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APPROVALS OATE ID/SIG. <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <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 />Rough Mech. <br />Final Test <br />FINAL -t /?bltN,iN r<-v <br />Notes, Remarks, Etc. <br />OWNEN AUILDER DELCARATION <br />I h.eby arrm undcr pcnoty ol lcrhry rhd I d cxcmpr fmm thc Cor 6croN Liensc Lrw to. $. ro.win8 Ea$n (S.r?031.5 <br />Businc* and Prolcssn,n Code) Any Cny or Co! y which ,.quitus a Fnil lo construcl. lllcr, ihl'rovc. &mll(h or ctun aoy <br />srtucror. Fi, b ns irsuore, alm rcqltcs rh. orplicsnr for su.t pcrd ro fiL a ligmd 3l.rcm rhlt hc or sh. L [ensd pur$ant <br />b rh. ImvisioB of dE Co.t@mls Lisnscd L3w (Chaprcr 9. ComNncing with Sftlion 7000 of Dilhion I .tllE BBincis !.d <br />Pofcshns Codc)orrhrl lEorshc Lscxcnpr thcrcfomand thcb0sk forthcallcscdcr.hprio.. A.rvioturionolSslionT0ll.5by.ny <br />applic.nr lor ! ,,cmir subi(ls lhc applklnr ro r cilil pcnslrt of not mrc fian filc hundcd dotle! (1500). <br />-1. <br />as owncr of Ih. r,mFny. or my cnl'lo)es wirn waecs !s thcn wh comFnsorion. will {h tlr @k a8t hc srn&r@ ir rct <br />intodcd orotrcrcdforsk(Sd.7Ol4.Blrinc$uodR$fcssionsCodqTIECo.a.tolslice.sL!*.lo.smllpplytoanowkrof <br />lh. tmpcny who btrilds or i,pmEs tlE@n, rnd rho des $ch s* hiNclf or hcrslf .r lhmush his or hcr ow. cmddrcs. <br />6vid.d lhdr slch imphhmnri @ mr hrcnd.n or offcEd for slc. li h.uei t r buillli.8 or in oEE h sld *ilhin om rce <br />ofonFtrion. llE O,tur BuitLr will hsr rlE bdlcn of ImlinB rt r hc or shc dA tur hriu d ir!{oE $c popqry fm tlE pu4Ds of <br />-1. <br />N owncr ofrhc t'otcrry. om dclusivcly conrEdins enh licctr*d conrEcros ro cornnd rlE trcirr (S&. 7014, 8u\ims <br />.rd PDrLBskio c.dcr Thc Conrm.tols Liccnsc Ltrw docs lor.tlplr ro nownd ofrioF.nysho builds or i-rovcs rhcreon. <br />and vno co.tncrs lor $ch pmjccts wnh a Contmclois) liccnsd nlrsunt rornc Conrrucrr\ l"ken* bw). <br />D!(.: <br />I hcrcbt afiirnr undcr tcntrlryof ,.rjDry <br />-l <br />hatc ard will Binrri! a C.niftar. ol Conscnr ro Sclfinsurc for wrkctr comt.ns on. !s prcvidcd for b, Sccrion 3?00 of rh. <br />Labo, Code. ror E pdfoll11aF of Eeort aor wtth ttE I'.mir i3 i*ued. <br />_l hlvr and *ill moinrsin workcE comp€nssrion inslnnce, s rciuned by S.crion :1700 of rh. Lrbor Codc. lor fie p.rfolmrcc ot <br />lhc srk fm whth lhk pcrmh is kr,cd. My *ortcN' corwnsalion insorae cdi.r ord rDlby number @: <br />Policy Numb..:Jrrircg: <br />_l ccniry rh,r in rh. p.rr.,mn.. orrh. work lor vhih lhh F.mir is issu.d. I shall ml cmploytrtry p€mtr in sny nMN. <br />s s ro h.{m subj.s b rhc rcrtcs coq,.nsrion lawr of Califomio, lnd a8N rhd if I sholkl tE oft srbjcd 16 ttE <br />workcs conp.ns.tunlrcvisionsofSelion l?00 ot rlE ktrr C.dc- l nElL fonhtilh contlr virhtlt)$ tmvisions.. <br />WARNINGT Fdltrrc lo wu.. workcr uomp.ns$bn covcm8c is u.l.wful. and sh6ll slbjccl $ coployd lo cttuin{l lrmhics Md <br />.iril find\ up k, ok hxndr.d rhousr.d (!lm.urc), in sddnion lo rhc cosl ofcompcn$lio.. d!mg* ar nrolid.d ror rhc <br />Sccri,)n.1076 ofrhr Ltrhtr Cod.. nrl$.{ and <br />I ncrcbyaiirm under Fnallyoll.rJlry rhar I ad lien\.ri ui.lc' pr.virio. drChaprs 9 (.onmmin8 wnh Scrbn ?fix)) orDilhion ] <br />oi rhc ansi csr.nd Prolisions Codc. a mylicctrs is itr tull for(c und cltccr <br />AITLICANLDECIAAAIION <br />I h.rtt)yafimundcr pcnolry ofFdury on orrhc rolbtins dsle{idn\l <br />D.nbliri.n PMnirl^:tr{or Noriicalioo Fcdcr.l Rc8ul.liou (Tnt,11J, Pud6r <br />-Rcquncd <br />t.ltcr ol' Nolifi cdio. <br />&d Ounrylo cntcr upotr the <br />6 ? <br />Psmi,\{nr <br />0 <br />MECHANICAL.INSPECTOR RECORD <br />II <br />COMMENTS <br />Other <br />Above T-Bar <br />Meter Release <br />D.L:-,4 <br />l-iccn\cch$ Liccn* Nu rh(r l <br />IAIiIBI&IIANIINDINCAqEN(I <br />I lErcby rffirfl undcr p-trrltyol pcrrtry rhor lhcrc i\ ! on(rucli,,n Lnding lscky for rhc F,hmuncc ol rhc uork to. which rhit p$mir ir <br />hsucd lSc.. 1097.Civ C.). <br />II