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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDEI DELCARATION <br />I h.rcb'y .llrn lidd Fnalry ot pdjury rtd I @ q@pr tlE rh. conr6l6 Licce Lae fo. lh. following rcen (s6.703 L5 <br />Businds Dd Profdion Cod.): Ary City or Coudy which rcquic a Fni ro @Iioct, .116. irPIovo &moli.h or r.Fi. dy <br />stlucls.. rior ro ns is.dc.. aLo rcqliB ln. eplicer for sh Fmn b fiL a sien€d $d@6i thd lE .. !h. b lic d plN&tl <br />lo lt pmvisioE oloE Contoclois Licd!.d Lrw (Ct!9rd 9. Com4og wilh Sethn 7000 of Divirio! 3 oflh. BBins @d <br />Psfdsioru Cod.) o. rhll h.o, sh. b a.mpl th.r.6oE dd lh. bdlis aor th. all.g.d qdflio!. A.y viohtio. ofsetior r03l.5 by any <br />sppli.ant lor a posit 3ubjeB r[. rppli.er ro ! civil pmty or tur noE rha nvc hlodrcd dolla! (1500) <br />I, B oM6 oflhc FoFrn or ry dployd *irh was6 s rhct elc conp65dion wil do thc work sd lh. sltocl@ b m( <br />i ai.d o. ofr.rdl ao. eL (Sc.7044, BuirB Dd PrcfeioN Cod.: T1. contraclor's Liccc Law doB nor @ply to an oms of <br />lh. FoFty who hoil6 or in rov6 thden. &d who 66ech wfi hinslfo. h6.lf or thrcugt nis or hr oM drhyc. <br />prolid.d $'r !u.h imFo!@@ts @ml intad.d orolldrd forsL.ll houcc,lh. hiildil8 or itrprc\did t eE wnhin oN t@ <br />ofonpLiio,L rh. o,n6 Buil,ld qiu haw rhc h{do of poviis t!. hc o. sh. drd mt hrld or inFiv. lh. prtrFly for lF. putFE of <br />-1. <br />s ol{c olrhc Dropary, e .r.lsiv.ly .od.adins vih licd*d coilodou lo mi$n l lhe ptujc.1 (S(. ?044. Bunn6 <br />rnd ftDG*rbn Cod.: Thc Conlftlor's Licas. Law doB not apply lo o osnd ol propdiy who blilds or ihprov.s lhdon, <br />dd who .oitdcls for su.h Fojcls wth. co @ro(s) licdsd paler lo the Cotu.cro. s Lic.w kw) <br />_l dncrcEfl uodo Sdlion . B. & P.C, aorihis r6on. <br />wonxr!ls'coMpENsArIoN <br />PECI.ASAIION <br />I hccby .fi'm uodo pa.ly ofpqjlry onc oflh. following deldlioG: <br />-l <br />hlE &d will nairrain . ccnifi.ar otcoMr ro sclf-lBu. fo. ert6 compasdior. a F.vi{i.d for by scrio. 1700 ollh. <br />Labor Codc aor rh. psfollMcc ot$c mfi for which rh. FBit ir i,su.d, <br />_l hav. ed will oaint'in wort6 comp.N io. iNlr&cc 6 r.qun.d by Selion 3?00 ol rh. I$or Code. lor it. palome.c of <br />rhc @& for shhh rhb F@il is lq.{ My work6' comp<salion isurDcc cmi6 &d policy .unbd dc: <br />I ccniry ihd in lh. p6aomdc. oarh. work aor shich lhi Fmil i! Lrsucd. I shau nol onploy ey I,600 i. ey n&ner <br />$ B ro b{on subjar to th. wo*d compqasrion Lws ofcalilodi6. &d asE rhar il I should h..os. subjel lo lh€ <br />*ort6' omF,s.rion povisioN of Sdion 1700 otlh. kbo. Codo I shall. fonhrirt @npl, wirh tno$ pDri!io6.. <br />WARNING: F6il@ ro cr. so d'6mpoMio. covdaS. is unh$'tul. ed shsll subjccl u dplo)Er lo diiinal p.nal6 dd <br />cilil iin6uproon nlbdrcd rto@d dotla ($100,000), ii sddirion lo rtc cosr of comtssdion. dm8.s 6 provid.d aor rhc <br />Sclion 3076 ollh. trbor Codc inro.e ed <br />Drter_ A <br />I h@by rllm ulda F.rtry of pdjury tll! I u lics8 d @dq FDvirioi ofchlpla 9 {@omdcine wth Sdio. 7000) of Division l <br />of th. BsiB.nd Pref*ioa Cod., dd oy li.as is i! tuU foc aad.llcr. <br />I hdlby aitm undr p€nahy of Fjury lhal lh6. is a coairuclion Lndins asscy lor lh. Ffonndc. ofrh. wotk forrhichlhis Fsmil is <br />is!.d (S( :l(197, Civ. C.) <br />altt!(atlD[clAaalla! <br />I h:!by allim {ndd pcnah y oa pdju.y one of rnc aollowi.s d<l&ar ioN: <br />D€molition Pmils Asb6ros Notiljcarion F.ddal Resol ions (Tnt 40. Pan6) <br />R.quircd L.lt6 of Nolification <br />I cdi! lhd th. fcddal EaulatioN Esodins sbGtos moval rG not arplirblc ro rhis pojd. <br />_ I cfiiry lhar I havc rad rhi! applicaiio. rnd (ar. $sr rhc abo!. inlomtion n con.<1 I ag.6 to coiply wilh rll Cily &d Couf,ly <br />ordinancB md Sralc Lsrs r.lains ro buildins .onnrudiol dd hd.by authori7r rcF66larive oflhis Cny ed Counly lo €nt6 upon thc <br />abov. malion d poFny for <br />Appli@r or Agar SigEt@r A_ <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer G-12-)K Yr.'lltt)\ <br />Residential Range t,\7 <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 />Rou gh Mech. <br />Final Test <br />, <br />FINAL /0/l///r Otl,brnt'/tL- <br />.," G.L. Lx <br />Meter Release <br />Note_q.Eernq49,E!9- _