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APPROVALS DATE tD/stG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lvlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouoh Ductwork <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 />Rough Mech. <br />Final Test <br />Meter Release rl <br />FINAL \flfi\ r <br />l),tNotes, Remarks, Etc. <br />OWNGR BUILDER DELCARAIION <br />I h.r.by nftum utrdcr pcnalry of Friury $ar I m crcnq fom rhc Connmlou Li.cn* L5* for rhc folloeing @sn (S(.7031.J <br />Busincss ad Polcssion Codc): Any Ciy or Counry vhhh rcqun r a Fmil lo onsltucl. alrcr, inprov.. demlist or E"at My <br />slrucruc, Fi,r lo irs Lss!fte. dso EquiG lrE ,r!,{ha.t lor ch Fmjl lo 6k a si8n.{ slar.*.| rhd lr o, ilE t licen$d Pur ul <br />lo lhc tmvbioff of 0f, ConrBrols Li.!ns.d Ls* (Chapr.r 9, Comm.rine with Scclion ?000 of Division 3 olrhe Busae.i tnd <br />Pmfcasions Cod.) or ttlr hc or sh. h cxcnfl ficrclrom ud ihc l{.t aor oE .lhgcd cr.nplion. Any violarhn ofSelion ?031.J br'8ny <br />amlacair fd ! p.mil iubjccr. rhc trppliclnt lo a civil p..!lty of ml 'mn thd fiv. hu.dnd dollds ($500) <br />-1, <br />as owM ofrh. pottny, o, m, cnpl6ye.. eilh wlg8 {s inct sh oElEnsalion. will &r dt w6rt sd dE sEEiE is mI <br />iirod.t d offer.d tor eh (Se.?044. Bosircrs aid Pmfdsions Codc Thc Conlnclols LiceM L.w do.s tul arnly lo d osffi of <br />lh. Doncny who hritts or irs@t! rhc@tr &d whD .nB Mh *ort tli.elf or lEnclf 6, rhbugh hh 6r hd own omPloycs <br />prcvjd.d thd strch imprownts e ml inlrid oro,@ aor $lc.l( hos.B, E hildinS or it{,mttu L\ sld wnhflonc )s <br />of omplctior tnc Oqncr Buil.lcr will hok dE burhn of pmvin8 tn.1 tE or $c dit mt huild or itrpoE ttE pDp€ly for thc PlrPo* of <br />-t. <br />es owmr of rhc pfupL,ly. m .r.lusivcly .onrdin8 *nh lienrcd conlrsroG rd o.\@.r rh. poj.d (Sa 7044, Burids <br />ard PDftsio. Codc: Thc Conlmcxn s Liccnsc L,a d*3 nor eprly lo atr owncr ofnnpcny *ho build. or inprcws rhcren. <br />and who conm.h ror su.h ,mjsrs wnh ! Cont clorio liccn*d puNudr ru thc Conlroclols LiccnE l.l*1. <br />I r rrcmpr undrr Scc <br />UAf,(EBI.CAUIINSA.IION <br />IIEIIA.8AITQN <br />I h.(b, amrnund$ 0.n.lly of r.rjury onc ofrhc followiry dccharnrnsl <br />-l <br />hak ard wiu mirrri. a Ccnilharc of CoMnl to Scl nsurc ror eorkca .dn{Ensiion. s Imlidcd for by Selion 1700 of rrE <br />kbor Code. aor thc rcrfomnce of rhc m* ld whkh rhc pcmir ii i,sucd. <br />-l hale ad eill ini.l,i. worlcs compcnsation insururcc. as rcauncd by Sccrion 1700 of lnc hbor Codc. for thc Frfi,mN ol <br />rhc w.rk ror which this p.mn is nsucd My *orkc6' €ompcnsdion inslBm mri.r dt Flky tumh.r dc: <br />Poli.y Nunrhcr:-lix|]ncs <br />-l <br />enif, thar in rtr lidto.@tr of lh. wort fm which lhis p.rmi h issucd. I sh,ll nol cnq)loy lny Fmn in lny mroftr <br />s s ro b.rod sbtrr ro tlE wort6 otrllfnsrioi lrwi ofc,litomia, and aEE thd if I should liiom subiet io tlrc <br />worksr omp.nsarion prcvisionr ol S..!ion ]700 of rhc t!bo. Codc, I shlll. fonh*ith ooily eirh l,hr pDvisions.. <br />WARNING Fniluic h *.urc sorkcr'conrpc tuI. snd sholl subrccl cn cnllrtorq ro oidsal Imllks and <br />ro rh. co( of amp.nstion. damg.s a provdcn for lhcciril fincs $ ro ooc hundEd rhou$nd douus <br />S(rnr]076 of rhc l]hr (trlt. <br />o.", 1.I <br />tEg ltuul <br />t hcrcby amrm undcr Fndry of pcrjury rld I m licnsd und.r Foviiion of Chlrro 9 (on@rcing *nh Sdion ?00)) ol Divirion l <br />of <br />'h. <br />ausimss.nd PmltssionsCodc. ard ny li.cn\c h in tull <br />a-19 <br />I hcEby afirm!d.r Fnalry ol Fiiury thlt <br />isslcd (Scc 1097, Civ. c.). <br />ie ! @.srrucrion LMing rg.fty for lhc lcrfolmtc of the *otk for whhh lnis Pdmjl n <br />ATTUIANI.I]E(LAXAIION <br />I lf,rl$ynllinnndd $nrlry.ip-rjwyoncolrh. lnlk,{in[ dc.hrdi,)n\ <br />Dc.dirioi Fcnnirs Asbe\ro\ Norilicrrnnr Fcdcrrl RcguldnnN ( r(lc.1(r. Ptrn6) <br />RcquncdL. crorNorificrrior <br />-! <br />.6rif, rhd rh. fcdcn! E8irlalions ESrding asbcstos rcmvll e 6l arpltclbh to <br />I aBre n'.o'htly wilh rllCiryund Co!nry <br />utivcs nfrhi\ Cn, dd Cuunrytu cn's upotr lhchcrcby rxrhorizc rcnrcsc <br />*",{= <br />MECHANICAL.INSPECTOR RECORD <br />Vents <br />'P) ) <br />Lcids,r Noft <br />- <br />I h vcrcttrlrhi\ rfplirrri, d