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MECHANICAL.INSPECTOR RECORD
<br />0WNTJ8 BUII-DER DELCARATION
<br />I hochy rrinn utucr Fnrht{n p.rirry rhrr I Nn cxcnrlr lm rhc aorrrcnn Liccn* Lr* i,r rhc li'll,,si'rs rcr{ (Scc 7(r'11.5
<br />Bu\irc$ r Pn,fcst (irlcr Atrt Ci,y or Counry {hich rcqlnc\ r tiiinn n) can{rucl- alrcr. n pmvc. dcmlnh or RPrn tiv
<br />{to.rutu. fnorro \ NqnNc- aho Eqnncs rh. aPtlicarr li,r!u.h Jrirnil b Ilt I rilicd {rr.ntd rl hcor shc i\ li.dtr$d Pusurtrl
<br />h lhc Fxi\i,)n\ orrlf, Cuitr.nr\ l-iccns.J l.a* (Ch3Prcr 9. (inn t ci 8 *nh Sccrio0 7flD ofDirisi(r:l ol'rhc tl!\idc\s nid
<br />Pn'fcs\n,n\Ci'd.)orrhrrh.orsh.ircrcnDrrh.tcfrorrtrdrltbd{i\loirhcrllcgdcrciPrn Anyvi('L ionolserxrnT0ll5h}anv
<br />{!li.rfrl(rdFnnil$hjc.lsrl(,ptlic,nrroncivrlPcnrlryol..rrFr.ihJnllvchundrL'ddolh^(t500)
<br />I.,1 nwtrdolrhcDmpcny-orDycnl)loteswth*.aN,!rh.n$[.onDuisdn.*,lll]l)rhc]ortlndrhc\rturmi\mr
<br />inr$dcd or oitrcd tr, $lc (Sc.7(!,l4. ausircs rtrd thfc$ii,r Codc Thc C.nrd.r,tr \ l.icc!\c tiw docs n.raPplyh si o$i* of
<br />rh. tftll.ny wlnr hnilds or irrUrrn$ rhcR$n. dl *hl dmr \uch wo* hitnsclf or h.ts.lf or rhrr3h it or ncr ow c Ul,rv*s.
<br />omvidc{l rhar {i.h i,np' ov.n* \ urc mr i, ctrdLyl or ol LE\l for {t Il h,a.\tr. rl'( htrikliry o, irr{'rntlr r is *,kl sirhin nnc )tr
<br />oi.ompldiotr,ltu Ownc. Btildff siU hnvc rlt budctr ofrn)viry th! hc or \hc Jil mr huild or imprcrc rhc ln)Fly nr lh- rxr|nt ol
<br />l. $ osrcr of rhc pmpcnr. am crctusivcly ..nrBdnrr *irn li(cn\cl .oitr&)f b .onsrrucl rla Ptr+cr ls.c. 7(x,l Bu\incs
<br />riJ PmfN\tun Codcr Thc Cotrrrkr'\ Licctrsc ljw docs nor ntflyro rtr owNr oi nrcPcny wh(, huild\ or iDprcrcs rh.rcon.
