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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER DELCABAIION <br />I h€nby sflim und.r pcMlry of Fdury $d I m ci.rPr fmh llE CotnmloB Lien* L,v for th. following @sn (Se.?03 1.5 <br />Businc$ snd Pmfcsion Cod€): Any Cny or Counry which rcquiB a Fmn lo onslrucl. all6, imprcvc. d.mlirh o, E .n dy <br />sElctrE lrior ro irs issunce. lko r.$ies rhc E plkrfl for su.h Frnir to fh r siEncd staLmnl thot lE ot sh. is lienio.|)u^udl <br />.6 rhc pmviiion. of rk Conlmcrols Licon*d tiw (Chapr.r 9, Commcfting wirh Sccrion 7000 olDivhion I of lhc Busings.nd <br />Pmfcssions Cod.) or rhlt lE m slE is cicftpt rheEfrom anrl rhc b6sis lor ihe rlhged dcmplior. Ary viohlion of S*rb. 701 Lt by ony <br />aprlica for ! ,)qnil subj*B lnc applicant to a civil p..ally of ml mE thsn filc hlndEn douas {$500), <br />-1, <br />s owE of rlE prcFny. or my cq,Ly€e. sith wag6 &r rlEir e!.6np.nr.1ion. will do 0E h* ud lt sltEl@ i! tbl <br />inrcndcn or offctn f6r slc (56.7044, Busiess dd Profc$ions C.dc TIE Cotrlr&ltr s Li..6. t q &B ml apply lo d owBr of <br />lhc pmn.ny *lF tDills or i.nrces tl*En. rd sho ddr sh mrt hilMll or hcrsll or thmud his or hc! oqn e 'iplot*s.provid.d lhll ruch ihpmrcr s E mt inrcid n oftEn for sk. U, fidq@, rlE b{i6in8 tr inplwmnl h sh *ithin onc ,!e <br />ofcomphrkrn. rhc Owmr Builds will hlw rh. hrdcn ofFovin8 rt' tE or $. dn m toiu o. inprlE ln. ,a'p61y 6r ti. IIIFE of <br />L rs oerE o( rhc poFny. .n crclusivrly conrldin8 wirh lier*d conltrtoN ro @nslo.r rlE lr.jd (Sd. 7044. Busirc$ <br />and Pmfisrim Codc: Thc Conrrdroas Liccns. k* dfts rer alnly ro d ov6d ofproFnywho builds or imrotr rhcrm.. <br />and *ho conn ds for $ch FEds wnh a Conhcro(O ltu*d plrsM lo rhc Coorndor'i Ltcns L,w). <br />-I <br />m .xc6pr u..lcr Scdor--, B. & P.C. for fiil Eason <br />]YOXKEBS:I:9IdEENIAIION <br />IECId8AIIAN <br />I ncrcby afirm undcr Fm,ly of Frjury om of lhc following dsletiosi <br />IhDlcddwiU linrain, C.niicarc otcotr*nr Io Sclf.lnsurc for works conrt.\arion.as lmvidcd lor b, SErio.]TOOofrhc <br />d;-I(trrhr rtomrtucolrhcwo lnrqhiclrrh.Fnn n ucll <br />\rrllnhir rin $or kc( .onrB- n\!ri, ir\urrnc.. r\ rcquncJ h\ So.ii,ni l7(Xr.frh.l-!h.r Cdc. for rhc pdfomn . of <br />J. <br />V <br />-lccrri{yrnar <br />inlncoslormnccofrh. woit forqhi.hlhh pc!ftn is Lrsucd.l shlll nol €mnloydnyncnon indnymnmr <br />s $ r. trsm su6i$i b thc wlt61 smpc.srion h*s of Crlifomi4 and aErce rhd if I stEtrld bc..m subjd lo ll* <br />hrkcn.$mpcnsarionpmvirionsofS.dion3?00oflhcL{horCidc,Ishlll.fonh*irh6nplyqth(ho$Povisions.. <br />WARNIN(: lrJlur. n, wrrc $orkLn'is unhwtul. md shlll subF.r ,. coploycr io Gimind Fnllis and <br />r. in addirion lo thc cosl otco.D.nerion, ddmScs as providcd to! lhc <br />utrN$;LeaNraiqats <br />UIILAEAIION <br />I n ohy offrn uodr p.ully of Frjort lhsl I am lien*n undcr I'oliiaon <br />or rhc Busircss Md Pofcssions Cod., .rd my liccnsc is in tull forc drd <br />6f Ch,prr 9 (s,lrencin8 wirh Sccri,n 7(xl)r of Divi\n,i.l <br />qq u<51 <br />(](INSTRI]CTIoN I ENDIN(; AGINCY <br />Ihcrhtalfinnukl$Frrlly.fNrjuryrhrrthcEnrcon\rnEriotrlcndin8rgci.tfttrrh.pcrlonDn.c.ilhcworklirr*hichIhi\pcniri\ <br />isurJ(Su..l{47.Civ C) <br />_I .cniry rhd rh. rcd.r,l rcSul ions E8ardin8 $iE(os r.nFlal orc nor rppli.ftL tu rha tmirr <br />-l <br />ccniiy rhor I halc rcad rhh.ppttrri{,i @d rrarc rhlr rhc lh'v. infomrrion is corscl.I lrE lo amply*irnall Ciryand Coun'y <br />ordinriccs d Stdc tjwsrcl(to buildins conslrucrion. nml hcrctyaurhori& rq'r.scnrd'ircs or$is Cny <br />.bov. n*nrioNd l,mpcny for j,/"- <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />It/isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough 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 />Rough Mech.1/4$/"6 >\trx <br />Final Test <br />Meter Release <br />FINAL t - 7', -Lo <br />Notes, Remarks, Etc. <br />lrndci\ tuldrc\\ <br />APl,t'(],tNI I'T'L'I-AR,III)N <br />I trnbtdllmoklcr |xtr.hJ_ ol ncrtury onc olrhc iollo*ing dcclffrrn,ns: <br />l)cnrolirnr Pcn.ir\ Ashc\ro{ Norificrrn,n FcdcrnlRcguhrntri\ ('Iirl.40.lhn6) <br />Rcquitud lrrrcr 0l Nori,i.di(n <br />--------T------ <br />----+--- <br />i---+---