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DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hd.by lfftn utdo p..alr, of pqj!.y rhd I m q.rl9l from $. CoirrcdoR Lic.n* txw lor ln€ tollorins r6$o-(Sc.70l L5 <br />Bsin6 .d Prof6ion C.d.) Any Cny or County whicn r.qund r Fnit lo @tBtuci ata. inPovc .tarcliih or r.?.n ry <br />lrtucruc, prio, to ns iMcc, aho Equi6 rh. @pli.ul lor o.h Frnil io 61. a sign.d sldaMt lhd lE or CE b lic@.d PueAtn <br />ro th. FlvisioN oa rh. Conrncbfr Lienri Llw lchaptd 9. Conntuins vhh Sdrion 7000 ol Divisio. I ot lh. BuiB'ed <br />Prcftsio6 Code) or rhal lE or slc i3 c6pr rhdl$on .nd rhc b.sis lor rh. alkgcd d@ptioo. Any violalio. ofs.dhn 70-r I 5 by any <br />apptic&r ror r pcmir stjcl3 rh. .pplicer to ! civil pmrlry ofmr norc rhu lilc hu.dral doll@ (3500) <br />-1. <br />s orrG of 0!. prlFty. or my onployG oiih wa86 s lh.n sk coElqEdion. will do th. wI &ld rh. 3E!6@ i! Dt <br />inldrLrl orofi6.d fd sL (Se.7044, Builrs&d PDfdioN Co& ThcContncrd Li.6e t w&6nol4plyloeowot <br />tb. FnFty *ho bn& or ioFeE lh66., ..d who dc trh M hift.laor hdllor l}rud hi! d hd oM .n loyc. <br />Fovidcd rnn !u.h 6!.ov6En3 c @r iflq'd.d ( oln*d br $t ll ho6d. tlE hrilCiis c nrlroluan i sld *ihid .E )d <br />otco,pkrir( rh. o,^nd B{il& will hlw tlt hdl6 ofpoviis ltr. lE or dE dil rcl hild or iEproE t[. FiFly for lrE FrPo* of <br />-1. <br />s olle of rh. propdty. @ crcluivcly .ofir(irs wth licd!.d coil,a.ror lo cotrnruct th. prD}EI (S(. ?044. BGi.4 <br />and h!tosbr CorL: Tn. Coorrerof ! Li.6. L!r, do6 not .pply ro & own6 olpropdy sho b il& or inprove rh6@r. <br />md who o!q!c13 tor rlch Fljlrt3 w nr codBcro(c) lic6!.d puBo.,,r ro rn conitr.lor'r l.t6e L!w) <br />_l @.rdpt urdd S<tio <br />loaf,!f,i-corllEltarra! <br />DECI4SAIIO! <br />I hftby llrm u.ds pcqty ofFjury onc ofrh. folhwiie dcl@rioBl <br />I fiav. dd will tuinrli, ! Cdlificltc of Consr ro S.lllns@ for mllda orlpdrltion, s Fmvid.d tor by Sttio! 1700 oflh. <br />ttbor Cldc aor th. pq6m@c ollh. so* for stich lh. Fnil i! is!u.d. <br />-l h.!c ad will deinldin m*.8' .omr.$rio. ilts@mq 6 ,.qujr.d by S6rioD lr00 of lh. r.br Code for fic pafoilMcc ol <br />n is isG! My wDd(dt cortpcnsrion ireurm...rid md policy numb( 6c: <br />I c.niay rn in th. pdlolmnc. ollh€ sork lor $ htl lhi3 pdnir is Lsu.d, I shall nor orloy my pden in ey mund <br />s s ro b@ft subj.d ro th. *ofi6' @op6Batio( bw r of Califoni( &d 68@ lhal if I druld b.codc sublt' ro $. <br />*0l[6 snpdetion pFvllioG of Sdion lT00 of rh. hbor Cod., l skll. aonhwilh cohply with lhoe pbvilioN <br />WARNINC: failur.lo Ke port6 rcmpssllion cnvq.ec is unla*tu|. dd !h!ll subj..i sn oploF lo dmirr] Funi! t d <br />cnil lincs up Io onc hun&.d lhoMd doll6 (5100.0:10), in ro rh. .osr ol comDNrion. d, s.s a Diovil.d fo. th. <br />,or <br />(, <br />uct ls[l)laNraA(faaDlicllSallo! <br />I hdcby.mm undd FEhy of pdjury rhsl I dn lic6s<d ondd tno\ision olChaptg q (comroc'ns *Ih sdk.70O0l ofDivision l <br />ol lhc Rrn6s ed Prof*nra Codc, ed my l,cs. n in fnll lor.. dd.frd <br />0I <br />LI <br />CQI AUCIIANIIIDIICACIICI <br />Ih6.bt olliilnrndd lF.ahyo|psjury thal rhq. is a cotrnru ion Lndina dsd.y fd rh. p6fomdc. of the so,k aor *n(h lhs p6ni n <br />issr.d{sR 1097, ( iv ( ). <br />Ltfu( rlDfcl.Aaara! <br />I hsd! 0llmn trndd $nahyofrsjury on€ ollhc tull$yir r d(laahons <br />I)cmolitNn Fermils-Ash6rosNohficalio. Fcd6al R.!ulIirJhs(lnl..l0.Pd6] <br />Rcquilrl l-.(cr ol Noi6cdion <br />/; <br />if, rhar 0E f.d@l r.8ulrlioc EgadirS ab€l.i rdovsl d. mt applicabL to lhi! pojal. <br />irn is.oret.I agrE to comply*irh !U Cnrand coum,rhd I havc r6d this applicalbn <br />ordimncG md Slarc Laws rcblins to .uUbrt. r.?r6@ldiv6 of this Cny ed Co@ly lo al6 upoD lh. <br />abov. molioncd EoD.ny lor <br />Applicmi or A86t S{mtu <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Delectors lnstalled <br />Rough Ductwork <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 />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rou gh Mech. <br />Final Test <br />Meter Release <br />FINAL 4-<-ld 7 €, <br />Notes, Remarks, Etc.tl ut <br />MECHANICAL-INSPECTOR RECORD <br />I <br />APPROVALS <br />Vents <br />Grease Duct