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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 />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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 />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL /o/r/,(Z/1/1^ rt).-'o-..'
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DALCANANON
<br />I hcEby afatrn under pcnrlty of p.+ry th,t I u cxcmpl fron lhc .Inlrulou Liane L{* for ltE follo*ing @o. (S4c.7Ol l .5
<br />Arsituss snd Pmfcssion Cod€): Any Cir, or Cou y shkh r€iunes ! poni ro fti$ru.r. dI6. inlmve. &mlish or EFir my
<br />siru.t4, rior ro irr isswc, 0ho r.quiEs ihc q,pli.&l lor .uch Fmi lo lil. ! riemd nllcm rnlr lE or sll. k lien*d lu'.er
<br />16 rhc preisionr ol rli Cofituror'. Lien*d tle (Ch!rr4 9. Con@eing wirt sdioa I]m of Dithion 3 of tlE Busincss ud
<br />PDfc*ioi. c6dcl or rhll lr o sh. is excnpl lheELoo rnd $e bosas fo. lhc .1h8cd cx.m!lio.. Anyvblaliq{ofsc.lion?0ll.5byan,
<br />.ppliclnl loru tEoi subjet tlE amlicel lo r.ivil pcEliyof nol rurc lhd fivc hundrcd dotl&s (5500).
<br />-1.
<br />&s @ncr ot ir lolEny, o, my cnplole. snh e!C.r as rhe ir c,lc conpcnr.'n,n. *ill & ltE *ork 5d lh. ntutr is ml
<br />i.l.rftn or offcrcd for eL (Sd.?044. ausircs ".d EDf.sionr Co.ts TrE C.nrftroas Licn* L3w.tEr nor sl,Ily ro 6 ower of
<br />th. rrepcny wh. ttrild\ or iqmEs rLmn. aod w'[ d6 sh slt timsclf o, hcMlf or rheugh hk d her osn .mplorrcs.
<br />pmvidcd lnli su.h impmwmnG N mr intcndcd or ofiird forst.l( tFrcrcr. d. buildina o. irymEmd is $u whhin.m rBr
<br />ofcon{'lctioll rtt Osnq BuiLhr pillhlrc,E hud.n ofpro{lg tlur hc or stE did mi hoild or inrroE tn pmFny for tu pu4bc oa
<br />I. s owkr or,hc pi.Fny, n.xclusivclyconlr.cling wnh li.cnscn conlrnclos lo consr€l ltu rmrcl (Sec.70a4, Busnc{t
<br />lNl PirGsion Codc: Thc Conllmlols Licens Lsw docs nor olply lo an osflcr of pDlcdy who builds or imptovcs thcron,
<br />,nd who conrreri lor s!.h ,6.iFrs wirh a Conhdo(s) liccnscd ,usu,nl lo rhc Contmctois Lia.s tip).
<br />I sncicnDr hdcr sdion ,B.&PC lor rhir Me.
<br />EABf,EBa..CI}MIENIAITQ!
<br />DECI,AMIIO!
<br />I h.rcby am.o uoih, lEnally ol ldjury oE of the followi.S de.l@dons:
<br />-t
<br />hrw .,n will mintii, . CcnifEsre of Conrnl ro S.lf.lnsure for *ork6 onDcmarhe a p6!i&d fo, by Se'ion 3700 ol lhc
<br />L$or Ciilc. for rhc pcrform ol
<br />'hc
<br />md( for shich thc pemi & i!s.d.
<br />-I harc and will minhin worlcs ompcnsalion insur.rcc as r.quir.d by Scclion 3?00 of th. L.bor Codc. aor lh. pcrr()fuc ol
<br />thc wmt for pnkn lhis Frmil is issucd. My *ortcs €onqEnslion i.slEtc dtrir !t polic, rumlEr 4ei
<br />Poli.yNu rlrr:-lixpirc\
<br />WARNINC: ljailurc lo scurc uorkcs compcnsario. corcmse is !trlasa!|, !'rd \hall subirr an cmpk)r{r ro rir Dsl !c ri.s and
<br />civil lincs up lo onc hundrcd lhouslld dollm dp.nstion, &mecs {s prolided for lhr
<br />Serion 1076 of rh. lrtfl CnJc inr.rci 3nd
<br />DECIJf,AIIO!
<br />I hcEb, afiiri !.d( p.@lty of Frjury rhal I an liftnscd undn ImvGion of 9 lconnEncins pilh Selion 7000) of Divkion .l
<br />of thc Ausincss !trd Pn,fcssions Codc. {d my
<br />c-01 83
<br />I h.rhy ir'lirr uMcr Frrkyorpr.jurylhal lhcrc h a comrrudion htrdin8 ascncy t)r rhc rcrforonc. orrhc w.rr 6t *hkh rhh lc,nril is
<br />h\ucd (Scc -10'17. Ci!. C )
<br />ATIITCANI.DES.AMIXA
<br />I he!, an'or udc, F.rlry of Ftiuy om of rlE followi.S dckBlio.3:
<br />Demlition P.rnire^sbcstos NorifMrion Fe&rrl R.albrions (Tirlc.l0. P3n6)
<br />-Rcquircd
<br />llllcrof |iorifuion
<br />MECHANICAL.INSPECTOR RECORD
<br />Pre-lnsulation
<br />-l
<br />crnify rhar ii rhc nclforturc ofrhc wor* for whth rhis rcimi h irlucd, I shlll nor eq)loy any pc6on in ony mmncr
<br />tu as to tEcom rubjcd lo lhc worlcl omp€nelion l,es of Cdiaomio, lnd nBEc lh ifI should li{oft $tj6r lo ttE
<br />M{.rs conFoslion pmvisioos of Sccl io. l?00 oi lhe tihor Cbdc. I duu. foflh*ilh cohply qith lho's povisionr.
<br />I fcdcml rc8lhlioN ESardin8 sbcslos rcmvll lrc nol al,Pliobh ro rhk pmF..
<br />I
<br />lndCounlylo.nr.r trF'nrhc
<br />Pn'Irn, lnr in\Ii.(i,r !urI,*r.
<br />-^,,glzlt6U-...--..!
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