Laserfiche WebLink
APPROVALS DATE ID/SIG.COMMENTS OI{'NEf, EUILDER DELCARATION <br />I hcrcby alltrm undd p.ndhy of ,Eriury thal I m .xcmpl fmn lhe Crnraclos Liane Llw for lh. follovine @sn (Se.?ql l .5 <br />Busincs and Prcfdsiotr Codc): Any Cny or Counly whht rcquncs a IEmn ro onerucl. alld. ihprotc, dcmolhh or rcpan dy <br />slrlcturc. prior ro ir3 irsusmc. d$ rcquircs rh. al,|rltdr tor su.t Fmll lo lib ! siSn { slal€m.l lh.l lE or s}rc ir liccnsd pursm . <br />to lh. !rcviions ol llE ContEctof s Lien*d t:w (Ch.Pter 9. ConffiftinB silh Scdion ?m0 of Oivision -] of lh. Burir.ss and <br />Pof$sions Cod.) or rlEr lr d slE B crcnpr llEEf'on sd tlE lEsis for tnc alhgld cr.nplhn. Ary liolnlion of Serioo ?031.1bylny <br />amlkafl for ! pcmn lubj€re rhc lpplicant lo a cilil p.nshy of ml mrc !h fiv. tundrd doltus ($500) <br />-1. <br />I owmr of lhc pmpcny, .t ny enphrt s wnh waEes $ lh.n $b omp.nerion. will& llf w {dlltsrrulmh mr <br />itrrcn l€d or orcEn for qh (Sc.7044. Busimss rnd Phfdsi'.s Code: TIE C.f,hclor'r Litn* tis doca ml tlply to 3n owr of <br />ihcprrFny wno hoillls m itrFoc llt@tr od who .ro* sEh mlt hirelf or tuMlror lhmud his or h€r owtr rmpl6yc.r. <br />povidcd th s!.h intnocMse Nl intqldcd oronErd fo. sb.li ho*N( E hoildhs or itFrDtd i! $ld vilhin orc Fr <br />oaonphrion, dE OwM Built r u hlw ltE burd.n of prcvit tlEl h. o. sh. dil mt hiih or ir{'mt lnc pmFly lor tr lurlDe of <br />-1. <br />ar owrr ot rhc phpqiy, rm .x.lusitly onlBctins eith lkcnsd co,lindoN L oNlrucl tlt PNjor (Se. ?044. Susincrs <br />ad hofcsi,n Codc: Tnc ConrMlork Lic..$ Ls* dm mr .pply lo an o*nc, of rbpcny who builds ot imptow. thcrcon. <br />and sho Nnrr.c$fm such pmirts wilh a Conhdo(n lteMd pu6u.nl to thcConrEcloii Ltc.s t w). <br />I nncrDpr ul|dcr Sccti{nr-, B. & I'C lor rhis rcu$n <br />O*n!.:_ <br />]4IBf,ESLCAMTENSAIION <br />DEq,T8AITON <br />I hcrcby a,firn udcr penally of lcjury otu oi rhc foUowing dehhriotr{l <br />-l <br />hrr. ualsill.n'i riD 0 (tn ilicrrc of c(,n{nr b Sclf l n\ur. tu torkcn (.nrpcrrtion. a\ |mridcdlorhySccrbn-l7lnofrhc <br />l.rtxtr C(xl.- lnrlhc prfonMrtc o! thc sork lor *[ici rhc pcnni i\ nsuc{] <br />-t hvc.ndwill roinhin worlds conpcBarion in*umrcc, ns EquiEd by S.crhn 1700 or$c rlhor Code. for rh. Frfornre of <br />lh. work lor vnkh lhis penil i.s hslcd. My wortcu mmp.nsalion insuranc cMtr Jd Plicy numbcr rc: <br />\+2,*-t Fand <br />S. zlD rX, <br />-l <br />aniiyrhlr in lhc p..formre of lhe wort fd which rhis p$6il k iisucd., shsu not cnnloyanyl.ison in an, m!.ncr <br />so as io bccom subicr to rhc workcB 6opc dion l,wsolcclifomiq lnd rgN rhet iiI should kroft slbjccl lo lh. <br />wo*ol onp.nsation pmvisions ots.dion l70ooflhc L3t C{ic, I slull. lonhvith conPly wnh lhs lmllqions <br />WARNINC; Faihre ro sm wortcrl ompcnsrion covcrngc is unla*,irl. ond shrll subr.cl d .nPlorer to riminal I'cEkics a.d <br />ciril fin.s op l. 6ne hundrcd lhousand dollah lSllx),UD). in addnion ro lnc cosl ot.dnF!{rrion, dmuScs os F)rid.d lor rh. <br />Sccrion 1076 r rhc tjhor cod., inlcEsl ,Fd lnotuy\ l&1 ^ <br />( <br />D''"' S?g'lt no'"*'' ]4 vt,)/tlt'-*^ <br />-tJ-LICI'NT.IDIANIIACIOB <br />DECI.AMIIOIT <br />I hcrcl,yalfirm uidcr p.nalryofFrjury rh$ I !m liccn*\l uidci pn,visi('n ot Ch4ls 9(codntn.ltr{ wirh Sc.lion 7iI)OJ nrDivni'n I <br />rl rhc Buri cs\ ffd Pofrsion\ (1d.. d{ my licctrE n in lulltneandcffdr. <br />g tbnq36 <br />S.r,..1. r<- .-,*.*, A (l <br />CONIIXSqION.LENDIIC.&CENCI <br />I hcsby itfiirn uM.r lEnohy ol p.rjrry rh{ rhoc n . .onstrudiotr LndinB ss. y i{tr (hc Pcrformncc or rr& wotk ror uhich lhn Frnir h <br />h\ocd{sc.. :1097.civ. c.) <br />AlTLlClNl-lDlilA&rtIlQN <br />I lxahy n,! drr PcMlryot ltrjryorcol rhc l{n[,wi',9 dc(hr]rtrr\l <br />l)cnr)liriorPc' rirlAshc{o\ Nolificrrion Fd.hl Rc!uldnr$Ilirlc.llr. hrnO) <br />Rcqutcd l.cn.rof Norill.rrrB <br />k!--, <br />ilyrhd rhcicdcrrlrccunii('nsrc! J 13rshr{osrcnNvrlircnor <br />rlrr I lrvc rctulihi\ u|licinnrard {rrorld thcahvc irkrnrJ <br />rltrttrhlc h rnh lnjccr. <br />nrn h.odr.r. I rFcc t' conrply wirn illciryiDd Counry <br />irlc rcnre\cnL,trc\.r \(ir).,nd (i,unlyn'.trr.rur. rh( <br />drvc nEnrioftd pDt.d, ror <br />Aptli.at or A8cnr Siseiurcl <br />ro huildin8 con{rudion- uJtl <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 />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Rough Mech.../zolt9 -,w,+nE ) <br />Final Test I <br />Meter Release <br />FINAL b/'lt /rtr <b tft <br />Notes, Remarks, Etc. <br />MECHANICAL.INSPECTOR RECORD <br />Other <br />Above T-Bar <br />*. S.29. lt <br />I