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MECHANICAL.INSPECTOH RECORD <br />OWNER BUILDER DELCARATION <br />I hcrcby lffim udcr pcmlly of pci!ry lhal I m cx.trpl fmn lh. ConLaclo6 Lians L!* for lL lolhqins ten (S...?01 1.5 <br />Buiincss and Prof.$ion C.rte): Any Cny or Cou.ry whkh r.tuncs r IEmi ro onnru.!. rlie. nrqJovq dcmlish or EInn dy <br />stru.'E, prbr to irs ilsumc, rls rqtuircs ln lpplicMl aor such Fmil to 6b a 3hmd stllcmnl lh&r lE or snc h [e.sd pu^@ <br />lo lh. pmvhbns ol rhe Conuetols Liccns.d t w (Chatrer 9. Colmrcing wiln Scclion 7000 of Divirion 3 ol th. Busincss md <br />Profcasions Cidc) or rhlr tE or.h. n crcmrr rhcEliom und rh. beris lor rh. alLScd cx.mprion. Any violorio. otserion 7031.5 by lny <br />arplic! for a Fmil subirls lhc lrplic&nl ro 3 civil p.Mlly of nol mrc lhln fit hondrcd dolhG (Ssml. <br />-1. <br />I osrcl oarh. poFny, ., ny cmploF$ *iih wa8.s ds rhcn sh conp.ns,rion. six do dE wdt od rh. slrL.iw is mr <br />inrctrdcd or offcEd for ek (Ss.7044. Blsims ed Profcssk ns Codq Tnc Conrra€rols Lian* tiw docs nor lpply r. d6 oekr 6l <br />lh. poJEny vho trilds or in{mstEM.. I wlb &rs ffhk.l hims.lror h.Blrorrhmueh hh or her own.mtloyc.s. <br />rrovidcd rhlr slcn iinhrnek @ hr inrcincd or olY.En fot eh. lf. hokE rhc bllldiru or impmEmd is sU wnhin onc rreof.onpklirtr Fo,*k.Buih6wlnawlh.bod6ofFlineddltmdFdidmlhrihorinpmwth.pmp.nyforllE,ur.cof <br />I, ar owe, of lhe pmrcny. .n .r.hriEly conrE.ring with li.enrcd .onracx^ r on$dd ltE ,mjftl (Scc. ?04.4. Busimri <br />and P,trfK(ir Cod.: 'rh. Conrmror\ Liccns L,* docs nor applt ro e owrcr of propcny who builds o, inpmv.r rnc@n, <br />rnd who .onmcrs ro. s!.h ,mjrk wiih a conhclo(9 ltcnscd tin(@nr ro ihc Conralols Li..n* tiw). <br />I nmcrc rB undor S(ii,m , B. & P.C ntrrhN Nirr <br />l) rr ornrr gl)86E8ti:grMrr sarla! <br />DEII.AEAIION <br />I h.eby aflim !n&r Fnalry ot IEjury orc of lhc follo*ang &.l{,lionrl <br />-l <br />hnvc .d will @i.r!i! . C.nifEarc of CoBnr ro Sdf-lmm to. wk R conp.nsib.. a Frvid.d for 6y Sccrior l?00 of rh. <br />t bor Codc. tor the pfifomo.. of rhe qort for which rhc pemi h ii!!cd. <br />-l <br />havc lnd willmainrain wort.B'comp€nsaliotr insur.ncc, rs rcquncd byS.crion l?00 oflhc Lltnn Codc, for rhc p.rfut@rce ol <br />thc qor* for wni.h lhis pcml n isscd.omF.erion insuhre (uicr ard lEli.y.unber @: <br />[,q-'-b\;-?\(4 Q-1 <br />-l <br />ani,yrhat itrlt Dcrformm. of thc wolk ,or shth thh rrrmn is h\!cd. I shlll tui enpldy &y p.r$n in any lmmr <br />s <br />"qro <br />beom subjecr ro rhc wor*eis coml,cniait,n lrwsofcllif6mi& and agrc ihd if I shonld tr.om $hjel lo lh. <br />srtol omFcnurion n.ovisio.s 6f Serion 3700 oa rhc kbor Co<lc. I ndl ronnwnh soply Nilh lhos pmvisions.. <br />WARNING: railur. lo scurc wortcB'compcnsolnln srm8c is unlawful. lnd shrll suhj.rt an cmploycr lo cimiml Fnuli.s !.d <br />.ivil fincs ut ro oru huMr.d lhousand dolhs Iu).fiD), ir rddiiotr ro lhc cosr oicompensorio.. damEcs a\ tovid.d for rhc <br />Sftri.n :1076 .a ,h. I inr Cklc inrcrcd md <br />R[2,\rQ <br />DECI.ASAIION <br />I ncEbyarlrn!tulcrpenalryofFrJlry rhar I sm liened undcr pFvhion ofChaprcr 9 (.onftmine wnh serion ?mo) orDivhion 3 <br />.f lhe Busims od Pmf.ssions Cods. ond my ltcns k in tull aorc lrd cfrd. <br />az_P -lo utL(l '1 <br />.L t€ <br />II]NIAIgUAM,I:NDINI;IiENIL <br />i\{kalrsc. .1097. (ir ( l <br />d.TII,I(ANIII;gdMIX}N <br />I Imby 0nirnundd pcn,lry ot I'cijxrt onc ol'rhc n,llowirs dcchfuri,rx <br />l)cN)lirion PcnnirsAstrsos Norificarn,n fe{lcrrl RcEul rotrs (Tirl..l0. Pm6) <br />R.qutcd trtr.r ot Notif(dion <br />-l <br />ccrtily lnar thc fcnrd rc8llarions E8lrning ashcslos E.mv,l m mr rtDlicabk to lhis pDj*r. <br />_l ccnity rnar I har rad rnis amlicarion and sl,rc rhar rhc abolc infomrio. is .016l. I !cx* 16 .oaply wilh a Cny a.d county <br />odinamcs an,l Shrc taws lo b'iiEnrB.onhcrion. and tx.cby o$horiz. rr $ff.tircs of rth City,nd Colnry ro c.rc. ltl.n rhc <br />ohole mnlioncn Impcny tot <br /> trhunrorA8dnrSignrru <br />APPROVALS DATE tD/srG.COMMENTS <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 Delectors 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 />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release >nifa.FINAL lolloltfl T ?9) <br />Notes, Remarks, Etc.IU <br />5oJ <br />f <br />,"," Rhltq <br />____--= <br />I <br />- - -T------ <br />I <br />= <br />=