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MECHANICAL.INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<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 Dam per
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meler Release /A
<br />FINAL (-T-tr U
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DOLCAR TION
<br />I lE .by !fiiro uid$ I'eillry ot pcrjury thd I m .xctrl9r iilo th. Conr&ror' Lien$ tlw fo. UE lolloairg ,!sn (Se.7011,5
<br />Busincs and Prof$,n'n Codc): Any Cny or Cou y whbh Eqlircs , Fmil lo 6.dru.1 !td. irprcE &mlth or Elsir r,y
<br />srtudue, prhr ro ils issaft., als rcqlires rhc applt r aor sst lEmir ro filc s si8n€n stlrcmnr rhal h or sl* is lien$! pul:Mr
<br />lo lhe Imvisionr of ltE Controclols Licnsd tlw (ChEn( 9. Commrcing silh S@lio. 7000 of Divhio. 3 of lhc Busincs .nd
<br />Prcfcsshns Cod.) or that lEor stu is cxcqrl th.rcn m.,i rlE bas& lor lh. dh8cd.xcnplion. Any violdion of S€.lion 7011.5 by any
<br />apnlic! for a!.mir sbj(ls In lmli.a roacivil!. lItofmr mElhu filc hundEd doll&s ($5m).
<br />-1.
<br />!s owBroflh. pmp.rly. ornyctrl,loyrrs wirh w!8.s I thcir slc.ompcrslion. willdo tn. wort. tlE sEu.re ir ml
<br />i cd.d orolicrcd foi slc (Se.7044. B!.ift3. sd ftofcsions Codq Th. Conrhcroa6 Lhcne l,w &cr nor ipply io in owftr or
<br />lhc lmlEly who builds or i,poEs tlEmn. dd who d6 $ch s* himElf or h.rFlfo.lhmugh hir d h.r ovn crplor.s.
<br />pmvidcd rh8l such iqmvEmnrs @ rct i' .dcd trofr.En for sh li ls*cE. dE trildiry or i,prorcmnt is sld vilhh orc re
<br />of eq,lclion. tlt olrM Buil&r I hlt dr t!trhnolFlvin8 0El lEor Edn mt hild orinqmrc *E FltEly ftrrt purposor
<br />l. !s o*ncr of rhc rDpc.ln ad cxclusilcly conrrocriry uirh liccn$d .onlractoF to Nnsrtocr rlr rmjcr (Ss, 7014, Burifr3
<br />ad Pmfssim Cod.r Tnc Conlmcrols Liccnsc hw dft. nor +tly r{, an owncr or prop€ny who buildi or inrlbks lh.rmn.
<br />$d who co.tri.rs for iuch p,njc.r3 wirh o ConlE.lo(, lianed pusu ro rhe Conrrlcrois Ltcn* llw).
<br />-l
<br />m .xcq,l und.r Scdon- B. & P C. for rhls r&n.
<br />D.l.r O*r..
<br />UOAtrE&S:IOMrINSAIISN
<br />DECLARATI(IN
<br />I hcrcby lfiirn undcr p.rolry of p$iury oft olrh. rinbains d(lurdrn,ns
<br />1,':{lhrvcdl{,llnB'irsinsC.nir*rrc',rCon\.dn,sclll,surcli,r*orkcr'compcr\ati.n.*p(,vidcdI by S..rion ]rm or $c
<br />la&{ c,dc.lo' rhcrqlnrnrmc.,r rh( vnrl litr trh(h rhclcirn s 's\u.J
<br />-,
<br />havc ondBill.rainhin Norkctr conD.ns0rion insutu c. 6 r.quncd $y Scri.n 37(n ol rhc bbor Codc. lbr rhc NrlorMncc ol
<br />rhc work for qhich rhisl.nnir ii issed. Mv*o s onmtrerioninsurBr
<br />/Jf k -r-rrrt efr+'-s
<br />e g
<br />WARNINC: ttiluE to scurc sqkcs compcosriotr c.vcaSc is utrloutul, Md shall su$jsr !n nqrl.'lr ro sin"'dal Ilcnalrts and
<br />cilil line\ !p ro om hundrcd lholsand dollss (SloO.((xJ). in lddnion lo rhc con ofconucnsdion. drrusci,s p!.vilcd to, rhc
<br />inr.rc{ rnJ rionrr's rcN F_5 {
<br />LICIIISEIIC!)N1&I.CIAA
<br />DIICLABAIION
<br />I hc(hy inDrrndcrpcfllyoftrrjurtth1Innlic.r\cdunncrnnrli\irr.rChrrrrrq(.onrrn.nrgq hS.cridi70([)ofDrso]l
<br />ol rh.llu\i'i.s\ rtrtll)r.ri$ion\ (ixk xn,l f,r liccn\c i\ if li lli,r.crtr cfli.r
<br />o zc)6479 5 3
<br />I R
<br />cll&ualglllNrENlaliacEll:x
<br />I hcrcby ulfirm unds ,Emlty of F,lury thdt lhcr. is a cotrsruclion [Ming o8cncy forlhc perlormrncc oflhc qorl lor which rhi\ llcmir ir
<br />nsucd (SL{.1097, Civ c.).
<br />lIIUg NLDECLrISdlIo!
<br />I hcrL$y Jlllnn rnJcr ncnalry ollurjryonc ollhc tull6vins ncchrrtion\:
<br />I)cnxrliri(ii PUnrirl \hcn.s Notill.nrioi F.drrul R.3ul,ii{in\ l'l'iilc 40. I,rd6r
<br />-Rcquircd
<br />Lctrc! of Norii.dk[
<br />-l
<br />ccnify lhfl lhc fcdcml rcSrhtions E83ldin8 ashcslos rclmrll rc nor q,plicoblc ro lhh Dmirr
<br />I c.diry rh,r I have Ead rhi*pplicarion od i,r. rhdr rhc ar,vc i.forturt,n h c.rdr.I aerft rommrly*nh rll CilyaDd Counr,
<br />odinutucs and Srorc li*s rchrinB ro hilditrB consmclion. lnd hcEby.!lh.ri4 rcI'cs.larilerolrha! Cny ud
<br />,h)!c trhtrrionuJ trcpcny ft, in\pccri,)n e,q\'*re__
<br />Aptlicanl or Agctrl SiSndurc:H/.4 I
<br />l]luilll
<br />III
<br />COMMENTS
<br />Smoke Detectors lnstalled
<br />-l
<br />cerrify tul in th€ Frfo.rMrce oflhc wort for wnicn rhk pcrmii is ksucd, I shall nol chploy an, Fron in a.y tunn($ as lo bcsm .u6.isl
<br />'o
<br />th. vort6 snp.nerion lne. orcrlifomia nrd a&m rh.t il I dbuld h..om subiEr ro rhc
<br />wo ff conlFnstion pmvisioN or Se.tion lr0o of ihc tahor C.dc. I shlll. lodhwilh comtly wilh lho* pmvisions.
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