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DATE ID/SIG,COMMENTS OsG-B!ildr Dcclanrion <br />I fi.r.by .fiirm und.r p. lty ol pdjlry rhat I m .icnp fo.o U. Co.t6aotr Lieni. rl* fo, $. followins ,aon (!* ?03I.5 BGin6s <br />and Pm&.iion Cod.)r Any Chy or Comr, whi.h r.quiB . p.mir ro oBrtu r, .lln. 6prow. d.ooli3h or Ep.t ay llfucrurc, pdo! lo n3 <br />brue.. ds rcqut6 lhc applic!,u foriucn pmnro 6lc ! ristudsrll.m thllhcorsn b li..tu.d p@61lo lh. povisioN of rlE <br />Conraclois L'c.nred LBw(Chapls9, Comn.nci.s wnh S@tio.7000 ofDivi3io.I offi.Bu'n6!md Profe$on. Cod.) or thal hc or <br />rh. ir dcnpl thmfrlm rrd rh. b&is for rh. !ll.s.d d.hprion .Ary violtion of Sdtion 701 L5 by my .lplicanr aor . pcmir rubj.$ th. <br />rpplicur lo , .ivil ,.uhy of rcl mo,c lha livc h(drcd dolla { $500). <br />La owncr of th. pmp.ny. or ny chploy.6 wirh was* tE lh.ir 3ol. comp.nsation. will do lh. woi( md rlr ruclurc i! nol imodcd <br />or ott r.d for slc ( Se 70{, Burin6t rnd Prof6tion! Cod. Th. Cont.do Li@nr Lr* dG rol .pply ro .n oM.! ol th. pFpcny <br />wto buildr or inpror6 rh.fttr d vho dq lct work niN.lfor h6.llor thoust hi! or hs own .nploy.6. povid.<l !h.r !!ch <br />impror.m.nlr t( Dol iDt.nd.d or otfd.d for {k. ll hos.vd. lh. buildiry or inpro!.n6t ir tou wnhin oo. y@ ot.onplaio.. thc <br />()lxGFBuildd will h!v. rhc burdcn ol prorir! th h.o, lhc nol boild o. ioprov. fo.lh. purpo!. of3!lc) <br />Yt6 oenr of rh. pbpdy. dn .tcl6iv.l, .onr6c B wnn licced cootocroB lo .osrtud rhc Foj*r ( S.c. ?O{.1, B6in6s a(l <br />P6a.sbn cod. Th. Conrmdor ! L E.N. L.w do6 nor lpply ro e owE of prcpqiy who buildi or inprold thq@n . ed {ho <br />6nrr.d.lor such proJell wnh. Conr!.ro(i) lic.ncd pu6ur.r ro rh.Coikidoar Lrc.n!. bw ) <br />_l d .x.npt undd Sedon _.8. & P,C. for thi! tun. <br />!o!trE!sl9u!E!s !o.!rDEc!4a/!IIs! <br />I h.r.by omnnuod{p.mhy of ,.rjuryo.colrh. follo$ins d.clahrions: <br />lh.v€and will,hrinl.inoC.nific.l.olCoB.nl to S.lf-lNUielor wo.k.B comp.nst6n.!s prold.d lorbyserrcn 1700olrlr <br />L.bor Cod.. lor lh. Frfonunc. oflh. wor* fo. which th. ,qmil iJ i!ru.rt. <br />I hrv. .nd will m. rnrain *ork6r conp.Mrbn 'n.u6nc.. $ r.qutr.d hy Sccr <br />'on <br />3700 ol th. llhor Cod.. aor $. pcdortunc. ol lh. <br />wort fot whict thr p.rnit ir isuci. My work.6 .omp.nst'on insuonc. €nid rnd po li., numb.r uc: <br />PolicyNumber: Expn6: <br />(liissdionne.d nor t compl.rcd iath. p.rmit h aor Onc hundrcd dollau lll00lorlc$) <br />I c.nify lh3l in th. p.rforndnc. oalh. work forqhich this pcrmil is strll nol .mploy any p.6oi <br />b.c!m. subrel lo th. work.6 onD€nsrlion hwsolCaliaornir. <br />.onp.oer io. provaion! or S(rion 17@ of lhc hbor Cod., I <br />Yt"o <br />IVARNING: Frilur. lo sur. worl.u comp.Bdion cov.ng. 6 unLaaul, tnd rhlll su6j.cl .n .nploy.r ro crimim I p.Mhi6 rnd civil <br />fin6 up ro oG hundcd rhoNd dolla (1100.0@).in .ddnb, lo rh. .sr of.ohp.n$ ion. dlms.s a povilcd tu th. Sdion 10?6 of <br />rh. bbor Cod.. rnr.id.nd lnom.y r f€ <br />LICENSED CONTRACTORS DECLARATION <br />I nftby afiim und.rp.naltyoapdjuryrh.t I m ric.N.d lndr pmrision ofCh.prc.9(comm.ncind qnh Sd io. 7fir0) oi Division I ol <br />lh. Busin.s.nd ProfqsioN Cod.. md ny lic.N. i! in lulllo,.. Md.Il{t <br />{-l-,s <br />I h.,.by.lfi,,n und.rpcnlhyofpc.juryrb rh6.kacocttulio.kndinaaacncyforrh.p.rrolmnc.ofrh.*orklorshi.hrhisp..mnG <br />irsu.d (Scc. -r097. Civ. C.) <br />Afrllcaxr.ti"u&clAaAllaN <br />Dcmolirion Pmit!.Arb.$6 Nolifiotion Fcdd.l Rcgul.rioB (Tirl. 40. Pan 6) <br />R.luircd t tt6olNotifi qtion <br />I ccnifylhll Ihc f.dcralr.gulalionr r.srdins 6b6los rcmoul.rc not 0Dplicabl. to lhis prcjKt <br />..- I c.niry rhal I h.\c Ead rnis ipplic.i ir .or.cl. I r8G ro .ospl, w iri .ll Cir, lnd Counr, <br />ordiunc6 a.d Sur. I iws ,.l.tin8 izcr.rr* lln.solthisCilyrtrdCounlyto.,lcruponth. <br />abovc mcntio.cd proDcn, for 9-g-,s <br />Appliances <br />Metal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork io.l(-18 r '6?4t, <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <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 T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />/2-f -/8 e <br />FINAL <br />MECHANICAL.INSPECTOR RECORD <br />M:\WPs1\Permii-lnspection Forms\M6chanical lnspeclo. R6cord doc 03 3l 06 <br />APPROVALS <br />Other <br />Above Hard Lid <br />/2-3+R 7z'zl A/,v C,?/r.al <br />L€nnc i Addrdr <br />P6mirr.. ne. (pdi0: <br />I