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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />l\4isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <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 />Rouqh Mech. <br />Final Test <br />Meter Release I I <br />FINAL 7 l4/VU6/hlfr7z-- <br />Notes, Remarks, Etc L I <br />OwliEI BT'ILDER DEL(IRANON <br />I herby amrn und.r,cmlt, of Frjury lh.t I u cxcnlPl lrDn lhe Co ra.r6 Lienc Llw to.lt lolhsnlS rcasn (5...703,.5 <br />Businc$ !d Prcfcsion tu.): Any City or Collny *htn tluiEs o Ismit lo oinru.i. tlld. iq,rcw. dcmllch or qdt iny <br />srdcruE lrior !o its hsurN. also rqlici rhc dppltd for socb Fml ro lik a s'gEn slltcmnl thlr lt or shc b lieocd pursaln <br />lo Oe fimvhioni of ltE Conlr@lqt Lic.n*d L!{ (Chsplcr 9. Comfting wnh Sccli.n 7000 of Division I oi lhc Baincss ad <br />PDfc$ions Codc)or rhnr tE d shc is cicq,r rheBfionlnd th. bNis for th. sl legcd .xcmplioD. Any violalio. of Sedion ?011.5 by any <br />.pplksnl for . Fmil slbieri rhc .pplio ro a civil Fmhy of @r mrc lhm fiv. hudrcd dolbr ($50O). <br />-1. <br />aq own r ofrhc pon ny, .r my .mllolrcs *irt *E8es as rnct solc 6nlc.ialoo. uill do UE *mk dd tlE srEl@ ic m( <br />inrcn&d o. offcr.d lor sh (SN.70.r4. au.ifts lnd Ptorcsshns Code The Co.r.dot Lienr Lw &.s ml lpply lo e o*N of <br />rhc tDocrry pL lrilds or inODEs rE@tr !t vto dar sEh m* hi@lf or lErslf or lhreu8h his d hc. own cn Ploy{s. <br />provid.d rh[ such imtmrmnk e mr ini. 6 or ottu aor it. li ho$q. rlr tditdi.g or inrimwcm is eld wnhin .m re <br />ol.o,pLrion. ih. osmJ ariE6 will tuw rlr t{rdcn ofpmrna t'.r tE or slE dil d tnild or ir{rcw ilE Fottry lor llE p!.Dos ol <br />-1. <br />asowrcrofrhc nmDcnx ancxcluri!.ly.onmdinE wirh licnq{.o trloN to conslruct l,E tm}cl (SN.7Or4. BusncR\ <br />and PJDfAshn c6dc: Thc Contr4tols Licctrse liw docs nol apnly ro u ownci 6r pmp.ny who builds or improts lfi.r.on. <br />a.d sno co Bcrr tor {ch pmjc.lr wirh a Co.hcro(*) lirn*d puBunl lo thc ConE!.lois Lie@ Liw). <br />-l <br />rrcxcmpt undcr Sel <br />lo8.[EEc'.cllMEENSArl0N <br />DECITMIII]N <br />I hcrcby afii,n und6 pcndlry 6r p.rjury ooc of rhc followir8 dcclararions <br />-lhrvc <br />nl *illn!,inrxin a Ojnificrrc .f Cutr* b Scll:ltrsun tur sorlcrr con$cn\rtioo. tr\ pnridcd f(, bySccrion:1700 ollhc <br />llbor O)dc, tur rh( !c oirnmcc ol lhc Nork lnr rhich lh. p.rmir n i*ucd <br />-l hrvc 0rd will dint.in vo*c6 Nftpcffarion insrtumc, as rcquircd by Sslion 3?00 of lh€ ltbor Codc, for lh. Ffor.Ma of <br />rhc work for which rhn pmit is h$cd. My sortcd .omF.stion iosumc€ dEicr and lElky nldbs @: <br />I ftdirt rh.r in rh. p.rfoirmrc oflhc roll for lhth lhh lcrmir is isslcd. l shrll.or.nDktylny rcMfl in riy @mr <br />s as !o bccom slbiEr ro tlr w6.ld c!,np.nerion lews or colifoi.ia. und usrcc rhlr ir I sholld bccom sub.,cct lo th. <br />w6rke^ oqrnsarion nrovirions ofScdion 3?00 ofthc LBhor Codc,l shall. fonhwirhomply wilh lhos Povnions.. <br />WARNING: FailuE lo se so*es @n{xn$ion ovc6s. ir unlrwtul. ed shall subJel sn cdllorr b aimind FMhix.nd <br />civil lincs up ro otu hundrcd Inouend doum ($100,000), in addUioo io thc ost of.otrrrc.salion. damges as povidcd for lhc <br />Setion 3076 of rnc bhor Cidq inrctur and arromy\ fB. <br />UCINTIILCONIXAII!)B <br />TDCIAXtrIIO! <br />I hcrbyoifi,mundcrrcnrlryofr.rjrryrhdr Ln' li.cn{rl u.dcrpn,visn,nol'Chlprs 9(dnn' tuinssirhsc.rirnT(lG])ofDivisioi:l <br />or <br />'h. <br />Bus,mss.rd PolcssioNCodc. ul mr lkcnsc n i. fullto,ccnidcffN' <br />CIJISIBIJCIION.LINDINIi-&AEI.CI <br />I hcrcnyrfilmlndcr pcnalrrorrojrry rhar rhcs is n.onirudbn lcndine rrcrcy artr rhc pcrrornDn.c.rrhc wor* r'or shich rhi\ IE nir is <br />nsucdrsa. 1097. civ. c.) <br />AlrLl! NLI)[C!ABAj19! <br />I L1!hyi nnrundcrNnillyoipcrjuryoic.l rhc [.ll,,si']! dc.lnrnrtr,rr: <br />Ddnh lir io. l'cirnirs A\t {os Norin.ar i.n l;.dcrul Rcrulnr ions ( l ilh ao. ld6) <br />R.qunel I.ttcr oI Norillcurbn <br />I c.n ift lhd tnc rcdcral rsglbtions Esedins &\bc(o\ Emral src nor utpli.obk lo lhis Pmid <br />-l <br />.cnif, thli I haw rcad rhk applicrlion !d slalc lhal tn ltnw inforndion is cotrc.r. I .gI@ lo @mply wnh al Cily lnd Colnly <br />ordinuccs ud Srarc lj*s Ekting ro boildioS .onslflcl iotr &n hcr.by rulhorir rclrecntal iEs ot Ihis Cn, 4d Counry ro ctrln lIDn tlE <br />above mnrn,ned potcny for an.r€crion l,lrross. <br />Applicsr or A8s.l SiSMtle:- <br />Ptnnircnam (pri ) <br />tr.ttltl <br />Policy Nunrhcr:-liipir\ <br />- <br />Lien\c Ch *:-Lic.nr! Numhcrl <br />bndcli Nlm: <br />- <br />I <br />= <br />= <br />I