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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lvlisc. Equipment <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <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 />FINAL (oo trt/l loL <br />Notes, Remarks, Etc. <br />R <br />), <br />OWNER AUILDER DEIfARATIOIT <br />I hmty arm undd poihy of pcjury rh,l I m.xdpl 6o,tr thc ComradoB Lic.M hw forlh.lollowi.g lten (Sc.70.11.5 <br />BEin* ed ftoaGsion Codq): Any Cily or Cou y which rcqunB a !6ni ro coturtuc1, .lrd, irprov., d.tDolish or r!p.n ey <br />strucluq Fior ro iG isae. als. r.qui6 rhc +plk'nr lor such ldhn lo filc a lisn.d $arm6l lh8r lE or $. is li.ascd plmdr <br />rc rnc FlvisioB of tG Contrlcroii Lic.nsrd L.w (Ch.pr6 9, Com6.ing w h Serio" 7000 of Divtion 3 oa rh. BlstB &d <br />PofNions Cod€) or rnrl IE or sh. is ddpt rho.fiom dd th. bosis for $c aU.gcd q@ption. a.y vioLtiotrofsc.lion ?031.5 by my <br />,ppli@t for a pdsn subj*B lh. rpplicad lo a cilil p.mlty of nol nor. th fiv. huldrcd &,ll,e! (1500). <br />-1. <br />6 oM6 ofllE Drorsry, or my .oploJ6 eilh sr86 s llEt $1. omposslion, will do tlE wort ed ft. st\x{u! ! ml <br />n ord.d o.otl.ed tu 3rlc (Sc.?044. BunB od Prolcaiod Cn&: Thc ConlDclolt Lic@ t w doB not .pply lo e oud of <br />rlrpDFty who hil& or inprD€ rh@^ dd who d.6 scb w* hiMlf or h@llo. trc!8h hi! or bq oM dployd, <br />prcvid.d Inar such ihFomdns ec rct ina.!.d orofa.d tu elc lf, how6, [Et{rUnB or inpov!!@t b eU wnhi, oic r@ <br />ofolplrbr thc O$!a Auilia wil h!v. {E h!d.! olFDvilg tha hc or sh. dd mr buid or iDFoE [E popsty for tlE pr].F*of <br />-1, <br />6 oBTd ofrh. ptupqry, m crcluiircly conreriu vnh I.d*d .oirEdou to conslruct th. proj..r (se. 71144, Bsin6 <br />and hDiision Cod.r Th. Contd.loar Licdsc L.p do6 nor .pply lo d opnd of Oopcn, who builds or inprovB lh66d, <br />and rho coirdcG for such Fojdrs wirh a co.'rado(, licoed punudt lo rhc conl.lcldis LicG. l,w). <br />-l <br />m .xdpt u.d.r S*rio'r . B. & P.C ao. Oj! t!en. <br />D.te: Ow!.r: <br />]1ABtrDII.(AUIIN,'AI]AB <br />DEC!t84Uq! <br />I td.by amm under !.flalty of poiury onc ofthe follo*iill d4l&attuis: <br />I har. od *ill mainrain a Ccnincal€ ofcoNmr ro Self-lNur€ aor worl.B- conrpcn$lion, B pmvid.d for by S6lion l?00 of lhc <br />libo. Codc, fo! rh€ p.rfonne.c oflhc wo aor which lhc pdtnil it isucd. <br />]lll hat. and s <br />' <br />ll m nrr'n *oAe6' comF6d 'nn 'GUe.q d rcqut.'l 6y Sslion 1700 of thc l-abor Code, aor lh. pdfomMc. of <br />t. work aor vhich rhis Ddnil is isu.d. My xorkdi .omp.etion insurocc ffis erd Flicy nunbd e:Z\ (,)lnf;rtwnc^ol Itt+wtw.- <br />V{It q4th17to ,0 I <br />-l <br />ccrily thar in th. pgaormnc. o[lh. work lor *nich this p.asil is i$u.d. I rh.ll nol oploy any pmn in any n@n <br />e B lo beo@ s-ubjc( lo thc wrt6'comp.Mrio. l,ws oacalifomia. md esB rhar irl should b..on subj..r to tlE <br />Nod6 onpos(ion povilios of S.dion 1700 oarh. Libor (iodc I dDll. fonh$fi codply whh lho* !e!aioN.. <br />WARNINGT F ilurc to su€ work€6' comp.6aln'. ovm8€ it l. dd shdl slbjd e oDlord to oimiEl potrlli6 dd <br />civil fi0.s up ro orc nundr.d lhoMd doll6 {S100.000), ir pcEalion. den 36 6 prcvidcd for lhc <br />Sdion.1076 oalnc bbo. Cod., inlGt Dd drotuyt <br />t I <br />I hd.by alfm unda poiaty of Fjury tlld I @ li@s.d uadd Fovi.ior of Cn plg 9 Gohnocin8 wifi Sdion 7000) of Divirio. 3 <br />ol rh. Busins ed Phf6im codc. ald 6y lttu is h tull loE ad cflGd. <br />1nb4-z.a <br />II \L,\N c. <br />coIlIaICuo!.IEl[lBGSGEr(I <br />I h@by arm un kr Fliny of Fjury thd th@ ir ! oBrrudirtr ldding asdcy fo. lh. Ffo.Ir@. of th. srk [' whth t[! Fbil i <br />i$!.d (sd. 10e7, Civ. C.). <br />-I <br />cdify ltrl rhe Ld6l rc8ul6lioB r.eddinS 6b6ros rmoval e not applicdble lo rhir pojd. <br />'--tcdif, rhd I h.v. rcad lnis appl <br />\ ordi@c6 ed srar. L!*s Elatiog lo <br />rh. otovc inlomarioo G.or<r. I nsr< rocomplywirh rll ChyadCounly <br />rolhortu EDrBcr aliv6 of this Cily &d Corniy ro 616 upon lh. <br />abole nolio..d prcpsly for <br />\ Applitur or Asan sieiatu Ir 4, <br />r <br />Duct Work <br />Meter Release <br />///t4/8 <br />L.nder'sAddr6 _ <br />appr rcar,ri nrcirn rimn- <br />I h6iry afim !.do pcnalry of pajury onc ot th. followinS dcleatioNl <br />Dcmolirion Pmils-Asb6tos Norification F.dsrl R.sulat ions (Titlc 40. Pan6) <br />Requred l.€rro of Noi6cdion <br />--------r------ <br />--+-I