<br />dnd *ho conh.rsli,ru.h pn,j(r\ wirh rContu.rr,(\J lic.lsed pu$lair h rh. crrnkcntr \ l,iccn* Larl
<br />-l
<br />a crcmfl undcr S.c
<br />O*ner:
<br />!OIf,E8a..C!]MEE!SAIION
<br />DECIA8A]XON
<br />t hcrcb, o Flrn u.dcr lc.llry o f p.rrury ore of t hc fol low ing dc. L..lio!s:
<br />-t
<br />h^rn'i sill nBi nirrCcnrtrlrcolCon{.trrt,Srlllislrcfrsuikcr'conrPcnsxri,'n.ri,rovidcdlorhySccrion.lTfi,olrhc
<br />L.htr C,{lc.Ior rhc p.rro'tui.. orrhc wort tot which rhc Psn,ir n n\kd
<br />-l
<br />have {.d will ndnlain *orlcB omFnsition instrancc. as rcqlircd hy S(l ion :1100 of llE L!6or Codc. t6r rh. Pcrfomftc of
<br />rh. m.t fo, vni.h lnis ,crnil is i!$cd. My eorl6 conwns.lhn insurde oftct .In F,[cy nunh€r ci
<br />\)t*t fr-^)
<br />5.ZQ (t
<br />-l
<br />ccniryrh0t inrhctcriormnceoarhcaolk for sfikfi lhnFrnrir h issu.d.l shrll nol.mplor.ry p.Ron intrnvman*r
<br />m A ro bcmm slbif,r ro rlr mltm conp$sdion laws ofcllifomh. tnd sgE ttll ifl .holld bctom subiccl lo rlE
<br />wortcs' ompcnErion pr6virio.s ofselion 3'700 ol rhc Litbt Co<h. I sh,ll. fodhqirh onply *ith fi.s Pmvisioni
<br />WARNINO: Failuic lo sctrE smtc6 cory.nsaion oe6sc is unl,wful. !"d shall rublri d .q,hrr lo sinid FMnb and
<br />civil 6ncs uD 16 orc hundrcd rhousnd dollus ($IOO.OOO). in a.ldirion lo lhc on of cot\tnslion. dlmges !t prnvid'il r'or rtu
<br />Sccriofl:1076otrhc tjhr(odc. irlcrcn ond alrormy i tuca
<br />o,r", S.zLl.lX
<br />CoNS RUCTIIIN I FNDIN(; ACENCY
<br />I turcby nlltn li.lcr Fn,lrtol0.riu,ylhllrhcrc kr.on(ocrion lcndirS rscncy turrh. |rnanrhncc ollhc*qk r whicnthi\IEnnir i!
<br />issucd (Scc llre?, Civ C )
<br />APPI ICANT DT.'T:I RT\,IION
<br />I hctr$y oftn rndu rcnalty ol,rrjuly onc orrhc roll.uin8 d(ldrrnnx:
<br />DcnnlirtunPcrnits Asb.(os N.rifi.arionI'cdcml RcEulntionrlfnlc,u).Pd6)
<br />_Rcquncd hncrol Mnificari,'t
<br />-l.dirynrd
<br />rh.lidcrolrcsDlrrionstulddingriht(.srcnn'vrlre nor iltJl{rhlc n) lhi\ proiecr
<br />Av.cdiryrli lhJrc rcrd rhtr onn rcrhrnril {rrc rhJrrhcdh,rc irhnMrnu n.otu.r I rsrLr,oconrPltwirh&llCirvotrd Cou !
<br />.klinrncc\rnd Sralc ltrssrcl in!obuitnrs con\lrudion, lnd hcrchy nrhori^ rcprc\enlrii!$ o r rhis Citv md Counrvkr ctrrcrun rrh.
<br />!l$vc mnriorcd l)lopcny ro insFcr
<br />COMMENTSAPPROVALSDATEID/SIG.
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.t [zo t3.^l,ttfiOt
<br />)
<br />Final Test
<br />Meter Release
<br />\NGgFINAL
<br />Notes, Remarks, Etc.
<br />rn^b.zrI
<br />*,", 5 zv-l?
<br />UCENSEDJOj*IIACIAA
<br />DECI,ABAIION
<br />I hcrcby u,nrm undcr p.nalr, of p.rjury rhnr I .m lie.sd undcr P,llision of Chaplcr 9 (omnking Pnh Sdion ?0(x)) of Divntun l
<br />ol rhc Busi..$ snd Prcfcssions Codc, od my lic.ns h in tull forc. od .tfccl,
<br />,''**".*.., 6 , r*"." N,.h., lotl q ,6
<br />o"r., 5. ,tl . I t conrmro. A (r C
<br />Lnd.r'{ Nam:
<br />-
<br />Apnlicrnr d Agcnl signnturc:
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