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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Iriletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <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 l <br />FINAL 1/tilt[ ,.t 1ry14 /) <br />Notes, Remarks, Etc I,l \) <br />OWNER BUILDER DELCAX.ATION <br />I hccby dIlirm uodcr n nolly of p.rury lh.l I m crcmpl fmm thc Co.lmron Lieosc L.w for llE folkrwir8 een (S.c,loll,5 <br />Ausin.s a'd ftoLssbn Codc): Aiy Ciry or Counry *hi.h rqu,Er . ,smn io conslruct. alls. inprcv.. d.mliib or 6Fir ey <br />strucrurc, Fior to ns issuec. ,le rcluir! lhc applkd f6r luch F nit b 6le ! sig.cd stdcm lhli h. or sh. is licctred PrNril <br />lo rh. pDvtions ofttE ConlEclor's l-icensed Liw (Chafld 9. Coo@ncing wnh scclion ?m0 of Dilision 3 of lh. Busincs {nd <br />Pofcsions Codc) or rhrr h. or.h. is .xcEpl thcr.ton md thc bsh for llE alk8cd cicmplion, Any violario. of Sdhn T0l1.5 by.n, <br />applicrnrfo.ap.mirsubi{lsrhc.I,I,li.urro!civilFMlryofmrmr$dnrchundrcddolm(3!00). <br />-1, <br />!s opncr of tn pdpcny. or ny cq,loFei sith wag.r as rhcir soL 6m!.nsalioo. will do rhc *o* !.d 0E llnrrw is ml <br />i €,icd o, offcrcd fd slc (Se.?M4. Busiros ud Proa.shns Cods Th. Codreror's Lh4* kw dms mt qdy lo & ovM ol <br />rhc prorErry *le hiilir or rpreB trE6n. dn eho des sh w* hims.lf or lE$lf or ftreogh hL or h.r oun ct{thy.ci <br />prcvn.n rhar such itrprDrftnl$e er inrcid.rlootrrld to.sl.Il hoEB.llE htildii* o. idFEm Ll sld wilhinotu Fd <br />oforpkti',LttE OvM Buillq vil haw ln h!d.n of potirg lhd i. or shc dit ml b']ild ot i"pmw thc I,DIEty for 0E purro.of <br />-1. <br />.r owNr ol rhe pmFny, d .xchsiwly (ontm.linB silh liansd cootadoN ro .o.sruci dE pmjel (Sc. 7gr. Blsims <br />.,n hDErsion Codc: Thc Conrdroli Liccnrc Law d@s nor apply io o.ownd oaFmpcnywho build$ o. in!revcs lhcmn. <br />und who c!fla.rs ror su.h pmicds Birh a Conrhdono liccnscd l,orua ro rh. cofl.{.tor3 Lhcns Law). <br />-l <br />an demp u.dr Selio I&latulnnra{,n <br />SABTESfIjOMIENSAIITN <br />DEIIABAIION <br />I hceby affirm udcr petulry of pcrjtrry om of lhc followine delaEtiotrs: <br />l-rho!Cod..,nrrhc prrlan, rccolrhc soik nt uhich rhc |tnnir i\ i\suci <br />-l <br />hive aii *iU tuintlin vortcF conp.Narior inslEmc. ar r.iuitd by Serion l7O0 of IIE tl6or C!dc. for rlE Frfo'lMe of <br />thc work li,. which rltis lcmt is n$cd. Mt wor .oqlcnsal ion inrurucc carier dd policynumhcr &cl <br />-l <br />ccnirrth{ in rh. !.rlormmc of thc qo* f"r *hichlhis pcrmir h isrucd.I shall nol emPloy ony l'crsn in lny nm*r <br />s N to tEco'E s!t'j.{r ro rlE qor(er' enrFnqrion L*s of C{liiornia !trd asrce rhlr il I rhould b.<o@ subjd io ti. <br />rorkc6' compctrsal ion pmlirioB 6f Sccr ion ]7m of rhc llbot Codq I sh.ll. lonhwirh codply wnh tho* lovhionr.. <br />WARNiNC railur. lo slrc w{trkc!( mnD..\al EBs. Li ul,*ful. a.d shdl subj.rl s cmrloF to oioin l lEollts ann <br />.ivil fincs ut ro oa tundmd thousand dolh^ ($l in lddirion r. rhc.oi ofcomlcns ion. daeSc* !s tovid.d fo. d!. <br />s(lrcn roz.for|}c br crtc, <br />".", t/z/rx <br />ugtNsu2-QlrB ltaB <br />DECI,lIf,A.Ilgtr <br />Ih.rbyalftmu.dcrprnnllyotp{rjlryrhdlnnlic.{dud(rmviliotrol(hJPtcr9(.omnrn.ingsirhSccrion7lxx)loiDiri\io]:t <br />ol rhc tsu{mss!n Pn'i.\rions Codc. and mr li.cn$ is in tullt&raidcfrd <br />o b <br />calcrBucutl!.J.ENDMilGENq <br />I hcEbylflirnuld.r F Iyof Fjurylhallh@ b t @nqulhn h.ding llcmy lor ItE lqfomrc of tlE s,k for *'itn thir pcmn !i <br />isiu.d {s6. 1097. civ. c.). <br />ATILTINIDDII.AtsAII!]N <br />I Iulty nlllnn un,l$ pctrrlly oipcrj yoncollhcftnk,wi'rEdccln <br />'rn)n\: <br />D.nnniliotr Pcnnirs Arli{o\ Norifi.rrt'nF.d.rnl Rc8ulatio.\(!nt.(). Pan6) <br />RcqunLi bncr of Norilicdion <br />I ccnify th0t $c fcdcml icslhriotrs rsddins arh.nor nhrlI drc nor npllic$lc to this pmj.{r <br />-l <br />cenify rhd I havc rcad rhh atplh ion r.d stt. llBl ltrc atolc iflforolion ir corel. I lSre lo @rPly wnh Cn, aod Colnly <br />ordimnccs ond Srorc l-a*s Elarin8 t, <br />Arplicmr or Agc.l SiSnrluE:{ <br />II <br />Grease Duct fiaa <br />ahovc rmnri,ncd pmpcd, ihr <br />tt