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MECHANICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTS <br />Appliances <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 />Above T-Bar <br />Rough Mech. <br />Meler Release <br />FINAL lP l1 Tl:y'M.tt z/->>) <br />Notes, Remarks, Etc.tut <br />OWNER BUILDER DELCARATION <br />I herchy uflirm under pcmlry of p.rjury rhar I m cxcmfl !is'n rhc Conra.ro6 Li.cn* I-lw fo, rl'e followitrg r.!sn (SR.7011.5 <br />Busin s and Prolesion Cod.): Any Cny or Counly whkh Equir.s ! Fmil lo conslru.l. .llcr. iry,rclc d.tuliih or rctEi m, <br />sttu$e. Fior to ns hsuoe. rho r€quircs rh. qDltlnr for seh Fmn lo fiE a ii8*d slarcftnr rhlr lE or eh. i! licchen IUI!@L <br />ro lnc p,lvhions of tlE Conrmcrols Lkcn*d &w (Chapr.r 9. Comming wirh S.crion ?Om of Division I ofrlE Busincs lni' <br />Pmlcsions Codc) or rh.r hc or she h cxcdpr rh.elioh aid lhc b€sn lbr rhc rllcBcd cxcnflion. Any violario,r ?l Sc.lion 7o3l.5 hy !., <br />opplicr lor r Frnrir rubj.cri rhc ap,,licanl lo acjvilpcnrlryofnol noe rha. tive hu.drcd dollm ($50o). <br />_1, as owrcr of rlrc Fotf,nr. or my chplorE6 wirh wl8cs !s rhcn sh mtr{E.s8rio.. oill do rhc rdk r.d th. srEru. b mr <br />i&nd{d oroffercd for sh (Se 7044. BusiEss and Pmf.asions Codc: Tne Co ,elor's Li.cn* t w do.s nor ,pply lo e owd or <br />rhc pmpcny whr brikli or itrq)bK rbcftn. 0rd who des kh fr* himsclf or hoslf or lhmuSn hk or ncr own cq,loyccs. <br />tbvidcd rhar such impmhEna m tur inrcd.ndoit@d tor sb lt tbuMi tlE brildi.S or mprorcm.r is $U whhin orc rsr <br />of conFlcrk n. rhc Owmr auiE . *ill &r rlE hnd.n of tmvin8 rhar lE or shc dA mr hild or in{,ow rhc |fDpqry f6, iE pupos oa <br />-1. <br />as o*icr of rhe Iml,cny. an.r.hsilcly onractins enh liensed conft.roF ro ..nsru.r lhe lmje{ (se. 7044. Busim* <br />ord EdskrnCode: Thc Conrmror's LiccNr t w docs.or lpply to !nown.r ofrroFnyrho blilds or idlloves rher6n. <br />and who conrrcls aor s.h Ircitls sirt a Conl@ro(, ltcnEn p!6u!nr to rnc C.nuado/s Liene Lls). <br />-l <br />m.xcnrpt und$ Sd <br />UOASESE.COUEENSAIION <br />OEEI.AEASS <br />I hcrehy atfirm und€r p.nalty of pcrhry onc ol $e ,ollowinS d*laanions: <br />-lh!v.. <br />will mintoin s Ccnificlrc of Conscnr b Sclf-lnsuc for wortes smPctrstion. &s pmvidcd for by S(rion 3700 ol lh. <br />t:t r Cod., for rh. Frfolr]1!re of the wolt for which thc Fmi is hsucd. <br />-l hsvc and will manrlain *orlc6 comp(nsrtion i.surnncc. as rcqlncd by SNtion 3700 of lfic ljbor C.de. tu rhe Ffomm. of <br />lhc *ort aor vhkh lnls !.rmil is nMd My *orlcl .ompcnslion insunna caEicr !d poli.y numbd @: <br />-l <br />ccniry fiat h thc pc brnnrc. of lhe e.rt for which lhis p€n.il k isslcd. l shrll oor cmrloy sny ,l.aon in eny nmmr <br />sr arro b.d,e rubjrcr ro rhc ao.*m mnrFneri.n hqrorcatiromi,, md aerc.lhar if I should h.{onrc subjccl lo lL <br />w.lkdc .onrl.6mri6n pbvisions or Sdiion 17fi) ol lhc lllrr CdL. I *h,ll. fonh*ilh complt *nh thos tmvnionr.. <br />WARNING: Fdlurc lo *curc sorkcrj conpcnsalio. ovcn8 i\ unltrwtul. ed sholl slbjet !. cmplortr lo oiminal FMhi.. 8nd <br />civil lincs uI lo oiE huf,dEd lhousand dollus i{r,, danuucs rs ti{tid.d l{n rhc <br />12qI <br />Drcli-&utax <br />I h.Eby imrn lnder p.tuIy of Jrrruy rh{l I ao lim{d !t*!.r l,ovi-rion olchaplo 9 (coImBin8 *ilh Selnn ?000) of Oivhion 3 <br />of lhc Ausimrs a Prof.ssions Codc. ud my ,iccnr is in tull fom and crfEl. <br />LZO 753 L?L <br />/24 // <br />I hcdb, affird u.dcr Fulryof <br />hsucd (Scc lO97.Civ. C ). <br />th,r rhd. isa.\,nnrudhn hndins d8cfty for rhc pcdormm. oflhc vo* aor lhichlhh tErhi n <br />AIELI!TNLDElIiAJIIj)N <br />I h.rlny ilinn u ntlcr !.nrlrl ol Frury om rl rlr foll.sin!.t.lrrri{tr}: <br />Dcnn)l nitr P.nnns A\b.{.\ Norih.[($ I cdcril R.guhrt{! lTirl. J{) l'r6r <br />Rcqun(,1 Lc!rcr ol Norilicrri.tr <br />I ccnily lh.t rhc Ldcral nglltrlions Egadir8 rst stos romvd arc ml lpplic0blc lo lhG po,.rl. <br />i(ni ld inrcrhrr rtu nhrc nnnflndinr is comcr.l aeBlo.omplywirhall Ciryond Counry <br />.qrcs.rar ive\ of rhis Cily ard Cou.ly lo cnl6 ulbn lhc <br />,"", 8/zq/t8 <br />lh n3 Avr* g br,?lia*<z <br />IAPPROVALSDATE <br />Metal Fire Place <br />Final Test <br />-------r----- <br />I