|
APPROVALS DATE ID/SIG.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 Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<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 />Rough Mech.9''lblnf @
<br />Final Test rl vl
<br />FINAL f-v714 4e-
<br />Notes, Remarks, Etc.
<br />MECHANICAL.INSPECTOR RECORD
<br />OWNER BUILDER DELCARATION
<br />I h€rcby afr,m udcr Itnslr, of pdjlry rh,r I dcrcq from rhs Co rero6 Lier$ L{w for rlE folhving rusn (S.c.7031.5
<br />Ausinc$ and Phf$sidn Codc): tuy Cir, or Colnry which rcquirer a pcmir ro @oslE l. ah.i inpmv., &mlkh or rcFn ey
<br />shcluE. Fnr lo ns bsuM.. aho r.qliRs ln lllliconr for such Fmir ro fik. ri8i.d srormnr rhar lE or ilr b liens.d otrN.ltl
<br />ro the Fovhions of$c Conlocroi3 Lkcn$d Lrs (Chlprcr 9. Comcming wilh S.clion r0oo of Division 3 ofthc Businc$ lnd
<br />Pmfc$ions Cod.) or th lEorshciscrcmprrhcrcfromondrhc6,sisforrhclllc&d.rchplion.Any!nalio,olscction7031.5byd,
<br />lpplicanr for a ,.mir subjsk rhc a$licrnr ro r civil trMhy of ml mrc rhrn livc hu.ded dolkB (S5@1.
<br />-1.
<br />as oqrcr ol lh. pmtEnn or my cmployc{s wirh waBcs !s rhct sk compcngl ion. sill do dE *olk o{ dE itrrh i! ml
<br />inrodd or otrcrcd for rdlc (Se,7044. Busin.$ {d Percrsi,ni Codc: Thc Coni6.r.r's Lic.ns t w dms rcr lFply lo .n owns oa
<br />rhc l,orEny stn b{ilds or irymws lkmn. sd wno {kB uh q,* himclf or hcNlf or thnu3h nir or lg 6sn cq)loyc.s.
<br />ln,vidcd rh.r snch infl*.'Enk m nor int .dcd oi oftcrd for eb lt hoerr, rl* bxilding oi nr{muBnr is sld wirhin onc }ea
<br />of cor!,krhn. lh. Ovncr Alihcr sill ME tlr t lrlcn ol fmvinS ih&r hc or shc dil er ldld or i'r{hr rh. rrDlrly ror rh. poqrs of
<br />-1.
<br />.s opmr of rh Imo.ny. trn cxcllsivcly conlm.rinS wnh lien$d conrrodom ro con\md rhc pmjecr r Sd 7044. Busmls
<br />!d &.G\bn Codcr Thc Co.trn.loar Li.cmc LEw ddi er apply ro o osn.r ol poFny who builds or improrcr lhcrcon.
<br />lnd who otrlrocrs fn such pmFIs wilh a Conl.&to(s) liccns.d rursront ro rhc Coarrucror'r l-iensc tjw).
<br />-l
<br />amcrcnq urner S6tion- a. & P.C. tor lhB Mon.
<br />UCB6Df,IjI:OIIIEITAIIO!pEcldlallq!
<br />I hcEny dim !ndc, pcn lry otFriry orc otlhc tollosing d€la io.!:
<br />I hav. rn will mi.rrir . CnrifEllc of Consnr lo SclfhsuE for sorlss omFnsrion. as pmvidcd for hy Sdrion l70o 6f rhc
<br />Lrb.r Code. for lhc perl6,rl@c of t,E md( fo! *hbh $c p.mir i.r hr@d.
<br />-l
<br />hsvc and will mainroifl work.B compcnsalion insur!rcc. trs rcqlircd hy Sdion 1700olrh. Laho. Codc. tor rh. Frfommc of
<br />*hihrhi!Emi i! h*t. Mv*orksl o@Mrn inrumc tricr ud tElt, nunb.r @shk- tr.^/,g'2|1.\1
<br />I ccnilirlu' inrhclcrronnnccollhcworklbrwhich llrk lcnnir h n\ucd.I shlllnol employlnypcron in!.ym ndr
<br />e trxlo bcs,m subjcct xr rhc ert.6 compcnxdion law\ ofCulili,mi!. &d xErcc rh, irl should tr.om subj&r lo lhc
<br />*olls\' comli.nerion pmvhbns of Sccrion IIX) ol th. lihr Gnic, I \hnll. fonhwnh comrly wirh rh.c lmvisions
<br />WARNING: Fiilurc t, $curc *orkcn salncNtrri,'n covc,asc i\ tril wtrl, ,trd dDll iublccl 0n cnrtlorr ro rini,al l]culris !n<l
<br />cilil &rs !p ro onc hundrcd rnousand dol,a6 ($l(n.lx in addirioo ro rh. cosr of conpc orion. drm8es rs roridcd for rhe
<br />Sc.ri,D.10?6ol rhc l,rhnAxh. drrr{ rtrJ rnont
<br />DECIdBA.TIO!
<br />I hcehy otfirmunds ncnlllyoiIr,jlrylid I m lien{rl undcr rn,lision orChrpr.r 9 (comn.ki.e unh sc.rbn 7ftxjl ofoirision 3
<br />ol lh. Bu{i.cr\ fll PnrlcssnxN Codc, en .r, liccn* is i. tull n,ce md cifLrl.
<br />L6-Lr ( d I
<br />I h.rby ofiirn und& Fnnlry or p.rjury ih.r rh.E k r con(d.rbn Lnding ae.ncy tor ttE ,,.rfornme ol rhc oork fDr *hkh rhi* lE tui ir
<br />ksDcd(Ss 3097.Civ C.).
<br />AITLICAILDII;LABAIIAN
<br />I hEby nftiin uM.r F.rlly ol trrjury o c ol thc follownrS dc.lr(l ions
<br />Dc'mliinrn Pcoirs Asbcnos Norificarn,n Fcdcrnl Rcgrhrn,n\ ('rirb.l(1, Pan6)
<br />-Rcquircd
<br />lxfl cr of Notifi coli'n
<br />-l
<br />rcn ily rttrr rhc lcdcnl rq]lhr ions Erardins altf,sros Enrovol !,c nor arpliclblc to rhis pruJ..r.
<br />I .cnily rhnl I havc nad $t aptlkarhn at n0tc rhd lhc abovc infonmiion h coR..l. I !8re lo coq,ry wnh d Cny a.d G,unry
<br />ordi.arccs and Stat€ L!B\hildin! con{tucrion- ud hcrchy rhori2. Eprc*nrdils olrhis Cily Md Counlykr c.ir u8nr lh.
<br />$ov. mnrbn d pol)crl, rbr
<br />Above T-Bar
<br />Meter Release
<br />,",", ' t-\Y.tX
<br />*" "t'lq.ll
<br />Lxndcis Ad&c*:
<br />-
<br />*". $'\q.)X
<br />f-------T------
<br />[-----r-----
|