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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Com pressor <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 Range <br />Other <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 />Rough Mech. <br />Final Test <br />Meter Release <br />"X*^+eti,FINAL nIs ?r) <br />Notes, Remarks, Etc.I U\ <br />OWNER BUILDER DELCARATION <br />I hq$, ,fftn !id6 poaty of FjEy lbd I @ 6@pl tw lh. ConlrdcloB Liccne Liw for lhc follo*i4 ta$. (Se 7011.5 <br />BBins and ProldioD Cod.): Ary Cny or Cou y which rcqunG . pdtnn b onstud. all6, impov., danolilh or Epan eJ <br />srruclrc prior lo ns is@cc. oto requi.B th. epplicd for such pdnt to 61. a s'gi.d 3tat.!Bl th,l h. or slE b lic.tu d pueel <br />1o rh. FovilioB of th. Coilrelo s Liensd L.w (Ch.pls 9, Com.kins wih Sdrio, 7000 of Division I'of lhc Baind &d <br />ftolcsiors Cod€) or Ihal hc or rh. is 6dpr ihactoo dd rh. bdi,! lor rhc all.g.d qsfliob. Any viola on of S..ion 701 1.5 by ey <br />appucmllorap6f,t$bjcutt.pp,i@rtoacivilp.!.lryofnormGdEfiv.huodr.ddolles($500). <br />-1. <br />s omd otlh. propdly, d ny mdor6 with eag6 s fieir $lc .onl,6s!rion, wil do tlE *orl dd llrc st uci@ b el <br />iolad.d or of.rcd lor saL (Sc,7044, Burine dd ProfsioB Cod.i Th. comrechis Lkoe Law <lod nol @pl, lo & oms of <br />th.pDpary who hril& or inqorc llEor ed wlD &6 *h w* hiMlf or lB$lf o. teugh his q [d 6M mployq <br />providcd rhrt !u.h @prev@.d! @ sr idd'&d or oturd lor elc ll hoffi. E hildna or ihprwtul n $B wilho o.. ,@ <br />olconpldion. th. OMs Buildo- will h.v. th. brdo ofprovin! th, h. or slE did ml build or inpmv. lhc p'oFry for {i. AtFe ol <br />-1. <br />s oM6 ofrhc piop6ry. @ qcluivcly contrclilg wit lic.$.d coitracloN lo conslrucl lh. pljcd (s6. ?044. Buin6 <br />dd hltsiion aod.: 1 h. Coorr.doca Licdsc L,w do6 nor apply ro & o@a ofprop.ny wbo blilds or inprovB lh6@n. <br />dd $,ho .o.rra.rs aor su.h Fojcrs wirn a C. E ro(s) ltd.d puB@r ro rhc Conrft.lor3 Lic@ rrs). <br />_l m.ranpl undd S6t <br />lYoaxlgfl(ouEExtalrQ!p[claSarta! <br />I h6.by a,nd u.d6 Fra[y dfpajury on. ol$. lolloMnr d(ldaiod] <br />-l <br />hav. dd s i ll rainrain r Ccnifie!. olcoosr ro S.la-l6nr. aor mrt.re conrpens ion, 6 ,rovided lor by SNrion .1700 of rh€ <br />BProdc. ro,'hces'omu(.orrh.$oa ror (h(hrh. pqn 66iu.i <br />&a' e anrl * ,lr marnra,n worl.6 corh!.Gar <br />'on 'Bmn... ar r.qun d by Serion l7l)0 of lhc Labor Cod. for rhe pqtomMc. ol <br />lh. $ort lor rvhich lhis p.mn i! su.d M, wo,kds compcBdion imurmc. c id ard policy numbs d.:cYFks.s <br />I ccniq ihsl in lh. Faollfuc. of rh. work lor which rhn psn n iisucd. I shall nor @ploy ey ,Bon in ey 'nend$ 4r |o b.comc subj*t ro rhc wo*6 @npaEaioi las ol Califo@& od ,g€ th,l if, druld beohc subjdl lo thc <br />sork6 coftpdstion prcvi.ios of sdion 1700 oflh. tlt r Cod., I slsll, lorlhwilh comply wnh lhoe prolisioc.. <br />wARNlNc: FailuE lo s@ eth6 .ompcis.lion ovdec i. ula*ful dd rh.ll subjsl rn 6plo,6lo dini.al FDlri€ dd <br />ciril nn6 up ro onc hundr.d rhoMd dou6 (5100,000). io additio! to th. cosr otcomp.Ntion. dmsa a ptovid.d ror rhc <br />inrd.d dd $ooey ! fG. <br />IICIISTD-CANIAACI]tr <br />DEIA8AII(A <br />I hdcb, amrn udr t6alt, of pdjury rhar I m lic.sdl Md6 prolishn oachapts I (.urmd.inr willt Sedion 70LXr) of Dirision l <br />ol rhc Busin* ed PrcrdrioG Codc, ed my lictu. ir in full forc. dd .fi{r <br />C-z-o 7776 0zl <br />conh..for t -- <br />ca!!:r8lqroN.LENDINC.6CElC[ <br />I ho!6y.trm ulds p@rlyorpdjuyrhd tb* i! ! odrtu tior lddiis 6sdy fo. Uc pafotr@c or{Evo ( for ehih rhb F nt <br />isocd (Sc. 3097, Civ. C.). <br />AIIUCANLDECI,dAAIIO! <br />I h6.by afrm undq poohy of pojury onc of rhe loUosinr d(ldalions: <br />D.mohion Pmtu-Ashstos Norificdion F.ddl R.gnlarnrns (Till.l0. Pd16) <br />-Requted <br />L.11er of Nolifimtion <br />ordinan.G and Std. t ws rcl,lin8 ro b(ilding codrucrioc ed hs.by aulhoriz. rclr.9rali!6 oarhis Cn, d <br />abov. mmtion.d prcp.ny for iNp.c1 <br />r\pplicml or genr Sisnarurc:a <br />rl <br />WD <br />Furnace <br />F- <br />-l <br />cErify that rhc f.d@r rcrul.tioc asddii8 abd6 rmolal e. nor appli.abl€ lo lhis pmj6l. <br />-l <br />c6tit thd I h&€ rsd lhis applicarioo &'d $al. thal Oc lborc iofomadon is cor.d. I agE ro omply wilt all Cny and Couoly <br />I <br />tt