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MECHANICAL.INSPECTOR HECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER EUILDER DEL(IRITION <br />I hceby rmro undc, oenolry of Frjury thrl I m .rerq frhnr rhc Conracro6 Lixns Llw lor rhc fouo*ing Easn ascc.?o3 L5 <br />Busin.sr a Pmf$sion Codc): Any Ciry or Counry vhth r.quncs r lgmn to onnrud. .lrd. itrVmE d.m[rn or EFir {n, <br />sltuctft, prim to ns istulncc. aho rcqlies rrc al,pltant for such I'cm to filc a sisned na|cmfl rhar hc o. lhc is licco$d purCumr <br />lo lhe povilions ol 0r Cofi&rofs Licens.d L{w (Charrc, 9. Coomrciig wilh Selioi 70OO of Divtion I ot rlrc Buritrs !nd' <br />Pmlcssions Codc) or lnal lrc or sh€ is crcmpt lhcrefron lnd lh. b,sn for lhc all€Bcd cremrlion. Any liolalion ofsc.rion 70]1.5 by a., <br />+plic.nt f6r r Frmir subjccri rh. applic&i ro ! civilpcn.Iyofnor mrc rhd illc huodEd dollds ($500). <br />-1. <br />As ownsr oI r hc pmlf,ny, or hy cmplor.ca eilt wlBcs as rhcn sob mmpcns.r ion. will do rhc wk d rhc Nruhrc ! frlt <br />inrcnd€d or ofrcrt for sh (Ss.?O|4. Ausiress lnd Pmfcssions Codc: TIE Conrdoai Lie.e Ltv d@s rcr .pnly io & owBr of <br />rhc rmFny sho hoil& 6r in4mB 0ENn. rd wtD d@r ruch ed hinsclf or h@lf o hrcugh har or h6 own cnphrcs. <br />lrovidcd ihrl s&h iryrctnEnrs @ Nr hrcnd.t oroficd for eL.lf. ho*evcr. tlE ttirdins or irprcEmnl ieH *irhin oE ){s <br />ofcotrqlcrio[ rlt Owtur Blildcr sill tlw rhe hid.i oatmling rh,r lE or sh. did mr hlild or i!!mE dte Io,Ery fo. d. puFs or <br />-1, <br />&e oot. of rhc pDlsry. ah cxcbsirl, connerios wirh liceisd .onrich6 ro 6rnod rhc roj*r (s€c. 7&4. Busim$ <br />Dd ftotasin Codcr Ttu Conlmc'or's Liccns. trw docs nor rpply lo eoencr oftmpcny uho builds or imporcs thcran, <br />.nd elt' 6nt icrsf6 srch pmjers *nh ! co.rEdono li.cn*d plr@nr rolh. coorrcr.is LiccM bw). <br />I rmcrcmpr uMcr S..ri.n- B. & P.C. n, rhn rcason <br />yIBXIBSICOMIEIIAIIIIN <br />D&CIAaAIQN <br />I ncrcby lmrm ututcr pc.rlry 6f tFju.y oft of tlr fotlowane dc{LrthBi <br />Ii,txn Orlc.,or rh. !s r'onnlNc oilhc $ork tr rhich rhc lBnrir i\ i\ucl <br />Z&l hirc rnd uillar3inrrn, $ork.^ .o ,|tn\Jri{,, i'rurJ,{.. r\ rcquncd hvS..rnn,:l?(X)olrhc lrhor(irdc. lnr rhct'c!lornrN..l <br />rhc *ork lnrshichrhi\ pcnnir i\ n\urJ My*orkc^'compcn\riioni'NurrncrcrtriUJdFilicynun$.rrtt: <br />Stz(k F\x'.cl <br />5 l1 5tz6/li <br />-l <br />ccnily thd i. rhc tEnonmncc ofrhc work ftr whkhlhir p.rmir h hsucd.l .hallnol cmployrny psso. in an, manncr <br />s Ls to bc.oft subjBr ro rhe wortcrs' .onlrnxd ion h*s of Cllifonh. lnd lse rha, if I rhoold tEoa subi(l ro rtE <br />worlcB onlltndio! povhbni.tScdion:l7Ll()ofrhc Lstnr C{)dc,I *lull. fonhwnh conply wirhrhos [ovisions <br />WAnNNGT Frilurc b scurc wo*c( compcns n cov.ESc k unhstuL otrd sholl subJ.cl atr.mployc! to sihiml lEnuhtl .nd <br />civil in.s u! ro.nc hundi.d rh.uend doUau ($loo,mo). i. addirion ro <br />'h. <br />cos ofconq*nsdion. d,mgcr !s lrovided for lhe <br />sc.iion.lr)76olrhc lf,trr(odc. inrcrcddn ariortuy \ lccs <br />-d.Jl <br />LICENIILCONIIACrcA <br />DECIA8ATIII! <br />I hcrcby allirm u c,r.nohrofpcrjlrylnul I amlien${undq pDvn io n oI Chaprcr 9(conlftn.ins sirhSecrion7ffn).iDivisnnr3 <br />of thc Busituss dd Pi.Lrsionr C.d.. dd nry li.cns is in tull rom dt c,TLrl. <br />ATIUIANI-I]ECI.ABA.IION <br />I rxRtry.lllm utrdcr r.orlt, ol !.rjury onc ofrhc followinC dc.lrations: <br />DcnEliiu Pcrnih-Asbcsros Norific,rion Fcdcrdl Rcsukrions (Titlc.l0. PDn6) <br />Rcqund b(cr of N,rifi coli01 <br />-l <br />ccni! th,l rhc fcdcral rcBuldiotrs EE0idnrB ostBros rctrFval0rc mr {pliclhlc h this tmjd. <br />Z-l .rn ) rhJr I hr'. ftutl rhtr Jnnlkd <br />'on <br />ud nrrc ,hDr rhc allxr inf* urioi i\ c.ndr I o8m to con{'ly *ith rll Cir y ond Counly <br />ordinlnces uNl Sturc Luvs rchrinS ro huildin8 cotrnrudion. n hcrcby rurhornc rcf,c*nrurivc\ o{ rhis Ciry and Couny ro cnr$ uF,n r <br />ahovc nrcnrnnr{ pn)neny inr insncdbnn!rI[*r <br />Alrl ic! trI or ABcnl SiSnaturc:5/t0/, <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Rough Ductwork <br />Vents <br />Toilet Boom / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type Il 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 />Rough Mech.5/r >//v <-x VIEfu$ <br />Final Test <br />Meter Release <br />FINAL 5/31 //a 9.EN Lgbtff$ <br />Notes, Remarks, Etc. <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />lttret Jt,vt to <br />to 11q"? L <br />u",. q, t.1 / 1 J r.o m,or <br />caNgl3lqlrlN.rlNpluclcElllt <br />I hcrhy aiirm undcr Fndry of rrju'7 thar risc h a con(ruclion LndinS oscncy lor rhc pcrfolrMoe of rhe sort for which lhir F.nt h <br />nrucd (SN. 3097. Cit. C ) <br />L(ndq s Ndnr <br />- <br />I <br />I <br />r-------T------