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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BU!LDER DETTARATION <br />I lE.t, llrm ui&r ,@dry oa pcjlry rhsl t @q@fl tom thc ConrE.loE Uc.ne ltw forrn followi,S rlbi (S6.7031.r, <br />Buins &'d Prcfqion Cod.)r Ary Cny or Coudy wnicn r.qun6 r Fmil lo oldrud. alls. imprcvc dsnolGh or lE.n ey <br />stteluc. Fior ro n! i$ueq also r.qliB rll applicd for such pdni h 6lc. sisrd nardMt Od h. o. sl!. b licd!.d F!t6r <br />ro lh. provisiom ol $! Conrrlctoas Li@nscd lrw (Ch6ptr 9. Cbm.ncing with Serio! ?000 ol Divirion I of lhc BBinB ed <br />I,rofcsiotu Cod4 or thsl hc or shc ie dcnpt thoctod ed $. bab for rh. alLscd q@prion. Aoy violalio. ofs6lion 701 1.5 by uy <br />aprlic&l lo. . pmit 3ubj€ls lhc applicol to ! civil pmlry ofnol eorc lhs 6!c holdrcd doll8 (rt00). <br />-1. <br />a om6 ollnc Fop6ry. orny dplorB wirh *!e6 a rh.n ek.onp@aio!. villdo tlE *orl dd lh. !iQd@ t @r <br />idtortcd or ofi.rcd for ssl. (3*.?044. Bcins ed PrcadioN Co&: Th. Conlnclor'! Lt@ bw do6 nol aeply lo e o*n ol <br />rn FlFly w$o hil& d irproG UEE( ed eho &c sdr eit hiG.lf or t'@lf or thrcr8n hi5 or h6oM mploy.6. <br />prodd.d rh.r such ioprov€GB e @r i'1d{,.r1 or ordd for s!. ll hoq@. rh. hiuiig or imFDrled i! sU winir oo. }6 <br />ofcohpErio'i, fic ol*rs Buitda wil har rh. hrh otFovins lhd h. or shc did d toild or ftipiov. 6c popqty b. UE pxrpo. ol <br />-1. <br />s oBnd oflh. prbpqry. d qclBivcly .oDtractins wilh licots d co rlcroB to oisrud rla !rcjer (Se 7044. BEmd <br />and PtDftsiD Cod.r Th. Conl6cloai Lt.@ t s do* n i .pply lo o own6 ofpropdry who build! or inprcG 0!6@o. <br />ed vho coitr*l! tor such Fojc.ls eth a connado(s) li.dts d ptlli@r ro $c conr...rm'i Lic@ l,w), <br />I hceby rlrm undo pcnalryofpajuryoocolthc lollowitrB drcl&.tioB <br />I haEodpill mimah rCdifi..icofcoMr to Sclf-lBur. aorvort6 @ p4elio., a providcd for by Serion 1700 oalhc <br />L.bor Code for fi. pqfo,rMc. oaln wo f@ trfii.h fi. Fnn ir i$u.d. <br />_l havc and eill nainain el*ec compolation iBu]ec. a r.quir.d by Sdio! 1700 or $. r.bor Cod., ror rhc psfomuc or <br />fi. @rL lo. which rhis ,6nn ! isad My wqk6 Napotsdion iBu@. @id ."d policy numb6 c: <br />-l <br />ccdiry Ist in rhc pslomM. ollh€ work lm s hkt fiis pmn is issudi. I slall ,ot nploy.ny F6on i! ey de.E <br />$ a $ bao6. subjd ro thc wo.r6'compo.dio. Lw! ofc6lifomi6. Bnd ,!E lhrt if I d'ould bdom. sbj6t lo lh. <br />worl6' conp@rion prcvirioB of S.rion 1700 oalh. t bor Codc I shdl. lonhwilh comply wilh thos prcviiios.. <br />WARNING: Failurc lo sd. so*d' @mpds{lion cov@r. is uilawtul. dd .hrll sdj.cl d oplolq ro cimj.al Frfti6 ed <br />lsd doll6 (S100.000). i. addirion rc rh. con or .omp60tion. dsag6 a Fovidcd for thc <br />I n@by amm lndq podty of Fjury thlr I D ljcqu.d u<kr FoBio, of Chlpld 9 (6m@ins wnh S6rio! 70OO) of Divisioa 3 <br />of th. BGiIB ed PEf6siod Co&, rnd oy lic@ n in A ao@ ed.trEl. <br />Liccse Clsl LiccM Nudbd: <br />- <br />D.le contn.tor: <br />co!flf,lcnoB.l,DrDtlc-acElct <br />I h@by .Ifir{ @dd Fulty ol pdjury Oa th@ i! . coiltoclb! LodiDs .socy ft,r ti. Frol:ll,e of0. wo* 6r *iici rhis pdnn b <br />i33!.d (sd. 309?, Civ. c.). <br />I cdir, lhd lhc f.dchl rcsolalioN regednrS sbcatq ronoval e. nor applic0ble ro thi! projccl <br />I cariry lhsl I h!v. r@d rhis applicar ioo and $ar. rhal rh. atoy. i.hrnlalion i cocr. I sgre ro cohply vilt olt c y ed counry <br />ordiflancE dd Srai. Llss El,liru to brildine codrucliotr.etnoriz. rcpr6el,liv6 of this Cily ed Couly <br />abolc nalioncd popql, fot <br />Apeli.er or As6r SisGllE:/a <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room i Clothes Dryer <br />Residential Ranqe <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rou gh Mech. <br />Final Test .-6) <br />FINAL vlelgo t,.rnnell) <br />Notes, Remarks, Etc.ttI ') t <br />Pre-lnsulation <br />Other <br />Meter Release <br />P.h.vNum$a' FrniB <br />Lende. s Addrs: <br />- <br />arpr.rc,llrlliiCiin,riid <br />- <br />I hdd, a&m und6 oaalty of p.rju.y oE of fic follosins ddldarioB: <br />O.molilion P@ir$tubd6 Noti6.rtio. F.darl R.guhrioc (Titl.40. P.n6) <br />-Rcqut <br />d kl6of Nolifi$lkm <br />F <br />I <br />i-