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MECHANICAL.INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Rough Ductwork <br />Vents <br />T oilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper --,-raED <br />Openings tsAr"-' <br />lnstallation .,,c t\2 20\[ <br />F.D. Drop Test |\u- - <br />-^-*s.667 Z\,^$c#'7'l -t'TtllAbove Hard Lid t tl[ / :r4 ll <br />Above T-Bar ll ll/7- <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL N17 ) <br />OM.FauiU.r Dehr.tion <br />I h.rcby lftu6 und.r p.Dlry of pajury tn.r I .m q.mpr form E Conr.aoB L@s. Llw for $. follo-tr9 r6on (G 7031 t Buind! <br />.nd Pof€rioi Cod.) tuy Cny or County which rcqui.6 ! pann to @Nrrud" .hs, inprov., d.mlBh or rcprn .ny l duc, pnor ro $ <br />i!3u.c., tlso r.qut6 tn! lppliq.t for trch pcmu to filc. si8ned rhtffi lhIhc orth. is lic.Eld pusu lo Oc p.ovi.ioB ofrh. <br />Co.mdol. Li@E.n Lrw (Chrprd 9, Cono..dng eilh S.clion ?OO0 ofDivirioD , of rh. BuiiD6! .nd Pof6rioB Cod.) o, ll|.r h. d <br />sh. n d.Epr tlsciom rnd rh. b$i for thc tll.g.d d.nprioo Any viohrion of 56rion 70] I t by my rpph@ lor ! plmit tubjc.E,tc <br />.ppli6or to a civil p.uhy of not mor. rh.n f&. hundr.<l dolLB (S500) <br />I, a oha of thc prop.ny, or my .ftployd wilh sgB .! thcn !ol. @mp.nslio'\ will do rh. worl lnd rn. rhdu. ir nor int.d.{t <br />oi ofr.rd lor sl. ( S* ?044, 8u663.!d Prefdrio Codq Th.Conhoor's Li..@ tlw do6 nor.pply ro u osd ofrhc pop.ny <br />who build! or inproB ds6r\.trd who do6 sud wort hiru.lf or hssclfor $rouBh his or hd oM.mployd, provid.d tuta.h <br />improvcm. s.rc ml intendcd or ofd.d lor lrk lf, howrvE rh. buildus ot inpDrcndr ir lold wnnir on. ya. ol @nplciio'\ lhc <br />Ou.rBuildq w l h.v. rhc burdcn of provi,S lhfl hc or rh. nor bIild or improv. fo. lh. purpo* ol eL) <br />I, uoMsof rn prop.ny, !n dcluiiv.ly conrhdinB wnh liGB.d @.k!do^ ro oBhd rh. Foj..l ( S*.7044, Bqii6i.nd <br />Prcfq.ion Cod. Tn Conr.dor's Lib.. he do6 rcl ipply ro tn oM6 of proldy who buildt or iiprovd rhq@n . .rd wno <br />onhd ror ru.h projdr wnh. conhcro(, li6.d puEu,r io rhc Coflrlcoa3 Lk .!c lre ) <br />_l m q@9l lda S@rioa .S &PC forrhis 160. <br />WON(Tf, S COMPENSATTON DECLARATTON <br />I hseby.flirn rndq p.uhy of p.rjury okolrh. fouowi.s daLdioG: <br />I hiv. and will mintcin r C.difiar. ol Coc.nt lo SclHnsur. for ert.B' @nprMrion. s proud.d for by Sdion l?00 of rh. <br />lrtor Cod., for fi. p€.for neolth. worL fo, *tich dE psB( is Gs!.4 <br />Il hrvcmd will@i rin vorhqs' @mp.Mrion insuEncc. 6 r.qun.n by S.crion r7m of$. bbor Cod., for th. pdfom.a offic <br />worl fo, whi.i Oi! pcmit a i$Gd My work.6' omp.nsr ion iBu.rne qricr od policy .umb.r uc <br />canEr //r/ J'- +tt,- '1 <br />L)CP6<. G L jzz g. <br />(Tti! 6..;tion @d ml b. @hpLr.d ifrh. p.rmn i! aor On. hundr.d.lolhB lllm) or les) <br />I .diry th.t in tlE pcrform.@ oathl wolt tor sni.h rhi. p€nn is mploy a.y pcreon in lny nanner so 6 ro <br />b.c.n. lubjdr ro !h. wo*.R ' omp.Mrion bws olCllifomi!, rnd <br />D.1. _Applio.t <br />WARNINC Fsilure to i.curc wor[c6' compcNario. ov.ag. is u.h$'tll,m cmploycr to oiooll pctulriB lndciv,l <br />fiaa up !o on. hurdrcd thound dolL4 (1100,000),i! .ddnio. to tlE @n of @hgcetDq drdg6 s prova.d for rh. Setion 30?6 of <br />dE Ltor Cod.. inrad .nd .tlom.y't f6. <br />LICENSED CONTRACTORS DECLARATION <br />I hci.b, .mrm undcr p.Mlry oa paju.y thsr I M li..G.d uidd povnion of Chlprd 9 (@nm.ncir8 win Setion ?ooo) ol Diviion 3 of <br />lh. B$ircsr rnd ProfdsioN Cod., .nd hy l(re E itr tull fore rn l .tr a <br />(r1o <br />Zvu z <br />und.r pculty of perjlry rh:r rher. i5 . .oGrucbon le.do8 !s..cy lor rh. p.rforru.@ of <br />( tna "^17 t,tt./ <br />tlE wort for vhich rnn p.d[ i! <br />tssu.d(SE r09?, Ci! C) <br />APPLICANT'S DECLAIATION <br />D.mohion Pmn!-A!b€l6 Norifiqrioi rqdol Rc8uhlioM Onk 40. Prn 6) <br />_ R4unld Llrq of Notinflioi <br />I ccniry rhar rh. f.dsrl r.8ulltioM regrrdhs rc mr lppliqbh ro 6t proi*r <br />I c.drry <br />'har <br />I hrv.rqd lhBrppli@ton is co(dl I !gr* ro comply wilh lll Ctry .nd C.unry <br />ordiumg .nd Star. I iB rclarinAb <br />.boE h.d6*d Prces$t iaDdion <br />ADplitut or lsot Brs / -)L>il <br />(A <br />/44^f Drk:__l-I <br />Rocord doc 03.31 06 <br />DATE <br />Smoke Detectors lnstalled <br />D.ic ____ _O@r <br />6hpc@tio, provilioN oaSdrio! r?00 ofrh. r,bor Cod., I .h.ll, <br />D.,. c."-"-( <br />lull'oia r.pr6cDr.riv.r ol $is City .nd CounIy lo 6ts upon 6.i--