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MECHANICAL-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Com pressor <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 />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 />tl <br />Rough Mech.Ir btfl Lt,rhfq) <br />Final Test <br />Meter Release <br />FINAL /-n Lr1u41 <br />Notes Remarks, Etc. <br />OWNER BUILDER DELCARATION <br />I h@by lffrE uf,dd p@hy otFjury lhat I m q@F froo rh. Co .!ooB Lic.N llw lor lh. followiry r.en (5*.70]1.5. <br />Bains &d Prof*ion Codc): A., Ciry or Cou.ry which r.qunB a p6tn lo @islruc1. ato. imprc!.. d@o[tn or '!'.n !n, <br />$rucruq rio. ro il3 b3@c.. .l5o ..quic lh. applicel for N.h Fnil lo filc r siF.d sal.l6t lh, h! or snc b licds.d plBur'l' <br />lo lhc provilioes of 0E Co 6rd ! Liccns.d kw (Chaprr 9. Conndci.s wth Sedioa 7000 of Division 3 of lh. Dcins od <br />Pmlcsior! Cod.) or th.l tE or dE i! .x.'Ipt lh4arob ed lh. bBis for t5. alL{.d qmplior Any violalion of Sdion 701 L5 by an, <br />applicsnr for . p.mir cubj6$ th€ ,pplic! to ! civil p@ty olrcr moE thd fiv. hundrcd dollas (t500). <br />I, B olrG ofrh. protEly, or oy .nplorc oitt eaa6 6 rh.ir $lc .onp@alion. will do ltn mrl( rId llE nn*l@ b ml <br />ir 6d.d or otcEd for sL (Se.7044. BNird ed ProadioE Co:E: Thc ContEcrois Lic6. t w 66 nor aprly lo e oMd ol <br />th.FDpqry who hil& or inglE rh@o. dd who do6 *h @rI hi@lf o. h@laor ll@u8n ni! or lE oM dployc <br />provid.d lhll such inpmv@ls ercl inlgdcd ororsai for$h.lf, how@.lhc bqildi.8 or trrFowl i. sld wirlin on. )@ <br />olcohpklior thc Ow Buitb will hrw tn hrhn ofpbvnU $,( h.o.$.did d h dor ibp@rc rh. t@tEry aor ln. Ftrpos of <br />l. so*n6oarh.prcpcly, @ qclsiv.lycof,lracting wi$ lic@.d co 6cloBlo coisltud lh.poj..1(56. ?044, &EirB <br />aid ftofssin Cod.: Tn. Conkedois Lic.6. ljw do6 oor flpply ro @ oMa ofpropdy who boild. o, iftprov6 lhoef,, <br />.nd who ont6.l3 ror $.h FDj.ds witn. cotun ro(r ltd!.d pGu!,n lo t. aonrrerd s Lic@ l$). <br />ll <br />I hacb, amm !.dr poaly of <br />th.vcddwillMi.i!.cdtifrcrtcolco.glros.llJN@forwofi6@npdsrio,LaFlvidcdforbyselioi1700oftt <br />Labor Co(k for lh. p6forMc. olrhc wo& for which thc Dc h n isd. <br />I halc &d eill naialli! *0116 conp.@riotr iDs@cc, s rcquid by SBtioo lr00 oith. L5bor Codc, foi lhe pdfonrakc ol <br />lhc wo* for whi.h lhis Fmn ii ie.d My wrl6 conFsrioa iaue. @iE ad policy numbd eci <br />I cc.lify lhat in ln p..nrmanc€ ofth. worl for which lhb pdmit isi$u.d.I shall nol.ntloy my r6on in any mann6 <br />$ a to h.com€ subjel lo rhe wo*d compdsrlion hs ofcalifohi.. ed ,sE lhd il I should beon. 3ubjcr lo rh. <br />wo*d' NmpqMlion provisioB olscrio. 3700 oflh. Lab.! Codo I shall. fonhu ilh onply *nh rho* pmvi.ioB.. <br />WARNINC: Failur.lo su. qork6s' comFNlion corms. is unlawtul. ad shall 3!bj*l e flplolt lo omin l pdahi6 md <br />cMl lin6 up lo one hu.dtcd rho@nd doll6 ($l ,000), in addnion ro lhc cosl of contmrri6.. d@a86 a povid.d for rhc <br />I h@by a,Tm uf,d6 poalry of pgjury ltn I m licalal und6 pmvilion of(tupts 9 (coftM.ins snh S.crion ?000) of Di!i.io. 3 <br />of ln. Bcin* ed PDaBioN Cod.. drd 'ry licdc b in tuU foc aql .tfal. <br />COTIfAILqIIO]TIEIDIIG-&GEICI <br />I hq.by amrm und6 peElly of pdjury that Ihq. is 5 coNlruction lddins asdcy for rl'. p6lome.c of rh. $orr aor *hich rhic p6nn !s <br />issu.d {Sd. :109r, aiv. C.) <br />l-uu! -NLoEC!"1-BrlI0r <br />I IEL*D dfmnu s ps,rh,-olprilryo.colthc firll(nvi,g de.liolnns <br />DcnoliriL{ Pdn'irsAsl{s(x Norilic n ltdcral Rusuhrnrns llirl.,10. I!tu16) <br />Rc(ttrtrrd l.erlc' of No(ifi !{ri(,, <br />_I cgliry $d rhc fcddal r.subdo6 Esading abd6 Moval 6c ful appltabl. to this Foic.r. <br />is cotral. l6srdlo 6nply*irh aU Cirrdd Counry <br />rcprs.drriv6 ofrhn Cily md Coutrly ro 016 uFn th. <br />^., If t+l tz <br />APPROVALS <br />Pre-lnsulation <br />,//\r\a <br />I <br />Cuir: <br />Poli.y Numbd:_ __-_ ____Expn6: <br />lt <br />I