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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough 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 />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />/n\ <br />Rough Mech.3-A-{1 x"ulbil <br />Final Test L)\f <br />Meter Release //\ <br />6 -11-r Y,Nl*t{t <br />Notes, Remarks, Etc <br />OWNOR EUILDER DELCARATION <br />I hdcby afam uid( p.odry ofpajuy tha I e .imfl hoE thc contEcloB Lic.n* L3w for lhc folowi!8 ra$n (s4.7031.t <br />Bcin6s dld Pmf*ion Cod.): Any City o. Couoiy which r.qun6 . Fnn b 6n!ltu(1. .lta. impov.. d.mlBh or r.,ait dy <br />!u!.rsc, ri6. ro tu isucq d$ r.qutB rhc applicel for $ch Fni to 6L a $9..d ltdmt lhd tE or 3hc b lic@sld PNuel <br />ro rhc FovbioB ol $. Conlrrdoa3 Li@r*d L.s (Chrptd 9, Cohm.rcins *i$ S6tion 7000 oa Divleio. I of th. BuinB ud , <br />Proa*iom Cod.) or th.r lE or shc i! .xdpt rhftioh ed lh. b@b for rh. rll.Sld d@plior Any violdion of S.nioD ?01 1.5 by ey <br />,pplicait ror E psmit subjds rhc applicor ro ! civil p@lty ofnor mE lt& liv. l,uidrcd dollas (t500). <br />-1, <br />6 oun6 ofrhc F$pdry. or ny mplorG vilh sag6 s lh{ sk comFrsarion. will d. lh. wort ed tlE na(E b mt <br />i dd.d or ofiddl for sL (Sc,7044. BBine Dd PrcfsioB Cod.: Th. Co 6clols Li.@ t w doe trol4dy lo e osa of <br />lh. FoFly eno hril6 or inp.o\B lbEer! dd who .tc sh sfi hielf or n@laor lnmu8fi his or hr oM mploye. <br />provid.d rhal sch inptorq@E @ nor inl66 or oite.d 6r $L. lf, howdq, lh. hiUins or inFoGEt i! $b wnhin orc Fr <br />ofoipl€rion, rh€ o'md Boildd w h.v. dE htrd6 ofpro\tg thI lE or sh. did rcl build or n prcrt lh. FoFt, lor rh. po+os of <br />-I. <br />s o@a ofth. FoFry. @ .xclBiv.ly conlrr.iir8 wilh licss.d codt .loB lo @Nlltrs lh. Foj..l {sa. 7O14. &ruB <br />drd P,DtosinCod.: ThcConL.ct l ! Licd. L.w do6 ,or apply ro u owna of propdly who buildi or imprcv6 lh6@n. <br />ed who coltlcl! for rucb Fojqre wlt e Codscro(, Iic6rlcd pdlafl to rh. conrruclors Licr* Law). <br />-l <br />d .xdB ud6 S.ction-. B, & P,C. for lhi! r@n <br />D.r. ou.r: <br />luaatrE8E:caMfr!5arlo!D[gda4l]g! <br />I h.Eby afrm ututd poalty ofpdjury oo. ofln followiir dcl@lioBl <br />-t <br />h!v. ed wiu @i,l.in . C.nifEalc of ColMr ro Scl Burc lor wrkdr' omp.Nlion, s Fovid.d for by S6lio. 3?00 oaln <br />Libor Codc fo, tlE pslolrl@. of $c mrt tm which lhl Parit b iscd. <br />-l ilvc $d will mainrlin oork<l compeBadon iEu6cq s r.quir.d by S.dhn l?00 ol$c Llbor Cod.. aor rt€ Ffomsc. of <br />rlrc work for vhich thi! Foir i! issucd M, world cosFrodion iNuEcc tri6 ed policy numbd ec <br />Po[cy Nub6:-E&ird: <br />-l <br />cdiry rh6l ii rh. pcfoman* of d. worl lor which ths pqnn is issucd, I shall ool 6plo, dy pcon h tny ddnd <br />$ s lo balmc subjar ro rn wod(6'omp.nsrior la* ofc.lifohia. .ni asc rtd ia l sh.uld h6on. subjcl lo ltE <br />slrte'.omFMrionpDvisioEofsdlion3700ofrhckhorCodcIdEll fonnwith.omply wilh lhoe pevilioB.. <br />WARNINC: Fsiluc ro s@ worL6' onpcMrion cov@g. i! ulawtul. md sh.U subjd d @doy6 lo 6inrin.l pcalb.trd <br />cMl lin6 up to on. hodrcd tho@d dot6 (t100.000), in <br />'ddnion <br />ro rh. .oe of @oFB.rio& d'ns86 3 Fovidcd lor lhc <br />Sction 1076 of rh. khor Cod.. ior66l ad .[om.y s f6. <br />Dnrq appfionr:_ <br />IICENSILCONTAACIOAl)lgaaallg! <br />I hRby amnn unds p.aallyolFjurylhnl I @ licdel und.r Fo\ision olCh ptr g (co,nmcncn[ Ni(h Sdion 70((J)oil)ivision ] <br />.l lh. B$inN &d I'relsions (ode. .nd my lt€'lsc is m iull aorcc md cllc..l <br />CONIIBICION.LENDNCIGINC( <br />I hfrby .mm un&, poi.ny of pdjlry tlld lhcc b a @!ssdb. LditrB s8!ey for fi. pohlllllM ofih. w* tu *nich $is part i! <br />e{.d (Sc. 3097, Civ. c.). <br />AIlllCAXLUiCr,/raAIIa! <br />I h6jl)y aflinn und$ lcnahy olpcjury one ofrlrc lollovinS dal.rations <br />Dcnm ln ion Pdmils-Asberos Notificor ion F.d6!l Rc8uhrtus (l lc40. Prn6) <br />Re{tun d Llll( of Notificdion <br />-l <br />c6tit lhal rhc f.d€al r.gnhtioN r+&ding dbGlos rdnovol e. iot ar,plicabl. lo lhis pmjel <br />-l <br />.driry rhli I hav. Md thi eplicari@ ed rl.l. Uw t. abov. infomlion b cotrd1. I !!te lo @mPly wilh .U City &d Coul, <br />ordiMc dd Slat. L.s chri.s lo hrildiog coostruclio,L od l6cby .ulhoiu rcpr6aroliv6 oflhi! Cir, trd Comly lo ota upon th. <br />sbovc ndrioncd DroD.ny for iaD(tio! purpos. <br />Applicer or Agot SiSMlur.:-- Dal.: <br />I <br />Pre-lnsulation <br />Other <br />FINAL <br />--------r------ <br />----= <br />--------T------ <br />I <br />t---+--- <br />= <br />=