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APPROVALS DATE ID/SIG.COMMENTS OlryNE-f, BI'ILDEX DELCARATTON <br />I hcrcby smrn un.Lr p.mlly of Fdury ln,1 I m cxcrul fmm lhc Corh.loN Lkcns L{w fo.lh. followinS @$n (S.c.7031.t <br />Blliness ord Profcrsi'n Code)r Any Ciry or Counry whi.h Eluircs a lcrrir ro.onn .r. .lld, iqrtuw. dctuhh or E|l€n dy <br />slrucnm, Fior lo il3 issume. alm EquiB lhc q,plhdl for iuch Fmir lo nle r siged star.trnr $ar h. o. shc h lic.n*d purornl <br />lo llE FDvhkinr of dE Conm.br's Li.c.$d Lir (Ch.prcr 9, Conftmin8 *nh Ssrion l00l) of Didsion I of rh. BBin6, a.d <br />Pmfcsions Cod.) or lh.l h. orsh. is.x.mpl lleElrooand E b6is lo. rhe rlbe.d cxcnption. Ary viohtion of Selbn ?0ll.l by.ny <br />aptlicafi for 6lcmir slbjeds rhc altlica b a.i!il pcnalty oa nor rcrc thln fiE hunded dolld {1500). <br />-1. <br />aj ovncr of lh. Flpeny. or m, cmployes wirh wag$ .rEi $L conqxnsri.tr will.lo tlE w* .,n E slrBlE ii ml <br />imcndd or 6fr.ed for sk (S€ 7014. Bositu3s and Prctesions Cod.: Th€ Conreld r Li.c.c L,* does mr qply lo M o*ncr or <br />$c pmFrty who 6uilds or iryma lh.on. ad who dB Mn qort hinsclf or ltrslf o! rthlsl hh or hci own cttoloyccs, <br />pmvidd rtut .Eh iq,m\tmils @ mt ht .d.d orotrc,ld ror sL, ll h.wE rh. btrildi.g o. i.p.owmil i. $ld rilhi. om )€t <br />of @rpldion. tlE Omr auihcr wil trE tlE hrd.. of povinS lnlr h. or sh. dil rel build or inprcw dE pDpcny f.r lhc porFe ol <br />_1. s.ow.eroftu popcny, ancicllsie.lyconrEclinBwnh liensd contracror ro.on\mcr rh€ poje.r lse.7044. Bu\inc\s <br />and Eoftssion Codc: Thc C.nlr!.itr\ Liccnsc tiw dms nor dlply ro anown.r ol!tuFdy who builds or improwr rhtrcon, <br />d.d *ho o tuds fttr $.h l,oirr\ *irh ! ConrEcro(s) liccned I'ununr ro rh. Conlncrolr Littrs L,w). <br />-l <br />m ercmfl und* Sftdo <br />_t hatc qld will Minr.in r C.natuarc otcotrc ro Sclf.lBUE ao( wrtc6 6mpc.slrion, a ,mvidcd for b, Serio. 1700 ot rr <br />Llbor Codc. for lh€ p.rfoM. of llE *mk for which lh. ,shil is i$ucd. <br />I hrvc and will mai.trin eorkcB .onFm0rion in\uraft., ar requncd by S..riun l7(XJ of rhc bbor Co&. fo. lh. pdlormm ol <br />-; <br />ilYr*" <br />-mrisrrion i'Nuran...drif drd lbricv trumhc, fcl <br />-l <br />ccnily lh b <br />'hc <br />p.raormmc of lhc wo.k for whkh lhic pcrmir t issu.d. l shall nol cmploy any pcr$n in ey mMrcr$ &s ro h..oft slbisr ro rl'c *orkcn'compcn\arion h,s of Califoni!, Md 4se rhur i, I should b..om !!bj..r ro rlx <br />eo*.6 smpcn{ ion povhi.nr or Sdisn :lT00 6r rlr Lrnr CDdc. r rlau. fo hwi'h conv,ly wirh rh.$ tmvirions . <br />WARNING: r{iturc to wurc qortcm omp.nsllion covcnSc is unhwtul,shnll ul+cr nn cnrDloy.r l,'.ri'ninJl Fnrhis rnd <br />civil fincs up lo onc hundrcd thousnd dollars ($100.000). in addilion lo I sl ofconrr.nsolion. daroscs rs tmvnl(l for lhc::it;ww,; <br />IIII]NSEJLCONI3AEIOA <br />DECLABA.IION <br />I hcohyriftmudd.rIlL lrtoflxrjxryrhrr Ln n(n{d trrkl.r lrrvi!.nol (hrrrcr 9(.oimrn.ing qirh Sccrion 7nX)) olOnisi n:l <br />ol rrr Bu\im\!u Prori\\ions Codr- {kl nry liccn\c i\ h tulllorccruxletricr <br />r -, d ,**.n,^*,,:/o3,2 ?u2 <br />D.b.' 4 /Wy/{.o*oo. )'* <br />IONiIIIJEIIQNI,TNUIN(;IJ'N{jI <br />hsucd(Sc. l(r7, Ci C) <br />ATILI!r!NLDE!"A-8AI!O! <br />I h+r6l rninn u ndc. Jrnrlll-..llrrlury oN.irhc li,lkrvin! dcc[rrr(nr\: <br />D. rlirr{ l,cnnir\ df,lor Nooll.loi r.d(fu|RcFulxrut\ ( lirl. ]0. hn6r <br />Rcqun l.ricrolNorifi.rli,n, <br />_l ccdily rhtrt rhc icdcralrcBultrlioB Eg0ldin8 asbcsbs r.'nordl$c nol amlic$lc ro rhh pmrccr <br />[|[.nnr,*, , r*., *n+nri.dmn rdI ordimnccsrndSlorct]wrrcl,rine'ottrildinEc, <br />{arcrhdrhc $rc inturmarior is c.nccr I asR b c.nfly wirh rll Ciry,nd Coun'y <br />and hclcby aulho.i7. rctEscnrariles olthn Cnyand Coun'y ro cnro uF,n rhc <br />ubot ftnlioned popcny for insp.clion purlxMs <br />Aptlirxnr or A!.ir Signrr! <br />p*t.,*\Nb,),r\ y') L) NA5)lEM( <br />ui7 <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Compressor <br />l\/isc. 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 />T ype ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />R ough Mech. <br />Final Test <br />FINAL ,/,k/lb <},#6 <br />Notes, Bemarks, Etc <br />MECHANICAL-INSPECTOR RECORD <br />Furnace <br />Meter Helease <br />]{oaf,E&ul.t0ltfjNsAll0! <br />DEC!.ABAITqN <br />I hercby lnirn !n.tc, pcnalry of lcdury one of thc f{nk'wing dccLu{donsl <br />I <br />tt <br />f- ---T------