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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE tD/srG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <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 Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Fire Damper <br />Openings <br />lnstallalion <br />F.D. Drop Tesl <br />Above Hard Lid <br />Above T-Bar <br />Bough Mech. <br />Final Test <br />Meter Release <br />furful*t9/,/.2l6lt4 1 AA-/ <br />Notes, Remarks, Etc.-)-U <br />/eil4lth r/tua777d /* f'/'t v/, rtl l'/d/.-/L 7 r-..-' <br />OWNER BUILDER DELCARATION <br />I heEby atfirm undcr lcnalty of !€rjury rhar I m eietrfl Ircm rhc Conm.rou Lie.* Llv fo, rfu iollowirS rc.$n (Scc.7031.5. <br />Bllim$ a j ftotc$ion Codc): Ary Cnt or Counry shkh rquir.! . Fflni! lo onilftt. alls. inpmvc &tulish or t sn &:/ <br />rh.nre. pri)l i. ils hsumcc. !ls. requircs rlE +plicd aor such Fmir ro filc . sign.n sralcNir rhd lE or ;nc is liccn$n i'utunr <br />ro thc Foviiions oarlE Conraclof3 Licnscd Lrw (Chapr$ 9. Coo@ncing wirh Scction ?OO0 of Divhion I ol lle Btsinc* and <br />Pma$sioN Codc) or ln lEorsn is.rc,pr $6d0nerd lnc blsh ror thc alLgd €rcdnrion. Anyviolaliono!sccrFn7ojl.5nylty <br />applis,r for ! pcmi tubjels rhc applic!fl ro ! civil pcMlry of mr md rhrn tiv. hu.drcd doll6 (t500). <br />L trs owNr or lhc phFny, or my cmployca virh wrBcs 3s rhcir sl. .omFnslrion. will do rhc wdk ud rlE sr.xr@ ic d <br />intcnd.n oroflirc{ aor slc (S*.I)44. Busiiess ud Pmfessions Codci Thc Conrrc&r's Lsns t w do.s nol .pply lo e owmr of <br />rh. pbFnt wtnt iL& or intmB rh.Bm. arn whD tter *h h* hifrs.lf or h.elf or lhreu8h his or lEr ovn crn9hyccr. <br />Inlidc<l rhar s!.n inlmvmnis @ mr inicndaltrollcrcd for slc lllrwftirLt iUi.Bor in{mwnEnr h $ld withinorc rg <br />ol corplerbn. rhc O*rcr Buihcr *ill ltsw rlE t{dc. of lmving rhat lt or shc dil mr tqilt 6r inporc cc pDpsly for fic pur,[$ of <br />-1. <br />a\ oqncrotrhe pmpcnt, !ncrcllsnrlyconrrrrinB wirh lie.\c<l.onrdor ro.onitu r rh. Fn+d ts(. ?044. Busim$ <br />Thc Co.rm.rols Liccnsc t w des nor app oiprop.ny who buil{h or inpr.v* rhcrc.n <br />rh.(ln n'.r.cs I i...{.liwrsuch pmrcLrs wirh ! cnnr,&l{,(\) I <br />I ncrchy r[nm undcr pcnrlryotpcljtry onc oflllc n,lbsing <br />I hrvcrtr willnrjdrirrCcdiicrrcolConscnllr)S.lllnsurcf(nsork{i.oNp.trqnu.n\ p(,viJ.d fdb}Sccli lTrDolrhc <br />tjhtr C()dc, lrtr rh. prlmnlmc oi rhc s$k lor w[i.h thc ltrnnir is is\ucJ. <br />_l nivcsndsill minllin sorkcr' conp.os.rion insuBft..N rqut.d hy Sdion l?00 of rh. Llbor Codc. ror rlx Frfot1rw.6f <br />rhc work fo. qhkh rlii Fmi is ic$cd. My w.rkd ompeNltion insuEncc trtr ud polty numbc, e.l <br />-I.crlify <br />lh,l i.lh. Frformms oflhc wort for *ticnlhk p$mil is issucd. I shollnol cnrkyan, Pcrs( i. aoy m.ffi <br />s as ro !.stu subjcr !o rlE so*cr3'onp.nsrio. laws otcalifomia and a!@ rh.l ir I sbuld bdom srbjEl lo lhc <br />vort(c6'oq,cnslrionpnvisionsotScclionlT00ofrheLatorCod..lsluU.fonhwilhc.oplywthrh.epmvisi,ns.. <br />lo Kurc wortcrs oryf,nsalinn ovcagc is ulr 3ubirr d cnplorr. ro oimi.ll lEmlris and <br />thousnd dollaa (S1(D.000,. in add <br />uqiNll!_g)Nrxi(Iats <br />DUcl <br />^R <br />\Tt()N <br />I hcrehy !,firm ude, Fnahy of Frjury rhar I rm ljenst under rovisaon ol Chrll.r 9 (snmming <br />of rlE Blsituss and PrcfBhns C.dc, &'d ny lkctrc is i. tull toe ard ctr(l. <br />S.crinn TlXX)r ofDiri\i.n ll <br />LimNc Clffsr Lic.ns Numhr <br />I) lc ( o l. (t,'. <br />l;OX AICUOXLENDINGTICENCI <br />I hcrchy riinn udcr F alry or Fiury rhd rhc6 i\ r .oh{d.ri,n LndinS ig.n.y fn th. Frforrone ol ltc work lor *hkh fin Fmir ir <br />nsucd (Scc.1097. Civ. C ) <br />83fUCrrNfDlrCL tlIUAN <br />I lErchya0nnrundcr pcnillyotpc.jurronc of rhc n,llo*insdccl&rnnr: <br />l)!nn)liririn l)rrnrir\ ]\\t no\ Norillcrrir Frc&tulRcSrhnnrs (firl.lll.ldd6) <br />Rcrtuircd t.n.rol Noiii(ri'n <br />-l <br />ccniryrhlt rhc li{cral rcsu lar idns r8ffdin8 <br />-l <br />ccniii lhal I h.E rcBd rhis lpDlicalioi and stltc h corcc!. I rEre io @m/y wnh a Cily <br />odinan.cs s.d srrr.kws rcbrinS rohuilditrB <br />rl!)h trrtrrnnrd tn'Fay n <br />Aftli.rnrorAgrtrrSigturu <br />Pnnritcc noft tl'rint ): <br />Furnace <br />Grease Duct <br />FINAL <br />--------r------ <br />----+---