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APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />I\Ietal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lvlisc. Equipment <br />Duct Work <br />Pre-lnsulation iltrS7- <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood A, <br />Type I Hood f)ea--to-'l1i r <br />Type ll Hood 0 <br />Grease Duct " t\J <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 <br />FINAL I <br />Notes, Remarks, Elc - f\-,z^ <br />..-l *-tt+y !h"t/.PltErrnxe ruryrL\fPE, l+ddb a-LIUA)l *-w)-2- <br />FtMf u/L/+P )He L /irraj lo -31r v\L{tli\Jrts v LrrP o.)a I <br />pfLE-Yt+f cc4^tiart N.td-3.lo T.WA <br />(,lVN!]R BUII,DEN DTJI,CARATION <br />I hcr.6r_ rlllrm lodcr Fnrlry of t rjtry rh l un .rr ,tr fior rhc (i'ntNhr L,iccn\r lr$ tur rhc tulb*irE rcNr (Scc 7031 5 <br />Bunhr\\ rnd Pmf.\\n,n C(xlc). Atry Ciry or Criunry whi.h rcquirc\ ! ,(n'ir n) .on{ru.|. r'lrcr. inrlrorq d.flnni\h or rcprn any <br />srudurc, prior ro ns hsufla. als requLcs lhc applisnl lbr such tlrnl ro nh , sig.cd slstem.l lhar tr or shc h li.o{d fuNd ' a <br />ro rhc Dmvnions of llt Conrrs.tois I-iccnscd trw (Ch,!rcr 9. Comn ncins qnh Seclioo 7fiXl of Divisio.3 oflhc Bu\inc$ and I <br />Phfcssions c6dc) or rhar lE or shc h.mmrl rh.rcfrom md rhc blsh for rhc altclcd cx.mprion. Air viololionoasarion 7o.ll.5 hy any .] <br />rrnli.a.tror.p.nnlsutjcIslhc.pplicenlloacivil!.rohyofnolru(rh.nfilchundtddollds($sdjl. <br />-1. <br />!r owN, ol rhc pnrEny. or my .a!plo)@. wilh w.a.s s lh.n $b smp€nsdion. {iI do ilE sdi !d 0r srntrE ii ml <br />i cnde.t or off.rcd f( ek (Sc.r044. Busircss md Ptufcssion3 Code Th. Coniretols Liens L3o ddr n n spPly lo e ow6 oi <br />thc flopcny *no hiildr or inrpreB ilE6o.8n who d&. Mt w hitMlf or lEmlf or rhouBh nit 6lE oM.nplott.s. <br />ptuvid.d rhsr slch in{,rcEmnls E€ mr inEnd.d or oficEd for st, lt hossi 0E buidiq or inDEE,tit t eld wittii om JEr <br />ofoq)hrknl rlE OqEr Buillc. w naw de hrdcn olpoing lhlr i. or sh. dn nor t i6 or inpmrc the Folsty for lL puryoc of <br />-1. <br />arowdof rhc rmlEny, am.xchsirclyconhcrin8 wilh liend o,nrlcro io.onnffr rlE poFl (S(. ?044. Bu\ims <br />md hotu:nn Codc: ThcConrmtor's Li.cnsc Ij* dBs nol0pl,lyio !nowncr orrroFny wrh blilds ot i'nProws thsmn, <br />and sho onhcls for slch lmJ€rrs wirh a ConrMro(s) tietrsd lu6@r ro lh. Conlrelo* Lien* L!e). <br />I dhcx.mDt undcr S(uon ,B &PC forlnicEe$n. <br />IITBtrEIIS:.GOMTENIAIIQN <br />DECIA8AIIO! <br />I heEby dfim trnd.r pef,.lty of Frury orc o{ rhc followitrB d(lealio.i: <br />-l <br />h& ,nd vill minl.in 0 Cdiaralc of Con*nl lo S.lf-ln$rc for Po s .oopcns,on. s FDvidcn ror by Sed.n l7m orlhc <br />Llbor Code aor llr lsfomie ot rlE srk for ehth rh. Fmit k nsrcd. <br />rlt so,k tursh].h rhir F_nrit is i\{'cd niyworl.rr tunDcnsrriiri i'\ ir .r.rricr rndNlicl nunrhcr rrc: <br />*a^lc-,.Co. <br />r -06 - oo3t - oo /1o o/ <br />WARNINGT Failue l. suE workctr comEnsarinr oEmBc is unhstul. ord rhtll suhj.u !n mphrr lo diminll lEMhies od <br />civil fincs up lo o* hundEd lhousnd dolles (Sloo.Om). in lddnhn lo lh. cosr of conlxnelion. donEBc. ar providcd for E <br />:::::T6/E-\( <br />Ir[CI2l8dIlQN <br />ol rhu hnir.$rnJ Pn,ri\\i{n\ (i'tlc, dfil rr li.en\c is h tulllnrccu .ii.r <br />B -7?*7cg <br />*" . a/z/te, co *dorl <br />AITII(;ANLDEILIEAUOX <br />Illnhylrr undn pctr{lly of I,erjlry orc or rnc rolli,wins declaun rs: <br />I)cmlirion Pcrmirs A\tE{os Norilicarion F.d.rnl RlBularioos(Tillc 40. }!n6) <br />_Rcquncd btr.r or Norirrclrhn <br />-l <br />ccflifyrh rhc Ldcnl rcSulnrions Eludir8 lsbcsto\ rcmvil!e nor rprrli.,hlc ro thG pflritt. <br />tLl.m'ryrl'rIM\crcndrhnJnnliclriona*lr crh, rre ,hrvc inrdnrtn'n ir corut. l rsrcc ro .ornlly wilh rll Cily ond Counly <br />6r,linurc. Jnd star. Ij*. Nlsr,nA rn buildm8 !nn{ru!rinr.nd hcrchy drhril r.[c*.rarivcs oflhn Cilyund Counly ro.nl$ uPon lhc <br />dh,vc Mnrhncd pmp.ny for itrspccrion <br />Amtic! or Acc.r siendiudr/ <br />Pdn,ircc NnE (pritrri )(.'or bttlt <br />w&m <br />MECHANICAL-INSPECTOR RECORD <br />W-Yffi <br />C(INSTRLICT1ON LTNNIN{; A(II'IILY <br />I hxBby afllrn und.r Fnrhy ol |f,rjury lhll rhcL- is u lrnslEcri Lndir! u8cN, ror thc Pcrfo"Ere. ot rh. strk ror *hi.h this Fnnil h <br />i\\oen rS.. :ltl97. Civ C I <br />l.nJc,'\ Nn'm <br />- <br />^," e/z/rs'-----r------ <br />--------r------ <br />-------T------ <br />I <br />tt <br />I <br />= <br />TWV