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MECHANICAL.INSPECTOR HECOHD <br />APPROVALS DATE ID/SIG.COMMENTS <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 />Smoke Detectors lnstalled <br />Bouqh Ductwork <br />Vents <br />Jqilet Room / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Jype I Hood <br />Type ll Hood <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Bough Mech. <br />Final Test <br />Meter Release <br />Notes, Remarks, Etc <br />OlryNER BUILDER DELCARATION 'I bcrcby artrn undcr Fn.lly of p.iury lha! I d .r.@t tom the Conticlo6' Lketrs b* for $. followiog Een (Se.70:l I 5 <br />Buiinc$ udl Pof.ssion Code): Any Cny or County *hich r.quncs a psmir to onslruct. !lrs. impmve d.mlnh or Eprn my -sn!d!r.. lrbr ro hs issuec, aho rcquircs rhc amlkd t6r such lcrmn 16 fib d ri8n n s|armor th hc o,3lE ii li.enicd puNot <br />lo lt* IFvisiotu of iE Conh.ln r Licnscd tas (Chq,tcr 9. CommftinS *irh Sccrion 70m of Dirision I of rh. Busin.s lnd . <br />Pof€sions Codc) or that hc or sh. ir ex.mrl thcElion ed $c b&rh for rhc alkgcd crcnnrion. Any riolarion ofseri.,n 7031.5 by.ny <br />aopli.air for d pcmi subjds lnc lppliclnl ro ! civil Fruhy of not mrc lhm 6v. hundrd dolqs ($5OO). <br />-1. <br />$ o*ncr of lhc r,rcFny. m my .mplorB3 wiih vog.s ar then sb conFnsation. will do th. sdt &d th. snEr@ ir mt <br />h.ndad or ofaced for sle (5&.7044. Brsift$ md kofc*shns Cd. Thc Conlrrctols Licre ljw dcs rcr lrply lo m owmr of <br />Itc pFFny who boild, or inpoE thdo.. rn wh6 dm sh hlt hatucll6r,EBlf or thrcugt hi.6 n r oM cnp&JlBr. <br />J,mvidcd rhtr 3uci inlo\aftors @ mr hrdn.d oroficrd lor sL. It h'M.lh. buildin8 or inpmwm.l is $l.l wnhin om ]t- <br />of@qrLtbo, tlE Ovmr Bui!.r wil hsE lhc hodM of proviog rh,r h. m shc dil ml build or inprcE ric tlBFny for dE puqr$ ol <br />-1, <br />as owncr of lnc pmpcny. rm cxclusircly conlrdhg wirh lic.nsd .o.r&hn tu onstocr rh. loifl (Scc, 7044, Busu.{q <br />&d Boftiqion Codc: The Conrturoi r Lk€ns. kw dfts nor onply ro an owrcr .f proFny vho builds or impmvcr thcrcotr, <br />and who o dls for 3uch Fojcdr wnn ! Co.tuiorl3) li.cn{d psuor ro llic Conroclofs Licctrs trw). <br />I unrxcru' undd S$lion ,B.&PC lorLh6l.Mn. <br />UAatrEIN:.COMTEIAIITTN <br />DEC!$AIXON <br />I hcrcby atfirm ln.lcr lEnally oa psj!ry onc of lh. aollo*ing deld io.s: <br />-l <br />harc {d will flinllir 3 Ccnifrnc ol Co.Fnr io s.ll-loiurc fq so*6 @nFn$tion. a! piov'dcd ro, by Setio. l7m of 0!. <br />Llhor tuc. for lhe F.fmc of th. *orl lor whth thc lonl n is!.d, <br />_l hltc md *ill duinlsit eortcn ohp€.salion irumncc. rs rcquimd by Salion 1700 oallE Labor qd., for th. pcrfornrmc ol <br />rlE h for which lhn lcmit is hnaj. My vork6 compcn{lion i.sumRc cEicr 8rd F,liy numh.r m: <br />PolicyNumbq: ErpiEs: <br />-l <br />enily lhal in lh€ F o,mna ol lh€ work for {nkh thh F.nil is issucd. l shlll Nr cq,loy .ny p.Mn in .ny ronmrs as ro 6cmm sbje! io $. e&s onFnsarion hws of Calilohia aBd aEr rlur ifI shouH lEc.m iubjNr ro rlE <br />wortc6' .omp.nslion lmvnions ol Selion 3700 or lhc t bor Co<lc. I s,ull, Lnhwirh orpl, snh rhos tovhioft.. <br />WARNINC: Frihrc ro scuE rorkcrs ompcnsarion covcroec is unlartul.8trd shnll suhjcct ar cmploy.r to niminal Fnrhis otrd*'KroTst1*ffi'**'," <br />DA:IASJSIQN <br />I hcrchy nintn u.dd p.nilry of Frjur! rhd I nn liNn{d u d( pn,!i\n,n ol Chaprd , (conhrtuina sirh Sr.rion 7LXx)) of Diri\i.n .] <br />.r rh. Bu\i'rcs\ rnd Prolcsions Codc. l8l mt licen\c is in lullforc!rtrlclltcl. <br />I)nrr ( onl <br />(:(NSreucTIoN LrNDritG ^Grr\aYI h.rcby dfm undcr F@Iy ol pfjury lhd the B . @iinrri,. Lrdi.e .g.ry for rlE pcrfillljMc of lhc *dt tr wha.h inii tqmn b <br />issucn Ise, 3097. civ. c.), <br />-l <br />ccn ily lhol rhc tadcrul Eguhl ions rcB dirg osb.sos rc.mvnl & n.r,mli.6lc h ihis lroJ..r. <br />I !.,r r\ L' l h,\.,.r11 I r..iJI.l (,(,,1x n n,1. Li dn I lsre lo eftoly wirh allC yand Counry <br />onliruoccs Ml Srurc l-rw( Eld <br />utxrvc mnlioncd popcny for <br />Afpiic,.l or A8cnr s+narur <br />'<:T'i <br />I <br />Grease Duct <br />Above T-Bar <br />FINAL <br />l)alc: Oener: <br />L..dcas Addre$: <br />- <br />rppucaiiiiii ii6F <br />I tu:ty .finn undlr Fn,lry of Frjury onc of rhc f6lb*ing &cldalionri <br />Dcmlition Pcrmik'Asbestos Nolific.tion Fcdcml Re8ullrions (Tnb 40. Pd6) <br />-Rcquirod <br />Lnf df lLrilKarb. <br />I <br />tt <br />I <br />I <br />i-