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APPROVALS IDiSIG.COMMENTS <br />Appliances <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />VenLs----r I-B-B-7D<I6ilet Roomlclothes Dryer- , <br />Rc'-sidenttdf Rlrqe-----/ <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />/ <br />Rouqh Mech.24249 1t/ \_./Final Test <br />Meter Release <br />kJ2/)i),FINAL 7-a-lg <br />Notes, Remarks, Etc <br />OWNER BUII,DER DI]LCARATION <br />Lrrchy rffii,n uidcr l)..rlry oI li.rJrq lnd I x$ c{.ilpr fmrn rhc Conhcro$ t-i.c.\c tjw tu Ihc l'ollo*irrS r.Nin (SN.?0ll 5 <br />Ilu\inc\\ rnd Pkncsliotr C.dc): Atry Ciry or Coxnry shrh rcauncs i Pcnnil b onsnkr. illct. imn(rvc. dc rli\h or rcFiruny <br />srrudur.. pridro irs n$mcc, rho rc,tutrci rl[ inflicrnr for $.h Pcrmir k,l,l. r siEneJ srdcn{ir Ihd lIor dE h li.cn{d plr\uanr <br />n, rl* p(,viln,ns ol rhc (-ontrrdois l,iccn\cd Ltrw (Ch{rcr 9. Conrmcnctr! wirh Sccrion 7ll(x) ol Dili{nrn:l ofrh. Brrnr\s aftl <br />Pnfcs\nnsCodc)orlh h.or\hc i\ .x.mpr tl[rcllom md lhctu\i\ turrh.,llcslrlcx.mtlion Any li{nrrionolS.tti)n?0ll 5 b, uv <br />ofplicrdftrpcrmir\ubjccrsth.4pli.rnlloaci!ilpcnnhyornor ktrcrhrtr rivc hundrd dollrA (SsU)). <br />l. n\ ostrs ol rhc lrl,rny..r 'ny <br />cnvlo)tcs *nh { rs.s a\ lhcn vnc.onD.tr iotr. *illdo rl'tr work r'd rhc (Mlurc i\ ftn <br />i cnnd or offcrcd nn Mh lsN.?()',l. llusircss rtrd llofis\ii'n\ codc: Th. Conkldois l-i.ctr* l$ docs ror {ply i,) in owu oI <br />rhe pn'Nny wh.tuldsori provcsrhcrNr.Mdshod.c!n'chk,lhinncll.ihcncllorrhn,ulhhisorhcr snc'qhy.c\' <br />p!'ridcd rhrr \u.h imlrtn$rnh{E trol i cn,L\l or oflttui ntr eh.ll ho\trcr. rh. huill]int or irnpntrtnrnl ir skl sirhinom tui <br />or.o plcridr. ttE {)BNr Buinhr sill h,\t rhc hnd.n ol |n nvins ltu hc or \h. did mr huild or iry(i! rhr Ia,rrry Lr r !u!nE ol <br />-1, <br />a\owmrofrhc p(rny, .n cxdtrsivcly conEaclhg snh Uccn*d.onturo6 to coo o.l rr* Pnjel (S<. ?044. B!.inc* <br />ond Eof6ci6n Codc: Th. Conlmcloas Li..rs Lrs dms not apPly to m o*nd .f proFrly sho builds or inptoves rh.rcon. <br />!!d who co m.rs fo, slch poj€cl. wilh . C.nhdons) liensd luruml tu th. Contrrclols Li.cns tiw). <br />I rmcrc rp( undcr S.nio B &PC <br />DECI.ASAIION <br />I ll.reby lrrm und( Fdlty of pnjury onc oI th. aollo{in8 d..h,.rioBi <br />I hnvc nl*illnuinrinr Ctnifi.itc ol Consnr roSclllnsnt tItr*ukclr d,mPcNrri'n..s Provii.d trbySc.rnrlTlDofrhc <br />Ulrn Cud.. frtr tlE |rarfornqtuc.frh. solk lht *hich lhc pcrrnir i\ n\ocd <br />-l <br />h{k and will minrsin *orkc* codp.n$ln,n inrutnce, ds equird by Sdi6.l7o0of tht tlhor Codc.lor lhc Frfollrlmc of <br />rh. work for qhich lhir tlmir is is$cd. My works oqt nr.rhn inslMc c!rt.otld policy.umbcr dc: <br />4.-/-/a <br />-lccrrilyrhfl <br />i.rhc p(iormmcoathc work lor *hichrhkFnnil h issu.n.l shall not cmlloylnyPemn inevmrrcr <br />F as ro b..om subj.rl h th. $orlcis coryE.sarion lcws of Califotni!. ond !!m rhd if I shouu b..6m sublcl lo llt <br />wo.lc^ d,mp.trs.lion povisions of Setion lToO of lhc L{bor Codc. I sh.ll, fo.lhwilh oq,ly wnh &br pmvisions <br />W f,NINO Failue ro kurc mrkcs comltc.eridn .5!.6g. is unLwtul. lnd shrll subFcl ar cmllo}lr lU dimin l FMllts and <br />civil fincs ur lo om hundmd lhousnd dollds (SIOO.o(X)). in ddirion lo thc cd of@mlEn$tion. da@8cs !s Pmvid'd ror rhc <br />Sl\tnnr 10?6 o{rnc Lrhor Cod.. inlcr.s otrd 0lte <br />LICENSIICANI&ICIAB <br />D}:ILABAUON <br />Ih.rch,rttmuM.r,.nrlryolpsjuryrharI!'nliNtr$]und.ttrovhi{inolCh.prct9(.onnmncin8$irhSdtnr?000)tll)ivi\i{Dl <br />of rhc Irusimsi:nd Polc\sn,nsC.dc. ud nylitcn\c i\ i'r iull ntcc.nd clltcr <br />lZeas <br />I <br />c0xiirSllclr0N!llDtxc-{GEE!:t <br />I hcrchy ltrrm und$ lrtrrlryollE J! yrhrr rh.rc t a.onsDdi)n lcndins dg.n.y n* tlrc !.rbr.bn.c orrhc uorh for which rhis txirnn Lr <br />i\rmd isc. 1{)97 Civ. C ). <br />A}IIIIANI.DEEi.ANAIIAE <br />I tmhy dlim undcr Nnnhyolpcrjurr otr. ofrhc n,lLrsing dcchrrlion\, <br />l).nx,l n Pcirniis Aslienos Norillcdrir)n ftJerul RcAulllion\ l-l'irl. d0. Pid6) <br />-&cqutcd <br />L.rrs.lNorili. ior <br />-l <br />ccdilrrhrr rh frd$nt rclul ion\ r.grlinar\h.{o\ rc ntr nc nor rnrli(nhlc t'rhn I'r.iccr <br />l.cnilyrhd t hr\.r.DJ rhi\ rfrfli.rri(flrtrd {rrcrhrrrh.xhJv. 'trli,rn i.nrh.omcr Ir!r.croconrfly$irhrllCifnMGnnrv <br />rh'r. nrirn,n.,l torcdy <br />t <br />MECHANICAL.INSPECTOR RECORD <br />a <br />DATE <br />Metal Fire Place <br />JJzIo"b <br />tr.n,lcr \ Nrm <br />-