|
lZ e oc 2( z s t, sYrr tfu,t"frfrfto1-tNspEcroR
<br />REcoHD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Itiletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Ivlisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork 2-t2, r9 ? &9)
<br />Vents
<br />Toilet Boom / Clothes Dryer Z-r2- t9 J).Sa bCvD
<br />Residential Ranqe
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />FINAL //-7-t? .Uc{*z I ,1)
<br />Notes, Remarks, Etc
<br />OWNTR AUILDI]R DET,CARA'TION
<br />I hcrhy nllirrn r.dcr Nnrlry {,i B rjry lh,l I rnr crcnfl tunr llt ({nnrrtn- tr.cnsc Lrw tur rh. Iolloqirs rca',n lsc( ]nrl 5
<br />ItusiN$ rnJ Pi('Ls\n,n Aftr n, Ciry or C.utrry uhi.h Btonc{ r f.trnir ro..n{rucr- !lrc.. i'nPi{rc, drmoli\h !r trnrn Jdl
<br />nru.rulc. nrntrt, i( iliuri.c, ako rclutrcs rhc {'plicnd for \uch t^-ani b fil. a \i!n.d ear.ftnr rlril hc.tsh. is lnun\ql ftrAt tr' '
<br />lo rhc prcvisi.Ds ol rh. Conkrct, s Li.cn*d Lrw (Chrficr 9, Connncn.irs sirh Sccrion ?(xx) of l)iliiotr :l of,itr l{u!nc$ rld. ,
<br />Prot sioi\ Cod.)orrhrr h.or{lf n cxcn{'l lhcreiro$rnd rhch.}ir Iilr lhcallcscd cxcnrlnnr Any vn,[rttrr ol Sdtr 7r).t I 5hr rny
<br />lpnlirnrtarap.nn(suhlL\rrhcrrplicnnrl,,!civilpcnrllyoanolnx,cihr iivd hutrdrcddollns{$5fi)).I
<br />-/t. r .sncr.rrr,c p",rnl.,,nrtcnrdoyccs withsrgcs \ rhcir q)lc ..mpei\arior. *illrlo rh. work nM rtr(n.lukA nur
<br />. 7r!r lrnlincsrtrr prcr'.!\io sc( c:'lhc c(n rn.k,'sLi.cn\c Lrwiocsnol aml,r,rn',qnrr I
<br />rhcpmFny $lm hoilds or imrfl*c( rllfr)n, drd ek, de\ $.h solk hnn\cll.r ltrrscli.r rhfl,uEh lri\ r hcr o*n cn{'lo)r.\.
<br />D.ovilcd rhlr s(h ntmknrnr\rn frn inrcndcd or oltarrd ntrssh ll.l$s$tr. rlfh^ril,iin8ot iq'.n\tnrnr issli*irhin,{'r F.tr
<br />of.otr{Lr Fn, rt* ()wns ltuillcr sill tulc rh. hurdrn olIll,linE rhd hcot\h. tlid rn blilllor illlla)vc fic pR,Aiy,nr Ih. flr {',1
<br />s['
<br />-1.
<br />!s oqEr ol rhc lropcrry. om cicluritel, conradinS wirh li.cn*i co.lrldos lo Rrtndcl lh. Eojd (Se. 7044, Ausrcs
<br />lnd Prn6ssion Codq Thc C.nr6crois Lic.nsc tjw docs nor 0ptly ro anolncr of nrdpcny *h. huilds or improrcs lhcrcon-
<br />0nd *ho @ntuk for sch prujsls wilh ! CoilEdo(d ltcnEd rlu6uor b rh. Conrdols Liccnsc L!w).
<br />btc
<br />UIC!r!Ar[!A]
<br />I hrrcby ilfirm und.r pcMlryolp.rj!ryone ofrhc iolk,si.s dchruri.n\
<br />IhrvcMdtrillnrdrirnCc ifiQrcofC.n\ctrlh SclflNU'c nt$orkr* (DPctr\iri.n. os Provnlcd f(tr6yScc..tr lTtrool th!
<br />I rhtrCodc, tu'rhc pcrro',Mncc o I r hc sork tur which rhc pcnnit i\ i$tr.d
<br />-l
<br />havc md will nrinhin vort r' compcnsrrion in$ftN.. !s rcqnied hy Sstion l?00 of lhc ljbo. C6d.. lot lhc pcrfomft. of
<br />thc ert for whi.t rhh pcrn i. i$!ed My w6rk.n onip.nerion insffi ffid !n poky numb.r e:
<br />-l.crriryrh,r
<br />inihc p.rroflMnccofrhcworkforwhthrhh p.rmir is hsucd,I shallno{ cnploy My pcron inan, runncr
<br />s as ro bccom subr.rr r. rhc *od(cn' .oopcnsdion la*s of Colifomin. rnd ngft lhrl il I slDuld bccon* $bF.t ro lh.
<br />work.tr compcns0iion pmrisions olssrion l7mof rhc tihor C{'rle.I shtrll.lodhwnh comPly *ithlhos lhehnrns
<br />WARNINGT failuE 16 sur. wor*cB' ompensolion svm8c is unhqtul. ad ehdl subFcr .. mplortt lo dminal lc@kier dd
<br />.iril fincs ur lo or nudEd lllolsmd dollm (Sloo,mo), in rddnion to lhc cosr of conp.osolion. d.mBcs !s provid.d for 'h.
<br />Lll.ENSrolQ In qraB,
<br />DDCLI,BdI]QN
<br />I hcmhyrftt rundn pcnahyofFrjuryrhll I am liccn{dunder p'ovi\i,)nolChatrcr9(c.nnmncin8 $il|SNri ?(XXl)olDirision.l
<br />ol rhe Businc$ !n{l Pn,ldsnr$ Codc. u trry licctr\c is ir lull li'rdc atxl.ttrr
<br />LiccEc Cb!s: Liemc Nur$cr:
<br />coNs'l it-lc fl(|N I IfNITING (:t'NcY
<br />I htrhy alirn undcr Fmlty of pcrru.y rhar rhqc is n conidcrt,n hndin! !!oty for rhc tulonruncc olrhc sork ntr which rhir ,)c inil is
<br />issucd(sa :l(l97_ civ c )
<br />AITIJCA I,I2T!:LABAIION
<br />I tlnhy lonD unncr p:niht or lxrjur, otu or rh. rall,)*nr8 dNhrdridF
<br />l).nnnirion lcnnils A\h.nos Norifi.rrion Fcdcnl R$uhrions (l'illc.10- Prrr6)
<br />Rstun d lxrrcr.f Noiilicrrion
<br />I cdily rhar rtE fcncr! I rcgu hr io.s rcsudiis !\trsros rcmolal & nn lpdi.ablc ro lhis prorccl
<br />I en ify rh.r I lEvc Esd rhn q'plicolion and stltc rhd rhc alnr intrm'io. is rmer. I cEE lo co'n ,ly wilh dll Cny and C.unr!
<br />odi.arcr a.d Sr!r. t!$ Elarine ro buildi.S r ud hc.cby NIktrizc rcprc\cniurivd olrhk Ciryand Counryk, c.tcr uton the
<br />,t$v. ftmion.rt ,r.Fny f.r ins!.cl
<br />ryt -"*'7(?/erc
<br />I
<br />Other
<br />Meter Release
<br />::qW{:ff:")i=
<br />I
<br />I
<br />I
|