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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />It/etal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lt/isc. 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 Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Meter Release <br />FINAL ,)v(^>7//t /< <br />^cnNotes, Remarks, Etc. <br />ot/Y,t <br />OWNER BUILDER DELCARATION <br />I hcr.l,y lJtm uids Foally ot F{ury lhat I m cxcft fiom fic Co.rtem^'Lt.n* Li{ for lhc followi.S lwn (ser03,5 <br />Busirc* rld Prcfcision Codc): Any Ciry or Counry ehth EquiEs a Fmh lo €oBrod. alt6. inPtorc. d.mli.h ot q'en any <br />srruclm. pri,r to ils bruft.. lho rquircs thc q!,rt..i lo. sh Fmit lo file s si8ftn sl3r.m.t lhal h. or sh. ii lics@d plmain <br />ro Oe prcvirioB of lnc Conrslmt Lic.n*d Liw (chq,lcr 9. conmcncin8 {irh setio. 7000 of Dilhion I of rhc B8ir.ss and <br />PDlc$iois Cod.)or.h.l lE orshe is.xcqll lhcrcfromald llr b4\i.lot rn dh8.d cxcq,lion. Anrvioblio.ofs..riotr?03l.5byany <br />orplicarr for { p.mir subjcrs rh. applica lo a civil p..dry of Nr mE lhln nre hundrcd dollrs (Stoo). <br />-1. <br />tri owmr of rtE prnFdy. or ny €ng oy(s wi$ {asB !s rhcn ob .oq,cn$lion. will do rhc h* ad rlE eMrE is ml <br />inrcftl.t u offcr.{ for sh (S(.1X4. Bu.ifts. .nd P,nfcsions Codc Ahc C.nlra.loai Lienc tjw d@s nol 4ply lo d o*ftr of <br />rh. peicn, who blilds n inpEws tltec !d whD do.s skh slk hintllor heMlror fimugn nis or hcr oq.n loyes. <br />pbvidcd rhar rkh inlormds N ml inlcndod oroficr.d for slc.lL hose8. tlt tdillirg ot itprowmr i3$ldwhhinorcJEd <br />of co.tDlctio.. r,E Owtur AuiLto wi! h,vc $c ttrrdd ol Fbving rld h. or slE dt ml h d or inlprct 0r tmrfiy rot 1tE l,ur]Is ol <br />L ds owncr ol rh. prupcny, !m.xch\ivclyconrdcrin! with li.cnscd ronhdou ro onsrtucr Itt poj.cr (s(.7014. Busirc$ <br />and,\.r.*irC.dcrTh.Cont0clolsliccn*Lowdocsmrolplylo!nowncroiptuFflyehohuildsotimprctsrhcEon, <br />and wno coorrrcl\ for suchrrejdk wnh ! C{,n!6do(\) lkcnscd ru^unl to rhc Conrrador's Lien{ Llw) <br />I imcrcmo udcr Sccl <br />IIOXf,EIN:COMTINSAIIOU <br />DECIABATq! <br />I hercby dfirm !nd.r pcnally of pcriury orc or lhc follo*ing d*lqarionrl <br />-l <br />haw dd pill mi.tsin { Ccnificrlc of Cons.nl to Sclf-ln$rc for klldi onpcnserion. d pm{idcn for by Sccrio. l7(D of ln <br />lahor Codc. for rhe Frfolr]@c of rh. mrt for whhh $e pmn i! ku.d. <br />-l haie rnd will mainrdin wort .6 comr.nslt ion iNuramc. es rcquircd by 56l hn 3700 ol tne bbor Codc. lbr lh. Il6fom@ of <br />rh. tr.rk lar {hich rhn !rnnir My workns comtEnsation in\u,lncc .ari dld Flic, numbcr sc: <br />el oq.H4ua',g <br />Cc.- <br />I.cdiry rh.i in th. pcrfoinEmc ofrhc sork tu shich rhh t'c,n h hsucrl.I shlll nol en{,loy an, I'cBon inanymon.cr <br />s as to tEom subj.lr x, ric {o c( .on{rnsarion l.wi or Califo,nir, .nd osE fiar it I rh,uld bc.om subitl lo rtE <br />sodcrs oiFnetioo povi,ions orscction 3?00ofthc titpr C(lc.I shrll, Ionh*irh snply wilh lhos pmlist nr <br />WARNINGT Flilurc lo surc workcs' d,mrcnsarion owBgc Lr unlaw6il. a.d shall subixr o .rploFr lo aiminol lEnaltics lod <br />civil ,i.cs up lo one hundrcd thousnd dollds ($100,000), in lddiiaon lo rlE cosl of conwn$ri61 damgcs !s provited lor lh. <br />LlcllrEllcoNraacraa <br />DDCLABA.II!}N <br />I hcEby !fiinn undq p(nxlry ofrcrjury Ih,r I nn li..n$d undcr pmvhion ofChapr.r 9 (coFmtuin8 wnh SL{rbn 7(D0) o! Dilkion l <br />o, rhc Busirrcssond Pmltsionsc{dc, and !,y lkcn{ n in fullnraaldclid. <br />Z:Z-I <br />CONS']IIIICTI(IN I FNDIN(; A(;IiNCY <br />I hcrcby,lltm undcr p.nalryofncrjrryrhd rhdrc n,cotrirucrinr lcMinsoscmy tor rhc Pcrfornrmc oflhc wo f( which rhis !.rnrir il <br />issucdiSc.. :l097,Civ C.). <br />I ccnilith.l rltLdcrrlrcsululions rcBuding a\h.{.\rc xrhltc nor ,lllicnblc Io lhis pojccr <br />-l <br />anify lh, I havc ,cad rhis lppli.arion and i,rc rhal dE abovc infortulion h .or.cr I tr88lo corrtil, wilh allCny rnd County <br />otrtinorccs urd Srarc l,ws rcbrins I{, blildins.dn{ddion, d h.rcby aurhoriz rcprcse triE\6llhhCnymd Countylocnlq utDn lhc <br />.bov. mnrhnol pmFny fo! <br />Amlicanr.r Ag. SiBml (o <br />EI <br />Grease Duct <br />Final Test <br />t n<Lr'3 Nmr <br />- <br />LrndcfsAddrc{i <br />- <br />rpu rc,r-iiiiiiiirnor- <br />I hdxt'y rffim undcr Fnahy .f pcriury onc ol rh. t lb*ing d(lnral ions: <br />Dcmnnion Pcrmirr Ast $os No icdion Fcdsal Rquhl bns I rnt ,r0. Pd6) <br />Rcquircd L.ltcr of Nolifntion <br />^,z(z-f lzalt