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MECHANICAL-INSPECTOR RECORD .JAPPROVALSDATEID/SIG.OWNER BI]ILDER DELCAR,ATION
<br />I hcrcb, a,Ird lndf ,c.rlry ol pciury $[l I m cr.dpl fion lh. Cortr&loa Liccne t e for lh. followin8 rcNn (Ss.?0]1.5
<br />Busincs rd Pofc$ion Codc): Any Ciry or Colnty which rqlig { Fmn b on{dd' .lB, inprcr. &mlkh or Epdn ey
<br />strucrurc. Irior ro ns issod.. s*o cquncs Oe .rplicrd fo, such F nil lo fih . siBmd slllcmnl lhll lE or sh. k liensd Plrsel
<br />ro rlr pmvkion oft& Co.tmlml Lier*d Li* lchupler 9. Cohmncing *ilh Sccrion 7000 of Dilnion I ol rhc Bulin $ atd
<br />Pmfcsshns Codc) or rhd tr or she Li crcnq rhedior ed rhe hori-c for lhc alhB.d cxcdplion. Any viob on ol Scdion 7031 .5 by any
<br />lppli.a.r ror a pmir suhjels lhc {ppli.anl lo a civil p.nahy of not mE fi@ lirc hu.drcd do!fis ($500).
<br />-1,
<br />s ose. .i|he pop.ny, or ny cmrlolss vni wltcs {s th.ir Flc comp.nsllion. will do tlE *nk td rlE slrrm is mI
<br />inl.nkd or or.red for eL (Sa.7044. Blsincs lnd Rofessionc Codc Tnc Cod@loas Liccr* t q dcs nol lpply lo e owM or
<br />tlrc Fopcny who hiilds or nqhE. rhe@tr 8d who dds Mh w.d himsclf or h.Nlf or ltml8h tis or h.r osn cill,lortes.
<br />!,ovidcd rhrr such impnlmnk m mr hrcod.d o, olTcied rq eL. lt hosw, llE blilding or iqEwmfl is $ld within oR )t
<br />ofcorytrhr tlr Ovrcr Blildd will haw t r hirLn of peving thlr lE or sh. did nor build or i,{'bE nE porEly for llt I)lrFs of
<br />-1.
<br />s owncr of rhe pFl.ny. .n crclusiv.ly cont!.lin8 with licc.scn onlr&loa ro connrud lhc pDid (S(. ?044, Buiincn
<br />od EofLxsion Codc: Thc Conhcroas Lic.nsc Law des nor apnlylo aosm, ofpoD.ny who hDilds or implole! lhcrcotr
<br />and who coirdcrs {or sh rmj(B vnn r Conturo(s) lixnsd puBunr lo rh. Cotnradois Ltcnr tiw).
<br />-t
<br />m crcmpl !nd6 sNlio.- B. & P.c for lhii Een.
<br />Dde. --,._ orner:
<br />w(,(r(Fir,ColiPi\a^iti )N
<br />D[CI,iI34IrcN
<br />I h.rby alnrnutuld Fndry ol pcrjury otu ol lhe ldlowin8 dccluBrn,n{l
<br />_l hrE rnd sill minrain a C.niric.l. of Corsnr ro S.lr-lnsurc for lorkc6 .or{rn@rion, as pmvidcd aor hy Selion 3?00 of lh.
<br />Libor C.d4 for rlE Frfotrr@. of rlE trrt fq whkh l,r. Fmit iq issucd
<br />I h0vc rnd will mintoin workcrs coq,caralion in$raftc. ar tqutud by sftlion 3?0o of lhc L€$or Codc, for rhc pdfotmnc ol
<br />rhc work for which rhn p€mir is hnxn. M, *ortm omn nsio. insurm cmkr !d Inli.y nlnbfi @:
<br />Poli.yNutrte ErPiEs
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<br />Llnity rhd ir rh. Frformrc of lhc lork fn vtich lhh Dc,nrir is irs&d. I shdu nor.m!'loy 6ny lrFon in liy tuer
<br />s Nro bc.om slbjEr to rhc s*c6 conFtreri.,l,sof Calitomi& and 08rcc lhat if I slt,lld ltom subtel lo llr
<br />woltcs $m,,cnsarion rftririo8 olsNrion lTm ol lhc khor Cod.. l shlll. forlhwirh d,mpl, snh rhe pmvhhnr..
<br />W RNINC: laihE ro s.w wortcra on{Eneiion .orcogc ir unl.wtul. $d shlll subj.u m cmploytr lo oEj,tl F lli: and
<br />.ivil fines up ro om hu'drcd thousnd dotlos ($l0O.Oo0). in addiih. b ln osl of dn{rnslion, dmg.. r! pDvkl€d for lhc
<br />Scrion 10?6ofrlEt tc Cod€. irBen rrd allrmy ! le3.
<br />LICINIEIIONIB.dCIAf,
<br />Dl,'(:I
<br />^RATlt)NI h.[h! rinn uMcr lcnrllrolI'cryury lhal I !n liccnsd undcr pDlisn,n orChrptc.9 (oNIEEi.s sirh Scclion 7uJ0).it ivnion l
<br />of I)r Brsinc\\lhd Pn,fc$n'nsCd., !ft1my licns n in fullturc clfNr
<br />SNIIA!(JII]NIENDIN(i.ICENII
<br />issucd (s( .lo9?. civ c.)
<br />AIILTSNLDEIII&III{JIT
<br />I l*rchy nfllm u M.r ,Enrlry ot I{rjwy onc ol rhc f{,ll(,trin! dc.lxrariirl\l
<br />Dcnrnin,n Pennit\ Ashcno\Norillrin lcdorl Rc8ul0rio..r'rnlc{r-Prn6)
<br />Rcqurcd litcr of Norili.d ion
<br />l.cnilyrhr lh. fcd.rul Eguld i. ns rcSudirS lslEslos rcmoell alc nor {tli.dbk ro ihn pior.l.
<br />-l
<br />.6rif, rhar I hr{. Md lhis E plicllion dn slolc lhll lh. etovc infornEtion i! .orer. I lgrc ro condy wnh ! Cily a.d Counry
<br />ordinlm ad srat Llws Elarin! ro b{aldirS .o6ro.rio4 ox! lErcb, thort Bprc$.tivcsofrhirciry@dcounlylo.nl6otEntlE
<br />lborc mntioftd I,DFny for i.qedon pu.lbsc!.
<br />Aplli.anr or AScnl SiBnaturc:
<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 />Rouoh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Banoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Ducl
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release I
<br />FINAL S m tg JSt-
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />Lied. Ch!!;-Li..e NunD.x
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<br />LcnJ(i\ NJntr
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