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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS OWNER IUILDET DEL(:ARATION <br />t hcreby trffirm unds pcn.lry of lcriury rh.r I m cxsmpt lmm lhc ConlricroF Lien* Law for rhe tollosing rcas. (S.c r03 1.5 <br />BlBircss rrd Profcsio. Codc): Aoy Cny or Colnry stich rqunci a ltrml ro @nnrucr. ahr. impbk. &mlish or qEt any <br />.mcuE Fhr lo ir L$!Gc. rl$ Eq es rhc rpplhor for such Fmir lo frlc a iigncn atcmnl rh.l lF or slE is lien*d lma <br />ro $c prcvisions of rhc Conlr&tois Lic.o*d L.w (Chlprcr 9. ConmEins wirh Sc.rbr Il00 ol Divisb. ! or llr Busin.$ and <br />PDtc.rion. Codc) or $ar tE o shc ii ci.alrt rMmn d<l fi. buris for lhe .ll4g.d cr.mplio.. A.y vioLlion oI S€dion 701L5 by !., <br />or,pli.anl fo. n p.mit subjcls lhc applicrnl lo. civil p.Mlryofml mrc lh$ filc nundrcd dolhrs ($5m). <br />_I. us owtur of rh. po!.ny, (tr 6y edpk,yccs wirh wlscs as rncn wb conFcnsar ion. pill do rh. wfft ed rhc srmtm is n,t <br />inEn(H or of.rcd for elc (se.7044. Businc$ .nd Pofcssbns codc Thc Cnffn loas Liccnsc Law docs nor !ppl! l. an owNr of <br />thc rmrEdy $ln t{ild\ or iqm6 fi6{ ard *ho des sh s* fiidiclf or h.Mlf o hmqh hir or IEr own .qrlo)rcs. <br />provid.d rhr s!.h ihpmrcmnts m mr inled.n or oflcRl f(, qlc. lL lx,mhi th. t iLting or inpmrcmnl h $ld eilhin orc )c!r <br />or cndplcrion, rhc Own( Bnikler will hlE rh. hr&n of Fhving 'h,r <br />hc or shc dll nor huiu or irpmv. thc pn'Fly for ltE puqD$ .f <br />-1. <br />as owmr of rhc F.reny, an cxchsiwly m Ecrins wirh lic.r$d conttucioFh on$rod tL lmjBt (56.704.4. B6ims <br />6rd hnlirsion Cod.r Thc Co.rerdr\ Lic.ns tiD d@r .nr lpply ro @ o{n$ ol rrcn dy eho builds or ioDoves lhcron, <br />ond who onrlqcrs for such poi€ll wirn a Contmtons) licnsd puBuonr ro rhc Contractor's U@nsc L!*). <br />llll(IAl]]tllrI! <br />I hcrcby .finn undcr lEnrhy of rsj!ry oft of lhc following dsLr.lions <br />l hrvc drlwill nhn irr('cnilturrcolCon{DrhSrllln\urolursorkcN(onrxNrlirnr.r\fovidcdinhySd.ln:17(Xloflhr <br />t-'htr Codc.lnrrhc P. ornrm.orrh. qo'k lr which rlt pcrn,ir is is\urd. <br />_l how and *ill m0inrain worlcn comFniation inslrarcc. !s rcqlncn hy Sdion lToO ofihc kbor Ct d..lor rh. Fnmmrc. of <br />lhc eoi( for *nich lhis !.mil is issucd. My workcs mmpcnslion insuErc dEirr !*! lolit numlsr dc: <br />WARNING: FailuE ro *{!rc w{rkc^ odtcoqarion..\!nrsc is unltrwhil. md sh,ll suhj.rt .n cmplorcr lo aimiMl lEmhics od <br />(ivil lincs !p kr om hundrcd ltouend dolhr (llfi,.txxj <br />SL{rion]076 olthc bh, Cod.. inrci.{,nd, omr'\ ri\s <br />). in addirk,n io rhc co{ ol.omp.nsrion, dlmgcs as <br />(-tc-r7 <br />ucEN$i!_carttrl(fllB <br />D}:ILIBAIION <br />oi rhc,lNi'r$ an'l Pn'rr\\i{'r\(i'dr. rid 'ny lirctr.c i\ i', inll kn.c rxl.fl..r <br />- <br />corltutoi- <br />C!}NEIAU{i.UONIENIIINC.AJiIN.SI <br />I hcnhy 0ftm undcr Fn.lryorlcrjur, thd lncrc h ! con(nrlior hndins !scE] lor lnc Ir iom!tuc orrhe *oik rd w,rich rhi\ Fnnir is <br />i\sx.d (Scc 1097, Civ C ) <br />ATTLII;ANLI'ICIABAII9N <br />I lrr$y arinn undo pcn,lry.ifclry onc ofrl[ lnlbwin8 dccllrdrions: <br />Dc.dirnnr Pcrn c'Asbcstos Notifica'bn Fcdcftl Rcsulll i{!N 0 nt 40.l'ad6r <br />Rcquinl Irn.r of Norifuri.i <br />I cdify rhd rhc lcdcful r.gul.lions a8jrdnrg sst$h{rc'mvdllrc tror ul)plic.blc lo rhis pmjccl. <br />-lccnilyrhar <br />I hrvc rcad rhh appliclrion and srurc rhd rhc ak,ec infornhri.i is.oncd. lagrm k,.rmply wnh rllaily rnd County <br />h.rcbyourhorir rclesnlalilc\ otrhh Cny lnd Cuu.ryro €n's utbn llE <br />abovc mtrlion d,opcny .',.pQ* <br />,*,7-16 t9 <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouoh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech.) <br />Final Test \t, <br />Meter Release <br />FINAL r0-hlltl/ <br />Notes, Remarks, Etc. <br />_l enilyrfiar in rhc Il.rl{{nun( orrhr woi* ror which rhi\ pcrmir i\ ii\n.d, I rhDU n.l cnploy dny p.rson in ctry manm! <br />sosrotE.otrsuhjdrolh.wo*cdsmpcnslionl.vsofcalirorn,andogrcclhrtifIshouldhccom$bi.rr.rh. <br />workcr c.macn$rio, pmtisions.fScclion 3?00 oi lh. tjtr Cod..I sholl. fonhwirh compl, *iln rbs pmehion\. <br />ordimnccs ond srrrc ti*s <br />Other <br />lnstallation <br />ziL\4l <br />/\\ <br />\I