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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE COMMENTS <br />Appliances <br />Evaporalrve Cooler <br />Furnace <br />Compressor <br />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Boom / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />lnstallation <br />F.D. Drop Test <br />Above T-Bar <br />?n)Bough Mech.I I <br />Final Test .I r <br />I ,{Vr}rrlFINALIr/r( {6 *r) <br />Notes, Remarks, Etc U\ <br />OWNER BUILDER DELCARATION <br />I hcEby slfirm udcr pcflllty of pcrrur, rhd I m crchpr fmm rne Conrldo6 Lhm{ Liw ao, rlF lollowin8 EasD lse.7ol Lt <br />B!\inc$s anij lrofe$tun Codc): An, Cny or Counry shth dluiB a lfmh lo .onslrucl. alle, improvc, d.mlnh or EItrn u, <br />s1ru.rurc. p.br ro irs isuMcc. oho rcquircs lhc q,plicer for rucn Frmit 'o <br />fik a si8ncd rrarcmnr rh.l lr o, shc G li.c!$d puBuMr <br />ro rtc pmvi{ons oarE Coirador's Lk..ed Llw (Ch.rtd 9. Co.mmine wnh Scclion ?m0 of Divisiofl I oflhc Blxin.ss lnd <br />Prof.isions Codc) or $ll h. or sht is cx.mpr rhcEfmn and ihc basis for rhc !ll.C.d crcmprnrn. Any riolrrion ofsc.lion ?0:11.5 by an, <br />applicMl for ! IRrn l suhjccls thc llllicantloacivilpcnalryofnolmrrhlnfivchundr.ddolldG(S500). <br />_l, asoencrollnc tmFny. an.r.lxsiv.lycont..rine wnh ljcnscd co racloF lo con(tucl lhc pmjccl 15* 7044. Bu\incs <br />and Pttrf6sionCo.lc: Thc Conrrkbls Liccnle Liw d@. nor aptlyro u oqnooapropc y who builds or improvcs lhcoon. <br />a.d who 6 .a.k aor ru.h pmicls virn ! ConrE io(9 licnkd puswr ro thc Conlr*roi. L&ne llw). <br />I m cx.md und€r S<rDn . B. & P.c for rhis EMn, <br />-l <br />hrle &d sill minlsin . C.nifrc.lc ol C6n$fl ro Sclf-!B@ for mrk6 .omFNarion. ss p6vid.d tor by Selhn 37@ of dc <br />a,tor tu . aor rlE p.rfnn1am of dE s.r fo which rlE ,€nir h i$Ed. <br />_l hdvc and willminnin sork ^'conpcnrorio. insuBF.. !s rcquircd by Selion 1700 ot rhc L,lxtr Code, forlhc p$formncc of <br />fi. $brk for whth rhh lErnit ir ir$cd. My wor*6 .ompen ion insurmc ori.r d lolicy nlnbo e: <br />Folicy N{r!b.i &piE3: <br />I.cniay rhd i. ihc p.noi,umc ofth. *ork for whi.h rht rcnni h niucd. I \h!ll nor .nDkry,ny p.mn in ony mo"ncr <br />s as b hc$nE subjcr k' rhc *o*si cotrqEnsar tun hws or Califomin. und aem rhd if I should tEom $hi€rr ro rhc <br />*ortcrs onpcNalion Doviion\ ofSeri.n 17fi) or rhc tilrtr Qd., I shdl. ronhwilh coqrly tith rhos [ovisions,, <br />u(ENsgllorrnA(r()B <br />D&CIASAIION <br />Ihcrct'yrin unncr pcmlly ol Frjur, rhai I rn licc krl !trdrr provisionofChnflcr9(comnEncins wilhSccrion 70i10)ol Diri\ion I <br />oi rhc ausircs\..d Pmlis\ior{(o e.and myliccn\c i\ in rull li,rce anl.lrlrr <br />CANSIAIJqUONIEBDIICICIiNCI <br />issucd lsrc 10q7, Ci! C ) <br />AIIIJCANfDECIABAIAN <br />I lmtry dlnD u ndq p.nalty olpcrjury onc olrhc nnk,win8 dcclururion\: <br />Dcnolirioi Pcdic A\tr{os Notia. k,n Fcd$al RcSUhrn,nsOnlc 4tr, Pd6r <br />RcquncdIr crof Norifi.llion <br />-l <br />..nify lhd $. lcdcBl ESnlitioN rc8arding aslrslos Emval !rc tul apglicabk ro lhh psld <br />-l <br />ccnify r&t I hqk @d rnn appliculio, ,rd rrare rnd dE atnvc inrormiion is .orot. I 388 lo comDly with s[ Cny and Coonly <br />ordiMrcs snd Slarc ti$s Ehri,B to blildi.g con.m.rio.. ad hcoby erthrift rclr*nllliws of lhis Cily 3rn C,!tr|, lo cnrs !po. 0t <br />lbovc mnthrEd polcny fd i.sp..rioi puqhci <br />Arpl i.in r or 8.nr siSMru <br />iffII,g.dlwi <br />I <br />ID/SIG. <br />Metal Fire Place <br />Above Hard Lid <br />Meter Release <br />-l- <br />as owncr of rhc prcFny, or my cmployc.r wirh wagcs $ rhet sh .onwnsd ion. will do Fwmk3dtlE sEur6 ir mr <br />inrcnd.d or oficrcd lor ek (Sc.7044. Busircss af,d Pref.$ions Codc: Tho Conlrocrols Li.strs La* d@s not aoply !o e ow,n of <br />rh. rrcFny who tnikLs o iqmqs thcdn. dnd sho d.a uh kni him{lf or h.r*lf or rkouSh his or rEr o*n mployccs. <br />lmvidcd rhar ru.h inlpro\mnk m mr intcd.n ororlsld lor$h.l( hwE.llE buildiE or irymEmnt ir sB wnhi.. )d <br />of corphtion. th€ Ownc, Buildd will htrv. dE bu&! of toving $d tp or .h. dt ml build ot nrylm* lhc l,bndiy to, lhc Flpoe or <br />WORKFILS' COMPENSATION <br />DECI,/$AIIQ! <br />I h.rchy um.m undcr p.nalry of pGrury oa of rhe follo*ing debr.rions <br />WAXNINGj Fsi[rc ro sw lort 6'€mp.N.lion oEmSc is unh*tul. and sh{ll subicl M cn{'loy.r lo dninal FEhis lnd <br />.ivil frn s up lo one h!.drcd lhousand doll&! ($100,000), in lddnioi to lhc.ost of comrcnerio.. da@8q as Fovijcd for lt. <br />Sccrhn.1076 ofrhc trbor Cod.. irlcE{ &d {lorry \ fes. <br />Lad.l3 AddB! <br />- <br />tt <br />I <br />I <br />=