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MECHANICAL.INSPECTOR RECORD <br />APPROVALS IDiSIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Ducl Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Besidential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Meter Release A\ <br />FINAL K-2149 o ! <br />Notes, Remarks, Etc. <br />OWNER BUILDER DELCARATION <br />I hcrc-by lftun rdd pcnalry of Fdury thnt I @ .xcmpl fioh llr Co @106 Liers Lle aor $c folloeing EMn (S€.70l l l <br />BNinc$ lnd Prcf.$ioo Codc): Any Cny or Couily ehich rcluiEs t F.mil lo on$rucl. tll6, inp,oE. .lcmlisn or qrn Mv <br />rrru.lE. prior to irs issumcc. lho Gquircs rh. ,p!lic&r fo. srch rrcrmil lo fih ! iigrcd $rm lhll lt or sh. n Iccnsd l,u^uMl <br />r. rh. lroviiio.s oa rh. Cont.clols Li.cn*d Llw (Chupler 9. ConmMin8 wilh Seclion 7000 ofDivhion 3 of$c Ausinc$ and <br />Pmacssions Code) orinll h or shc ii ex.mfl rhcrcf.om&d rhc horis for lhc llLgc{ cxcn ion. Any vlohlion of S*rhn 7031 5 byony <br />amliclnr for . Frmil subjer. rhc rppli.&l ro s .ivil pcnallt of nol mre lhu ,ivc hundEd dolhru (5500) <br />-1, <br />$ d\rB of lhc plFny. s my c'rPloler wiin e.8cs r. lhct $lc mnwmalion. *i! do Ua sol aid llE srud@ ir rcr <br />i,u.ntn or oficrtd for slc (5(.7044. Blsim.s ed Pmf6sions Codq Th. ConlBroas LLrM Llw docs nol erply to e owmr of <br />lhc pmFny *hdl ilds or inpmB lhdsG !'d *ho dGtrtkll hinscllor hrMlf or llmlsh nis d her osn cnlPhyccs. <br />pmvacd rnlt such itrr9rlrft s @ et inlcnd.d or oflcEd for slc. lf. lbkti tlE t ilding or nt{mwr.l t sU sithin orc Fa <br />ofonpLliotr trE Owntr BuiI-lLa {ill taw riE bordcn ohmiog th.l hc or slE did nol ttrik o. i"prcE thc poFry for llr luqbe ol <br />-t. <br />{c owmr of llE Prspsly. am crchsiv.ly @flr.cthB wilh lk.bsd conrE.loa lo o$trut rn preirt (Se.7@s, BNim. <br />snd hoftsri, Codc; Th€ Conrmrors Liccns. Llw do.r not ar!!, lo d owrc, .aprcPcny wls blild! oi inptov$ lhcrcon. <br />lnd who snrracrs for such pn sls wnh s C!fl,mro,{s, licden puMl lo llf C6 n loas Lisn* t w). <br />I nnrcxcnrnr undcr sccrn,B &PC rorrhii6,$n. <br />lv(rR(Fls' col\lPliNsaTl(lN <br />DECI,ASAIION <br />I hcrcby arrn unds pcinlry ot p.rjury oN of lhc followins dabdrioBl <br />-l <br />h.rc ad will tuhrsin a Ccnii. . of CoBnt to Scll-llse for wt6 @mp.nsalbn. s FDvij.d for by SerioD 3?m oalL <br />t$o, Code for rh. Fforture otrlE sort for whti rlE p6mil b issu.d. <br />I h.vcnnd willnrainhin sorkcrs .onFctrsll n insuraNc. us rcquircd by Scrr(r r7(X).1rl,c I rnor ( odr. tur (lrc Dcn,rrirf!ctl <br />rrn.r 0 txnlry ntrn N mr ir i*ucd My*ortctr conUc.srr <br />291-1 <br />-l <br />enilyrhnt in rhc r.n'oroDncc of$c wort for which lhk pcrmil is i$!.d, I shatl not cryloy s"y I,c Ytn in lny Mrcr <br />$ asro tx6e sxbicr ro thc rcrt6 clmpcnsBrio.lrw* otcdiromit. lnd lsrcc rhsr ifl should tBconE subjsl lo th. <br />*ortc^.onqx.snlion,mvisn'nsofSElion:lT00ofrhcLnhorCodc,lshall.fonhwirhcoorlywirhlho*pmYisn,ns.. <br />WARNINC: Failuc ro surc wortcrs ompcns&lio. .o!c88. is uohwrul. !trd shlll $bj.ct an cnulo)s to nininal Ftulris Md <br />civil lincr !p 16 orc hundrd rhous an addnion ro rhc cosr of cotrrF(srion. .l!m8ss !s pmvidcd lor rlr <br />llclls.Elrll)Nt&lgrae <br />IIICI.ABAI]IIN <br />I hrkby rflnnunder pcnally oapcrjulr rh,r I a'n lieDkn urd.r Pmvision orChnprd 9(conumtrcina vilh Seri,n TuJO) orr)irktu. l <br />ot rhc Blsituss and Per.sions Code. ad my liccosc i! intull foG,ncfiill <b.{24 <br />roilsr8lcuoNrElpllli-{cENcr <br />I hcEby .flim und.r F.dty of pcdury ltar rhcrc is t @isMlhn hnditr8 asctu, lo! rh. Fno,rMa of lh. *ort ror shth lht Frmn is <br />ksucd (Sec. 3(D7. Civ. C,) <br />A.TIILEANLOIEI.fi.EUQN <br />I hrtr$ynfiimundcr p!trrlry ol'pcrj!ry.ic orrhc r,,llowinS dcclarntions: <br />lxn$lirn,n PcrnrirlArhc(o\ Norincarn,n F.d.rul RcAUlntn'ns(lirtc 40. |)rd6) <br />-R.nuirud <br />L.(cr of Norrlt ion <br />I ccnifyrhd rh.lcJcrrlrc8ullli,)ns rcguding r$(no\ rcmvil r.c nor rntl(al,lc k, rhis pnlF:l <br />-lccnifyrhdr <br />I hrv. '.nd rhsrptli.rlionudrlurc rhnlrl*{h,r. irrorn ior hcotrccr.I ulrdro.onrPlywilhollCnva.dcornrv <br />ontinrN$ond Stare tiusrulari sr.buildm8con\rru.tt'n,undh.rch,aurh*izcr.frcsctrlrtivcsofrhhCiryrtrdCountyrocnlcrutfunirt <br />ahovc nEnliomd nmFny <br />ADplicanl or AE nlSie t 2-a <br />)tag)t <br />DATE <br />lnstallalion <br />Final Test <br />4 <br />Iffi <br />I <br />--------r------ <br />=