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MECHANICAL-INSPECTOB RECORD <br />APPROVALS ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcr€by amrm undcr penall, of F4ury lhal I m cxcnpl fbm rhc ConlreloF Liccns tnw for lhc lollowi.g een (Se.?0.1 1.5 <br />surinc$ ,ij Pof$sion Codc): Any Ci, or County ehth EtuirN a lErmn ro effirucr. drcr. improvc. d.mlish or rcpd y <br />slrucluc. |rb,b iii L*u.N€. ,le nqtris rlE ,pdicer lor such Fmir ro filc a sisncd srar.mnr rhlr lE or shc ii ticnsl I'Usu! <br />to lhc tEvhiom of$c Co reror's Lien*d Luw (Chspts 9. CommminS wirn Scctiotr ?0m oaDivisiotr 3 of thc Busincss ond <br />Pmfcssions Codc) or lh0l tE.r shc is s.npt $cEliomdd lhc hoin for rhc allcgcd .xenwion. Any lioLrion of Sdkrn 70:]l,5 by an, <br />alPlicant for a pcftit subjNts thc aplli$nl lo !.ivil pcMhyofnol mrc lhn.livc h!.drcd dolus (1500). <br />-1. <br />{s owrcr of th. pn'p.ny. or ny cmtloy&s silh {a8cs as rhcn sh snqFnsrion. will do rh wk !d tlE srrBrE ir mr <br />inlc h .r oficrcd for $lc (Se 7()4]l. Blsiftss ind Pmr.sionr Cdc, Th. Coirarocr t-ien$ Llw dncr mr ,pply io M ow.cr oa <br />rh. pn,I)cny who build\ or inlpob tlrB)d bd who d6 sch w.* timsclf or ncrclf or rtrou3t his tr hcr osn catlort... <br />povidcd lhal $ch inFomnls m ml inrcndcd orofr.rd for eh. Il homE the tiildinB o! inpmwmnt t $ld *nhin orc Fe <br />ofsnpLliotr th owN Builrd wil! h,r ilr hlrkn ofprovins thll lr or slE dn n,r hrild or in@hE thc nNrEry f6r e pu4ncot <br />-1. <br />as owftr of lhc fq,cn, omciclusilcly.onralin8 rilh liccnsd.ontmclonro mnsldcl lh. p,ojel (S.c.7044, Busms <br />.rd Pntsrion Codcr Thc Conr&rol3 Liccnsc Las d@i mr emly to d o*n( of propcny who builds or imporcs rhcr6n,and who conrmts for sul' I,ojccrs with a Co.ra.ro(.) litncd puFur lo rhc Co.re&ii Lkcrc t w), <br />-l <br />rucx.nr u crsLrrn .A &PC f{trrhi\rcr{nl <br />laatrEBI'toMPiltallaN <br />DECLATArlON <br />I hcrcby !flnnr undcr p.nslly ol pc,Jury orc ol rnc nnhwing dNldorbnsl <br />-l <br />lEvc ltd will mintlb r C.nifEdc of Consnr ro S.r-l.ruE for @ts oopcn$rion. &{ Fovile<l lor by Scljon l?00 of $c <br />L3bor Codc, fd 0E Fdo!r:!E of 0E m* to, shi.h {E Fnir n issed. <br />-l <br />hale aftl will man ain worlcs' compcnsltion in,uEncc. trs rcquiEd by Selion l?0o of lhc lnhor $dc. for th€ pcrlorronce of <br />n n$urnmc cu crlnd Fnicy Nmhn uc <br />d rlrL <br />I .cnity rh.r in rhc p.rfortu r. ofrhr work ftn whth rhis p.!ni k is\'.d. I \hall R,-,., _, [^_J. -;"_"-s a\ to h.sm subjer b ihc m*.r' conqxnsrion Inws or Cdifomir, rJd aBmc rhar if I stmuld tr.om eubir' ro trE <br />*ortcr'corycnsllionpmvisionsofSctionlT0OofrhcbtbrCodc.lqhnll.ronh*irhsmplyvirhrtbstmvhionr.. <br />l4ARNlN(;: F.ihtu t, *cu6 rorkcA .onpcn\dion covcmBc unhrttl- nnl \hrll \nhjccr an c,npk,ycr b Gi nrl!.Mlric\ rnd <br />civil lin$ up r. om hr.drerl rhou!$d dotlc <br />Sccrnr 1076ofrhc Llh, C(rl., inr.rci dnd <br />oft=5 1 lo'( <br />I htruht !tnnr undcr ntr3hyofncrjury rh"r I 0m li.usld ,rcvisionofChryrs 9(commmiry wirh S*ri,n ?OO0) ofDivhion l <br />or thc Busircrsotrd Pmrcssions cod.. en myltcnsc is infiilltorc&d.ffr <br />I h.rhy nlli,n, u rl.! ltfrlrtol|rr'j,trtrl rrhq. \x.un!n'.iio <br />n\uilrs.rlogT{\(l ir8 qcncy tor rh€ pcrfornrocc oilhc work lbr shi.h rhh P.m n <br />ASSLISAIL!&CIAIAII(IN <br />I hdrl,y atrm undcr !.nalry ot p.rjury orc of lhc follo*ing d(h,arions: <br />Dcmlilion PmiG-Asbcnos Nolifiotion tu nl R.gohtions {'rnt 40. Pd6) <br />R.qund lr cror Norifi$ri,m <br />-l..diryrh <br />rh. r.dfal rcBxlir ion* ,.8.Jding r\bcsros rcn,vi rc nor srDlhrhk ro <br />'hir <br />projet <br />l.cnilirhdr I hnvc rcld rhis rl !8re lo comply sirh a Cn,lnd C6xnry <br />0rivcs ofrhis Cilymd Countyto cnrcr uton thcordinaoccs lnd Stolc l-o*s rclir <br />ok,!c n.nriomd trepcny inr <br />AFth.rnr r Ascnr Sisnlru <br />l <br />^,", d.lt"'t8 <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Boom / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />o penings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />FINAL 6lzt (3_,U,ll(l ) <br />Notes, Remarks, Etc lr <br />DATE <br />Drlq Owmrl <br />Furnace <br />lnsulation <br />Meter Release