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MECHANICAL.INSPECTOR RECORD
<br />APPHOVALS DATE COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulalion
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type Il Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release
<br />FINAL
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DBLCARATION
<br />I hcEby .ffm un.hr Fnalry of pcriury rh l m .,cnpt iDn tlE C,ntabE Lkms ks for llE followiq EEn (Se7oll.t
<br />Buliftss ord Pof63io. Codc): Any ciry or c,ury whih r.quiB a p6on b ontu( rx6. idprow, &rclish or q,.n uy
<br />slrlknft, Fi,rro irs issuth. d$ (jliEs tlE.pplidr for tuhFmit lo fik r si8rEd $alm lhtllEo.slEGlidd Pursurr
<br />ro rtE Foviriotu ol rhc Conrtulff\ LieMd t w (Cnr r 9. Coltmfting *ilh S.dion ?000 of Division I of Ih. B8,rcar ud
<br />Ptufcssions Cod€) or rhlr tr or llE t! dcmpr llEEfroo rrd ttE b.!i! for llt alLg.d dcmPlion. Ary violstion of Ssdon ?011,5 bI uy
<br />sppli@ foraJ,cm subjer rhc lpplkat to r.ivil p.ElIy of nol mrc lhd fiv. hundrcd dolles (35m)
<br />-1.
<br />as own.r of th. peFny. m f,y etrgloyes *i$ q$cs s thcn oE comFns.lioi. Mll do lh. sott ard 0E $.f,1r n ml
<br />intcdcd or oficEd for slc (Sd.?044. Bu.i!6s &d Prcfcmio.s Cod.: Tt Conractoii Lieosc Lrw do.s nol anpl, lo d owrc, of
<br />rhc p6Fry who brildc or inprc*s d&Frr did wlb d6 sn w* hiru.ror hself 6r tntuld hh 01 hr own .,Ployccs,
<br />novided $.r iuch in{m\4mnls e ml htcd.d or o,Lrd for eL.li rbetw.llI hoildinS or inpreE'l t $Id wilhin or Jte
<br />ofotrpLlioll lt o'xtur Buit i vil hrrc th. hd6 of Foving lnd ,E d slE dil El hnu or iEprcw d. lmlmy for ilr pu!.$ of
<br />-1.
<br />I osmr of rh. I,ltBry, m crclusiwly snhli.8 *nh [ccn*d onrhdos lo oonrucr $. ,mjccl tsd. ?044. Bnrims
<br />!!d ftDftsrbn Codc: Th. Contrutor\ Liccns kw docs.ol molyro @ owncr ofpoFny who blilds ot imprcws lhc@n.
<br />8d $ho 6rrdr3 for sch pdF{ri sirh. Contraclo,{3} ltc.sd pus@l to rlE Cotueloas Li.rn* Lrq).
<br />lm.rcmnr undn S(rrn ,B & PC, forlhirro{n
<br />!!]AtrE8S:CAMPIXSAtrON
<br />DECLAAATON
<br />I hcrby affirm un{hr pcMlty of psjury oft ot1h. followin8 dclaElionsl
<br />-l
<br />irE un *ill mhr.in ! C.niff,.rc otc.Bnt b Scl lff for erk6 @np.ns.rion. s Pmvidcd for b, S€lio. 1700 of ln
<br />lrbo, Cod., lq tlE p.rfmtu. otllE sot for whkh llE Fmir ir irsucd-
<br />-l have rnd BiU tuinr.in *o*dr' conpcnsltkrn insrnncc. as rcquircn by scclion 3?00 of llr Llbor Codc. lor thc Pcrf('llrEre of
<br />rhc work for whth thh p.mil is is$cd. My port6 cotrvEoslrhn i.surM. cet. dd lDlicy nunhd el
<br />I ccnify lhal in llE pcrfnrm*. offie wo* for which rhis p.rmi is Gsrd. I sholl nor.mlloy rny Pcson in 4., tun$
<br />s as ro tE€om sub.icr lo rh. workcrs compenslion la*s of Crlifomia, lnd +N rhtl if I thould tLrom slhi*i lo ih.
<br />$od{sl coq*netioi liovisions ol Scclion 17(x) of lhc Laho Coac. I shall. fonhwirh con ly wilh llns nmvi4ionr..
<br />WARNING: F.aluE ro Nrc *orlcr' ompenethn 6tosc h mliwtul. dd shlll s{bjtcl an cnlt)loFr lo aimind p.ehi* ud
<br />civit nnca up ro.R hrndrcd lholsand dotler {5100,000), in rddilion lo ln€ cosl of conlEnntio.. dlm8cs as Prcvijcd fdr rh.
<br />Serion 3076 of rh. LltDr tu., iilced a.d {,ri.Gy s fc.r.
<br />l) k.: \IDli.rnr:
<br />u(:lx$LlllNrnacrcED!o.4&trpu
<br />I hcrchy nlltm undcr Fnnlryofpcrjurt th,r I m lidcn{al undcr pnrvisn,n or Chrfld 9 (.onnNtrcitrs *ilh Sccli.n'7{loo) orDivhi{rn l
<br />oa rh. Businc$ r Pn'lcsrinr Gde. rxl nrr licci\. s h full loR! rnd etltcr
<br />Conlr..roi-
<br />ABELICANLDECIAXAUO]T
<br />I h.dry afiirnr u ndc. rnrlr, o, ,.rju.y orc ol dc lbllownr8 dehrrt ion\:
<br />Dcfrririof, P.rnirsr\\h.{os Nolilic ion F_edcral RcEuhln,ns ('Inh,$, Pan6)
<br />Rcquncd t ncrof Norili.dion
<br />l.cnifyrlrt rlr ltJc!trl rcsulsr i(,n\ r.p!diqqn\h.{osrcnmvdlnrc nor ntrplicrhlc t, rhir ri,)jLtt
<br />-t
<br />enilyrhlr I ldc rc l rhi\ rpplicarion.nd sldclhnllhu nhrvr iitunn otrkconccl t usre h d'mPlt wirh .ll Cily rnd Counlv
<br />ordi.ln csrDd St.r tiws rcllliign'buildinA.onnflclidr. md h.rcby urhori,rlcprdcnhrivcsofrhi\CilyandCouniyrocnrdnlx,rrrE
<br />.hovc mnrioncd l'lopcny {or insldr ioo purross
<br />TAtpltd or ABc SisnaN
<br />(ITNSTRUC I()N LIJNDIN(] ACTN(]I-
<br />Ihcrcty rlrtnruidcr p. nlry.ll)crjrythd lhsc i\ rconnrudiotr lcndiisrgcn.y ror rhc pu'irnuncc otrhc work nrwhichlhn Pcnni n
<br />l$ucd (scc.l0i)7. (:iv (.).
<br />L{dr'\ NJir _
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