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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS O$NEN BUILDER DELCARATION <br />I h.rcby am.m nod.r Fn.lty or pcrjury rhar I m .rcnqrr from rhc C4ntrelos Lk.nc tre to. the followin8 rcNn (Se.?011.5 <br />Busincs and Proac$ion Codc): Any Cny or Coudy *hich rquncs a Dml ro co.sr .t, qllr. inprovc. dcmlhh 01 Elui! any <br />smcr!rc. lrhr ro ns irsue., aho rc1uir.! $c appli.4r ror such |tmi ro liL i sremd std.m lhit h. or shc b lk.ncd PUN$I <br />b lnc tmviions of rh. CoDtr!.lols Lisnrcd L!* (Chrprcr 9. Commiciig enh Sftrion 7O0O of Oivision 3 ofthc Bosincss and <br />PmfcssioB Codc) or rhli lEor sht iscrcnv rh.Eiion lnd rhc tosis for rhc .lhgcd .rcqliioo. Anyvioblionofselioi?03l.5br.ny <br />spplics for a p.mit iubi(k rhc applidnl ro 3.ivil pcMhy of nor rcE rhm 6vc hundrcd dollas (3500). <br />l. ai owftr of rhc FotPrry. or my cmployes *irt {!Bcs as rhct slc comrctrr{ion. qill do tlx vdt erd dr rtur@ is ht <br />intcrh or oficrcd ftr elc (56.?044. Alsifts s.d kofcssions Co<!q Thc C.nl.eloas Lisn* kw docs nol {,p1, $ .n oDrcr 6f <br />rhc l)I)rEn, sno hoildl or itr{,e$ tr@.. lrd who d6 Mh e* hins.lf or hcNlf or lnmugh his or h$ own cn rloltcs. <br />provtded thrt sch inprosmnts @ mr hlcnk orotu for slc.l( hots.lh.ltildi.s or inPibke.r i! $r, wnhinom Fo <br />ofor9k]rhn. rlE Oeer Buitl6 *ill harc 0E hrriM ol Imving ttEl lE or sh. dil ml build o. ihPht ft lmrdly f6. iE PuDoe oa <br />l. .s o*rcr ot lhc l,mrcny, sm cxchsiwly s racli.B *nh liccn*d conlacloB ro consttu trtr pmiel (SB. ?044. Bocim$ <br />ond EoG$io Codc: l hc ConrB.t.r's Li.enr. Llw d@r .or lnply lo e own.r ol prop.rly who 6uilds or imDDvc. lhcrmtr, <br />Md elb oirricli for och pmidk wirn a c.darods) lt.nsd puFutrt to lhc c.rtr!.ld i Liire Lrw). <br />-l <br />m.&mpl !td.. s.dio!-, B. & P.c. lor thb lEen, <br />uoaf,Ef,s:cl)gfEasArll]N <br />DECI.AEAUg! <br />I h.rcby offtrm und.r pcmhy of lcrjlry onc ol rhc louowing deldaions: <br />I hllclrl*ill nrin(rir rCcnii.0rcolCo,r$nt ro Scllln{trc for wort.^ .oNp.iern'n. as fn,vidcdfottySdion:l7lx)otrh. <br />Lahtr Codc. turrtc pcntrnhn.x orrhc work for which rhc r.flnn is issucd. <br />!rfr/. rnd will nrfllin workcs conDcnsal ion nNurun e. is rcquircd by sNr i,,n :17(n or thc tabor c.dc. tor lhc pcrfortuncc or <br />hich rhhFrnrir is istud. M, workcr'compensorion insursn.c .Mio ,ild ,olicy .u'nbcr m <br />/Ar 1-t -/ ? <br />-l.cnify <br />lhd ir lh. p.rfoflMftc oi lhc *6.k tbr *hich rhis Frnrir k issucd.l shall mr cmploy any pcron in un, n,nmr <br />$ !s ro bcom suhjd r. rhe q. s.onp.nsdion lsws orc,liromi...ad |ge lhlr ifI rhoold tc.otu subj&r lo rlE <br />*orkcF codpcnsation pmvnions ofs(lion 3Tmof ihc tibor Codc.l shrll. fonhwilh sryly qilh rhos pmvisions.. <br />WARNTNC: Frilurc k, ecurc *orl(s' compcnetion <br />civil fitrcs up lo onc hundrcd tholsaod dolloa (SI(XJ <br />i\ u hstul. r d rhill suhjccr an cnrpkiycr ro d'ninrl lrinhi:s dd <br />in rddin,n lo rhc con ofcomp€nsarion. dumags N rmvdcd lor lhc <br />of rhc lihrr C.dc. inrcds x.d'7'tr <br />IJCENSED-SONIMqI9B <br />DEqI4XAU{A <br />I hwby atrrm u.dn F@hy of pcq!ry thll I ad liMscd lildd !tuvision of Ch.flo 9 (coMtring wilh sN&n 7000) of oivisio. l <br />oi rlrc llu\irc\s rnn kofc\sitr* Co,lc. rnd ht lirc ( n in tulltur.cntrdcllc(r <br />? <br />(aNux!!::ur,raJ.IiNulNc-dffNq <br />I lr.chy niltD !nd( Fmlitol t{turyrh h.rc is,..trstu.ri(,n lcfrliiE nscncy ir rh. rcrronruic. orrho w.rk lbr whi.h r[h Fanil n <br />hnrcd(Se... J0q7. Ci C ) <br />-l <br />ccn ify rhar thc lcd€ral rcsular bN rcg,rdins {stx{os rc Dv0larc nololpliclblc lo rhisI)hjccl. <br />I ccdilyrhrr I hNc rcadrhiselrinurn,n ad (nrcrhs h. rw inrom$.n is.omd I oErNrocomDl, wirh allCiry rnd Cuunry <br />ivcs ollhis Cily 0trd Cou.tyt, cnrcr nF,.rhc <br />,,,",t.8-rd' <br />ordinrnccs dnd Srde lrws Nld <br />dil;;;'*"dbovc morioftd pml)cny f.r <br />Apnliclnr or Asctrl Sienll <br />L4-n)Z <br />Appliances <br />I\Ietal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />l\ilisc. 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 Range <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />lnstallation <br />F.D. Drop Tesl <br />Above Hard Lid <br />Above T-Bar <br />Bough Mech. <br />Final Test <br />Meter Release <br />FINAL K-/-ll x.u/"x) <br />Notes, Remarks, Etc <br />Other <br />kd.ltNm:- <br />kndcfsAddrcss:- <br />rppr rcliiirEi,urniw- <br />I lta*ry ,rim und.i F.llly of lcrjury ore of lhc follovitrg dcch,nl ionsi <br />D.mlirio. Pcrnits-Asbcstos Norificlrion F.dcral RcExl,rhns (Thl. 40. Pd6) <br />-Rca!ncd <br />Lcrrcrof f1{lliar.lrh, <br />r )// <br />tt <br />=