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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />It/etal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lt/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Meter Release
<br />FINAL ,)v(^>7//t /<
<br />^cnNotes, Remarks, Etc.
<br />ot/Y,t
<br />OWNER BUILDER DELCARATION
<br />I hcr.l,y lJtm uids Foally ot F{ury lhat I m cxcft fiom fic Co.rtem^'Lt.n* Li{ for lhc followi.S lwn (ser03,5
<br />Busirc* rld Prcfcision Codc): Any Ciry or Counry ehth EquiEs a Fmh lo €oBrod. alt6. inPtorc. d.mli.h ot q'en any
<br />srruclm. pri,r to ils bruft.. lho rquircs thc q!,rt..i lo. sh Fmit lo file s si8ftn sl3r.m.t lhal h. or sh. ii lics@d plmain
<br />ro Oe prcvirioB of lnc Conrslmt Lic.n*d Liw (chq,lcr 9. conmcncin8 {irh setio. 7000 of Dilhion I of rhc B8ir.ss and
<br />PDlc$iois Cod.)or.h.l lE orshe is.xcqll lhcrcfromald llr b4\i.lot rn dh8.d cxcq,lion. Anrvioblio.ofs..riotr?03l.5byany
<br />orplicarr for { p.mir subjcrs rh. applica lo a civil p..dry of Nr mE lhln nre hundrcd dollrs (Stoo).
<br />-1.
<br />tri owmr of rtE prnFdy. or ny €ng oy(s wi$ {asB !s rhcn ob .oq,cn$lion. will do rhc h* ad rlE eMrE is ml
<br />inrcftl.t u offcr.{ for sh (S(.1X4. Bu.ifts. .nd P,nfcsions Codc Ahc C.nlra.loai Lienc tjw d@s nol 4ply lo d o*ftr of
<br />rh. peicn, who blilds n inpEws tltec !d whD do.s skh slk hintllor heMlror fimugn nis or hcr oq.n loyes.
<br />pbvidcd rhar rkh inlormds N ml inlcndod oroficr.d for slc.lL hose8. tlt tdillirg ot itprowmr i3$ldwhhinorcJEd
<br />of co.tDlctio.. r,E Owtur AuiLto wi! h,vc $c ttrrdd ol Fbving rld h. or slE dt ml h d or inlprct 0r tmrfiy rot 1tE l,ur]Is ol
<br />L ds owncr ol rh. prupcny, !m.xch\ivclyconrdcrin! with li.cnscd ronhdou ro onsrtucr Itt poj.cr (s(.7014. Busirc$
<br />and,\.r.*irC.dcrTh.Cont0clolsliccn*Lowdocsmrolplylo!nowncroiptuFflyehohuildsotimprctsrhcEon,
<br />and wno coorrrcl\ for suchrrejdk wnh ! C{,n!6do(\) lkcnscd ru^unl to rhc Conrrador's Lien{ Llw)
<br />I imcrcmo udcr Sccl
<br />IIOXf,EIN:COMTINSAIIOU
<br />DECIABATq!
<br />I hercby dfirm !nd.r pcnally of pcriury orc or lhc follo*ing d*lqarionrl
<br />-l
<br />haw dd pill mi.tsin { Ccnificrlc of Cons.nl to Sclf-ln$rc for klldi onpcnserion. d pm{idcn for by Sccrio. l7(D of ln
<br />lahor Codc. for rhe Frfolr]@c of rh. mrt for whhh $e pmn i! ku.d.
<br />-l haie rnd will mainrdin wort .6 comr.nslt ion iNuramc. es rcquircd by 56l hn 3700 ol tne bbor Codc. lbr lh. Il6fom@ of
<br />rh. tr.rk lar {hich rhn !rnnir My workns comtEnsation in\u,lncc .ari dld Flic, numbcr sc:
<br />el oq.H4ua',g
<br />Cc.-
<br />I.cdiry rh.i in th. pcrfoinEmc ofrhc sork tu shich rhh t'c,n h hsucrl.I shlll nol en{,loy an, I'cBon inanymon.cr
<br />s as to tEom subj.lr x, ric {o c( .on{rnsarion l.wi or Califo,nir, .nd osE fiar it I rh,uld bc.om subitl lo rtE
<br />sodcrs oiFnetioo povi,ions orscction 3?00ofthc titpr C(lc.I shrll, Ionh*irh snply wilh lhos pmlist nr
<br />WARNINGT Flilurc lo surc workcs' d,mrcnsarion owBgc Lr unlaw6il. a.d shall subixr o .rploFr lo aiminol lEnaltics lod
<br />civil ,i.cs up lo one hundrcd thousnd dollds ($100,000), in lddiiaon lo rlE cosl of conwn$ri61 damgcs !s provited lor lh.
<br />LlcllrEllcoNraacraa
<br />DDCLABA.II!}N
<br />I hcEby !fiinn undq p(nxlry ofrcrjury Ih,r I nn li..n$d undcr pmvhion ofChapr.r 9 (coFmtuin8 wnh SL{rbn 7(D0) o! Dilkion l
<br />o, rhc Busirrcssond Pmltsionsc{dc, and !,y lkcn{ n in fullnraaldclid.
<br />Z:Z-I
<br />CONS']IIIICTI(IN I FNDIN(; A(;IiNCY
<br />I hcrcby,lltm undcr p.nalryofncrjrryrhd rhdrc n,cotrirucrinr lcMinsoscmy tor rhc Pcrfornrmc oflhc wo f( which rhis !.rnrir il
<br />issucdiSc.. :l097,Civ C.).
<br />I ccnilith.l rltLdcrrlrcsululions rcBuding a\h.{.\rc xrhltc nor ,lllicnblc Io lhis pojccr
<br />-l
<br />anify lh, I havc ,cad rhis lppli.arion and i,rc rhal dE abovc infortulion h .or.cr I tr88lo corrtil, wilh allCny rnd County
<br />otrtinorccs urd Srarc l,ws rcbrins I{, blildins.dn{ddion, d h.rcby aurhoriz rcprcse triE\6llhhCnymd Countylocnlq utDn lhc
<br />.bov. mnrhnol pmFny fo!
<br />Amlicanr.r Ag. SiBml (o
<br />EI
<br />Grease Duct
<br />Final Test
<br />t n<Lr'3 Nmr
<br />-
<br />LrndcfsAddrc{i
<br />-
<br />rpu rc,r-iiiiiiiirnor-
<br />I hdxt'y rffim undcr Fnahy .f pcriury onc ol rh. t lb*ing d(lnral ions:
<br />Dcmnnion Pcrmirr Ast $os No icdion Fcdsal Rquhl bns I rnt ,r0. Pd6)
<br />Rcquircd L.ltcr of Nolifntion
<br />^,z(z-f lzalt
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