY <br />I hGtby atlm undn F6lty ofp.rjory tltd th@ is a @ldruclbn Lldiog agc.Ey for rbc Fforo@. of tn *!lr f.r *'hi.h Ob Frmn ! <br />iilucd (Sc. 3097. Civ. C.). <br />ATTII(AII.DECIABAIION <br />I hod, afinn undcr poahy otpojuryonc oflhc lollovin8 dclertions <br />D.iolnion Pcnnns-Asb6ros Norilication Fcd..al Regulatio.s 0 nh 40. Pd6) <br />- Requn.dL.ndofNorituarion <br />_t cdiry r[d lhc f.dd.l rellarioB rcs&diis ah6los e.ova] u. ml appltlbL ro fih pojcr. <br />I cdiry $al I h,!r @d thb application ed slate rhsl th. sbov. infomar io. i! corcd. I r8rc lo comply will all Cily !trd County <br />ordira.ce rnd S(are L.ws rclariDg ro buildins connrudion. &d n6cb, Nthonrc rwr6amrh6 oirhi! Ciry dd Cou.ty ro dl6 upon lhc <br />ab!. ndlion.n p@pdly lor <br />Arpltcalr or fu.nt SEnnrur.* €/zah'? <br />Appliances <br />N,4etal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lVisc. 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 />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech.I 2-/3-/8 t //.{r-&, <br />Final Test <br />Meter Release /\ <br />FINAL 7-17,-lv fi-\{Jlr <br />Notes, Remarks, Etc. <br />L\ptr.s <br />,*,,*r*- 7O ltil 7 <br />".(o". ?^?ctlir) <br />I