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MECHANICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNI]R BUILD[R DI'LCARA X'N I hcr.br rllirn uodcr Dc.rlly ol p.rurv rh I n ctmlr ior rhc Onnrr.rtrr l-i.ctr{'t..\ lor rhc tull)$i'r! rcasrn lse70.115 aunN\\ ind Prrl.$i(nr Codr): An! C[y .r Ou y ]hi.h rtqun.\ r n rn t, ron{ni.t. rlrcr. nnpr*c d.nxrlish o! rqrn mt sn'.trtu. rritr{, ir\ i\\u^cc.rrsorcrltir.srhctmliinlx,\uchri('nnrt)flcrsi!tcd{rr.mnrihnrhcor\hcisli.cn\rdlur\urr r) rhc txihnr! ol rlE C.nrrrctr'\ Lncn{d Lrq (ChrDrtl 9. Connnu&n,! *irh S..ri(r 7(xxr ot l}ivi\i( :l ol rhc au\ nc\\ itrJ nmli.atrrturrpcirnn!rhjcursiho rfplnxnrrod.i!ilI)crrlryofnornrErhrnli\.htrtrdrdl(k'l1 F(11(xD -1. &! opffi ofrhc t,DFny. tr ny cnplolE wnh vagct .. Eit slc â‚¬mFnsdion. siu do llE wo* .d llt sfiElm is ml inrcild.d or oftrcd for sle (56.?044. Buiio.* lnd PDLssiots C.d.: Thc Conlncroas I-ic.nE llw d@s ml qplv to an owtur of Inc nmD.ny kho tdildr n inptm Eon. rn wh dos seh h* hinsclfot h.elforlltrolgh ht .r h.r own cmplovccs, pmrid.d thd sEh inDmvwnli@ mr inrcd.d o.otu lor sb.lt ln!ffi. dEt ildii8 or inpllNmnr t $U wnhi..m ltr ofonpkim. llE Owmr Buil&r wil haE l,E hnrt4n ol Fovila dEr lE m shc dil mr h]ild or itprow $. lbFry for ilE purPs or I. N.*n.rorrh. rmncny. amâ‚¬r.lusivclyo 6.rinS * ilh liccnsd conlndoh b mislru.l ltr roiccl (S< 7014. Su\incs and hn{6\nn Code: Thc Conkmlol s Liccnse l-aw docr mr applyro moqner orPmFdy who builds ot inrPmvcr rh*.on. 0nd who snlmcls for slch tejccl3 wirh ! Conllldo(n liccnscd nu^uur b lhc Cofllraclois Licens. tiw) -ldcxcnt u.rLr Selion-, A. & P,C. for $is Een, I{ORXFIIS' COMPFITSAfl ON DECI.AMIION I ncrchy affrm undd !.ndr, ol pojnry onc of thc followinB del&itionsr -l harc g,t wilt minrsin a C.nifr.rc of Con$nl bS.l rsuE for *0116 orpcnslk'r, &r ptoviLd fo. by Sslhn l7{l0 or dE trbd Codc. lor lhe p.rfortutuc of thc md( f.r which lhc Fhir is hslcd, -l har and will minl.in wort E .onp.nelion inMft.. s rc4uiFd by Sslion l?00 ol llE ltSor Codc tor $c perfolrlM. of lhc vorl lor which lhis !c6i' ir is,rn. My .\s.'li6a iB@c qbr old IDli.y numbc. d -l.cdily lh{l in thc lcrfotmftc of thc ao!( for *hich lnt Frmit h isslcd, I stull ml.mpLyanyricMn in rny nuE s s ro b.sE slbFr ro rlE m*6 conlPcnslion hws of C.litomi,, and a8m llur if I should h..o@ tubject lo rh. hrkâ‚¬G'ontienrarionpeliqnrnsolScction3T00otlhcLitErCodâ‚¬.lshlll.fonhqirh@mplyeithmoEpovisioB.. WARNING: Flilure b sue wrleF s'q,enslhn oEngc L( !nl,*tu|. ond sna[ suhF{r o @ploFr lo qinina] p.n lb and civil lincs ul ro onc hundrcd rhousrnd doUaN (3100.). in lddiiidn ro lhc â‚¬o$ ol comn nsdio , d.m8cs ri rrovidcd ror lh. Serion l0?6d Ihc L{tDr Corlc. inr.rcsr lnd MIFNStD C(lNI Rr{CT()R DIiII.AATUAN rf rln Au$cs{ inl Profus\i{rN Codc. d trrylic.tr\. is iD lull lar(rxtciLrl 76) 7 CONS'TRUCTION I FNDIN(; A(;ENCY IhcEby{lltmu.rltn,lrro,tEriurrrharrhcr.i\a.onid.ri Lmlir8 rgch--y ri,r rh. I,crtuatm.c oilhc work rar Rhich rhis Pcnnir i\ issucd 1scc.3097. Civ C ) AIELIEANLDECLABAI,IQN I h.r$y lliim undc! lcnalry.rFrjury om ollhc followins dc(irdn,x Dcnoliri{,n Pcrnlirs A\hjsos Norilicorion Ftdcral R.!uhtuns (Tirlc40. Pm6) Rcquito{ txrlcr of Noritn{in' I snilythdr thc lcdcDl eSul,rions mBffdinS lshcslos rcnnvoldc lor amlicdhlc to lhis lr'Jccr -l.cdiryrh t harc rcad lhis opplicrri.n dd sarc rhd thc trbvc inlorrorhn ir codu.t I a8lE lo conplr eirh lll Cilyond Counlv ordinarccs and Srarc ljws nl,rin8 buildins consmcrion. aid hcicby,urhorizc rclrc\c arrc* oflhis Cily ond County b cnln nlon lhc rh)vc trEn!ioncd pn,p.ny ntr ir t4 Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsu lation Smoke Detectors lnstalled Rouqh Ductwork Vents .<t Toilet Room / Clothes Dryer tu-7-lr v.t414/ Residential Ranqe Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openinqs lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rouqh Mech. Final Test Meter Release /.,, FINAL It-26-19 Y-\U\t) Notes, Remarks, Etc - lL/ J ,.' -rl Q - &l., T <5+ ffi =