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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Evaporative Cooler <br />Compressor <br />Misc. Equipment <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Duclwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />1F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release A, <br />FINAL ? <br />N otes, Remarks, Etc. <br />OWNOR bUILDER DELCARATION <br />I t@by !fiim @da !.Mlry ol pqjury rtd I e dmp{ tom th. Conmcldl Lic.w rlw hr rhc lollowils r.eu (Sc.7011.5 <br />Buiis sd Pr.fsion Cod.)i Aly Cily or Couly whi.h ,.q!ir6 ! dsir to o.5lNc1, dts, iml@va ddrolish or r9in uy <br />stru(E , Fior ro irs iaeue@. al$ rcquirB th. .pplic&t tu 3uct Fmi ro filc 6 siBncd d.i6r th.t h. or slr b licas.d pdudr <br />ro dr. FDvisioB of th. Contractors Lic.n*d t w (chlpd 9, Comtuils lirh Scioo 7000 of Divirion I or th. Buin s sd <br />Ptuf.sion! Co&)orlhar hcor3h. is qdpr thr.fiod&d rh.b&ii! forrn a[cg.d dmprion. tuy viobrion otscliotr 7031,5 b, uy <br />appticor ro, a pcnni subj6l! lh. arplic&t ro . civil pcetry of oor horc $& li!. tundrcd dou6 (1500). <br />-1. <br />a olffi ofih. pioFfiy. o, oy coplorB wilh w.s6 6 th6ir $lc .o6poMtioi. will do $. worl ald rhc srncl@ i! tul <br />inrqd.d or ofE d for slc (Sc.?044, BNiIE ed P@fBioN Cod.: 'nE Contr.crols Licd. Lrs doB nor apply to e oMd ol <br />lh.ptlpdy who tililds or ihproB th@[ ed wlb dc Mh mrt hims.llor l'*lf or 0rcugh his or ha om @ployc6. <br />provid.d tnat such iElfolEql!enor i qd.ddoliicd forsL,l( ho$€e.tlEhuildiigor bq.ovaFl i. eEwi'ninor. ra <br />ofcomplaio,L $c OwG Builds *ill hlE d. hdrn ofFotiry thd hc or slE dil er hrild d i",FoE lhc propqty for tlr purp@ oa <br />l. a oMs ofth. prcpaty. d .rclusiv.ly comra.tirg win li.ds.d coilr.cloB lo coNlruct llE FojEl (Sd 7044, BBd6 <br />dd P,lErihCod€: Thc Cont.acbrt Lic.e tiw do6 rct apllylo oMq of pIop(rywho buil& or inpo!61n6o.. <br />d who conh.r! for .h Foj..rs witt . Codad6(9 licds.d p1rl3@r ro th. ConrrocrLn s Lic@. kw). <br />I m .x@pt u.d.r Setio._. B. & P.C. aor fiis 160r <br />D.l.: Ortrc: <br />YABtrISI]I:AMPINSAIIA!pEctratBAluo! <br />I h@by amtu undd poahy of pBjury oE ofllE followin8 delMtioBi <br />_l hav. 6d will nli.rain ! C.rtifi.de oaconsr lo S.lf-lBu. for mrl.ro' oalP.60tio[ a prcvid.d for by Selion ]700 of lh. <br />khd Cldc lor 0E Ffo@c. oat. @ for sni.t fic pdnit is i$u.d. <br />_l havc a.d will hainlah *o*ds .onp.nsarion iNurancc. s r.quiEd by 56r ion 1700 of th. Ilbor Cod., for rh. psfoll@.. oa <br />*hich lhis p.mil is bsucd. My vorkda co'npsstion iNurancc . iq a.d policy .uob6 ee: <br />,u <br />_l cdify lh.t in lh. pdfol1@.. olfi. wort for whi.h rhis p.nni is issu.d. I sha,l nor oploy Eny l's. in y mMn6 <br />s a lo b.$'rc subjel lo th. wod6' conpmrlion las ofc.lifomia, &d agR thdl if I should b..om. subjcl lo lhc <br />work6' comFNarion !rcvisioB ofsdion 3700oflh. tnbor Code, shall, aonnwnh coEtly silh lhos povisiois. <br />WARNINC: Failur. ro sfuc Norkda compderion co!@se is mhstul. dd shall subj(l u dploF ro oimin.l FElri6 md <br />civil lir6 !p lo onc hu!&.d tholed do <br />Setio. 3076 of th. l,h.r Coda i6ldd rnd <br />in addirio. ro rh. cor of.ooF.sdion d.E gd a provid.d for th. <br />tt(l;lt}:D.(oNltacra <br />DE(dAAIIOI! <br />I hcrcby amrm ondr pmalty o l rslury Ihal I m liceNed trndn pmvnion ofchafls I (commocins \vilh Sedion 7000)oiDnision l <br />of rh. aurinss dd Proaerions ('odc. dd nt li.osc a\ in lull lorcc dd.lldr <br />C <br />cottraucuolrElDtlclcElcr <br />I h.eby ailm lnd.r p@ahy of Fjury thd lhEc i!. @naodio. kdding a8*y for lh. pqfo'r:e. of lh. *dt lbr whi.h lhis pd nit <br />i$u.d {s6. 3097. civ. C.). <br />ATSIII:ANLDICI,AEAIION <br />I hs.by tfm undd pdally ofpdjury onc oflb. following ddlrarionsl <br />Donolilion Prdils'Asbsros Norili@tioo Fcddal R.sulnions (,l]llc 40. Pan6) <br />-R.quncd <br />L.rl6 of Notifimlion <br />-l <br />cdrify lhDl th. a.ddal lceulalioE rcBadin8 NbBtos r.moral ar. nor applicabl. ro rhis ,mjd <br />-l <br />cdlify thal I halc rod rhi. arplicarion sd slalc rhar rhc ab.rc i.lomdioi i! .orcd. I 6grc ro @nply wirt all Cily .rd Counly <br />ordinaocB d Starc liwsr.lat lo bu ilding condrucr ion. d hcrcbyautkrne rqreorarivd ofthis Cirydd Countyro orr upo.rhe <br />ahovc n6rion.d pmpdy for <br />I <br />h."^ I A <br />EgTDf,!{8JI <br />Metal Fire Place <br />Furnace <br />Duct Work <br />qlarll? <br />=