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APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Insulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <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 />Rough Mech.7 z,C\r{ut/./(i'l <br />Final Test <br />Meter Release -4, <br />FINAL 4'.s,,azds z) <br />Notes, Remarks, Etc <br />OWI{ER DUILDER DELCAIUTION <br />I haeby amm undd podty olpqjury ltal I @ .xorpt 6!m th. Contrelou Lic.e Llw lor rhc fouoqi.g rdon (Se.70J1.5 <br />Bsin6! od ProlBion Cod.): A,y Cil, or Courny which rcqun6 ! pami lo @Blrucl. 6Iq. inpov., drtulish ot Ep6n my <br />srru.t@, ptior ro irs isuam. .ho rcquic thc arpli.et hr su.n F nil to 6k a sigrcd n6ffit thd lE or 3h. it licrud Pury. <br />ro rl'. FolilioB of ltc Co radof3 Licds.d Lre (Chlpto 9. CoMGing vnh Sdion 7000 of Division 3 oa lh. Bsind ed <br />Profrsio* Cod.) or lhrt hc or sbc b d.mpl thd.6on Ed rh. b.!is aor lh. tlh8cd ci@riion. Aly viol,tion otsdrion 701 L, by uy <br />applidr for r pdf,I subjds lh. rppli@r ro a civil pc$hy o rnor mG rh& nlc hlodr.d dolls (Jt00). <br />L s omd olrh. Fop€riy, or my mplot€ 9nh w!g6 s rh.ir sl. oopcNlion. wiu do di. rort &!d fi. d4c1@ i! ml <br />iitdxlcd o. otH for s.lc (Sc,?04,1. Bsind od P,oleioE cod.: Tt'. c.nrador'3 Lic@ Lrw &6 nol at ply lo e oMd ot <br />rh. FtrFty wno build! or im,r!6 $co.! ad who &€ sch @tt himclf or h6.lfor lhDush his or h6 oM .mploys. <br />Fovidcd rhd so.h ioltro€Gl! @ nor iflqld orolH forsL.I( ho\w.lh. hildins or inlio€ftd is $ld silhin oft,B <br />ofodpl(ion. th. olmd B!ild!, wiu lErc dE hrtn ofFoviie $n hc or slE did mt hrjld o. iEF!rc tnc FbFty 6r th. pqDs ol <br />-1. <br />s o\Ie olrh. Drop6ry. e .x.luivcly co.liactirs sin tico*d .otnrEcloB lo onslrud lh. proj..l (SB. 7044, Auind <br />Md Proftsbtr Cod.: Thc aonkoclols Licfl* Law do6 nol apDly to d ownn o apro!.ny who buil& or improve lhdon, <br />dd who @nt6ft for .h Fojco3 with a o(, lncBc{l pUsu.m hrlEaontraclois L'c6* LdN) <br />I hftby amm undo pqaltyol <br />I h6@ ed will @iil'in a CdrrEal. of coffdl lo SGII-IEU. fo! work6 @hpasdion, s Foeii.d for hy srtion 1700 olllE <br />t lor Codc, for 0!. pqfo'l@c. of rt mrt for wbcn tll. p@il k issucd. <br />I nxv. and will oainldr qort6 cof,p.Nalion iaurrncc. s rdluared b, Setion l7O0 otuh. kbor Cod.. for lh. psfomd.. of <br />lh sort for whtn rnis pmil is issu.d My vorl4 shpdBalion iNu&cc cini6 tnd policy numbs e: <br />-l <br />cdriry thal in lhc pdfomdce of $c worl lor whichrhii pomn t i,su.d. I shalltul mploy ai, pd$n inoy mmn6 <br />$ 6 ro b€omc sobjor lo $. wo'kEl compoerion laNs orc'liromia. md as@ rhar if I snoold b..o'D. suq4r to rh. <br />vorl6' @np@io, polilioB ofsdtio. 1700 of th. tibor Codc I 3hall. fonhwi$ soply wirh ihoe PmvltioN.. <br />WARNIN(;: Fsilure to surc workm' comp..s.lion covsas. i. unh{rul, md inall subjd e flploF lo oimin.l F@hi6 dd <br />civil aa6 up to on. hundr.d lhouend dolld 100.000). in .ddition ro th. co$ oa.omp.Mtio.. daha!6 6 prcvid.d lor lh. <br />Serion 1076 ofthc t,abor Code i.tais dil <br />ptd 1.,\t,\r(rN <br />I h@by lrm und6 p@xy oapgjury rhsr I u li@E d uda povision olcrlupl6 9 (@@.irs wnh sdi.n 7000) of Division l <br />of thc BchB md ProfBi@ Cod!, ed Ey licc@ i! i! tu[ foE.nd !rel. <br />Lic.NClN: <br />g)XsIA!JCIA!-tENDOEJGj:!CI <br />I hdcby .fnrD und6 p.oahy ol psjury that rh6c is a .onslruclion ldding ,g6cy for th. p<lomdce ot rhc *!tk aor $tich lhir IEnn is <br />ilruql(S( 1097. Civ C) <br />AIILICAEIDECIJf,AITON <br />I hddry aIEm undq p@.ty orFju'y oic ofih. followin8 d.cleliols: <br />DcmlirioD PhirsArhcro! Norifi..tio. rcdoal R.elldioB (Titl. 40, P.n6) <br />-R.quircd <br />1316 of Noifcaion <br />---\F r.,..l\-...^C\i\'vJ^^P-*"c\y' <br />)2F <br />MECHANICAL-INSPECTOR RECORD <br />I mJc'-r A id *\ <br />I f?ldal rcgulalions rcsEdifls 6b6los rmoval se not afi,licabl. ro thb prcjd. <br />I <br />**-g-?51S1 <br />I <br />I <br />I <br />I <br />I