|
MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNTR I}UIT-DCR DELCARATION
<br />I hcrchy rltun unlcr trnrlry ol Erjury lh l nnr cxc'npr fom lhc c(nn'do* l-,ccosc l-nw for ihc Lllosing rctrsr isc.7l).115
<br />Btr\inc$ rnd ltolc\\i,r Cixld) Any Ciry or cou y *hi.h r.qutrcs a Nnnir lo con(rud. rlrcr. imprk. drfrolnh .r rrFir trtry
<br />(tu.ru'r. prntr lo ih islurn.c, dl\o rquncs ihc rlpli.rfl lnr su.h Frnrir ro Ilc r sisncd n cmnl'hlr hcor shc i\ ltctr\cd pursurtrl
<br />ri rhc pravnion\ ol rhc Co rucroir Ii.cn\cJ l-as (ChlPrcr 9, Con r.n.$! wirh Sc.riur IUXJ ol Division.l ol rhcB\nr\\rd
<br />Pn,f.\\ion\C.dr)orrhrr hror\lf, i\cxcnu rhclcior dnd rlEhsn hr rhcallclcdcxcrnptiotr Anyvnrhri,niofSc.totrT03l5hyrtry
<br />+flicr r rrtr n p.nnir subEchrhc .tt'licnnl lo acirilpctrrllyol trot morc rhan lir huiJrd.loll.^ (S5u)).
<br />-1,
<br />N own6 6fuhc lmFny. or ny .q,loyes wnh wa8.s ,s lh.n st compctrstion. {ill do ric adt ard $c strBl@ is ml
<br />indncd or ofi.rcd lor slc (Se.?044. Busimss and Pmfcsions Codc: Thc Conrador'i Lieoc Lae {to.s nor oPt ly to aa otncr of
<br />rh. !6Fn, wh,t ild\ or inpmws ttEmn. &d who des Mh wlk himclf or h€rclf or lhmusn hh d h.r own c"'rloyss.
<br />providcd rhat such imrmrcmors @ mr hrddcd oro,Lrn &r elc, li howi lh. trildin8 or iq,mvcmnr h eL! slhin orc rt
<br />ofon{,hraon. tlE Owmr Ad&r vill n vc lhc burd6 of provin8 tlrl nc or shc did ml huild or inproE Ut l,oFny for t}E Purpos of
<br />l. .s owncr or lh. poF..ly, .m cxclusircly corlEclins rilh liccnred co.relor io @BLnd rL rr.itr (Scc. 7044, Bulims
<br />lnd EoEssbi Code: Thc Conra.k s Lic.nrc L5e docs Nr r$ly ro $ own.r of trcpcny {ho brilds or impov.s rhcrcon,
<br />rnd *ho m.rra for sucn pDirls wirh a Conrncto(, licnsd pur@nt ro lhc C.nteror's Liccnsc tiw).
<br />I rr.rc rlr und.r S..r .t
<br />!!:!LNBIUTN
<br />I h.rchynfllnnund.r F.rhyof p.rjurroncof Ih.
<br />_l hlw a,n will minrd. a CcnifEatc of Con*n o Sclf.lnorc aor *o eR conpc$arion,I pmtidcd for byS6lbn 1700oalh.
<br />bnor Codc, for rhc p.rfoMe of rhc wo* ror which rh. Fmir k Lssmr.
<br />-l
<br />h.vc and sill moinrrh wortcn codp€nsation inslrarc., &s cquidd b, Se.rioo l70o of lh. tjbtr Codc. for lhc pdfoimM of
<br />thc vork for *hhh lhis pcmil is i$ucd. My workoC @nFnsllion iosul,re stt un F,l.y nunb.r ec:
<br />Po,icyNunb.r:-ErDirs
<br />WARNINC: r{ibrc ro surc M*er' ahFnqrion .ovcEsc is lnh{rul ,nd shall subjer M cnlroter lo sininal FlDlri:r a(l
<br />civil fir\ uD h onc hundrcd thouqnd dol
<br />Sation 1076 oirlE lrtrn Cdq i.rcrcd and
<br />(sl ro itx cosl of conFn$lion. drrEses as p,.viddl rd lhc
<br />,,,",-</q [19tt
<br />I lErcby afllm !nd( FcMlry of p.rjury rhni I nm licn*d undcr otChoDtcr9 (onmrcins wirh Scdk n 7(m) of Divirion 3
<br />of rhc ltusinc\s and Pn'ic$i,nrCodr, rid dt lkc.sc ii i. fullfore 0rd.ffsl
<br />l)il( (onlrrrt('r
<br />l1)ISrrueI]AI-LEIOlMr!1inNC]
<br />-l
<br />anify rhll Ihs fcdcml rgllari6nr Egardins dbcsroi r.mval e nor appli.,blc t, dis lojccr
<br />lccnilirharlhrvcrcudrhhlptlicarionaidsrorcrh rhe ihovc infomr ion n c.ft.r l agm b .onply wirh nll Cily und Cou.l,
<br />odinanccs and Srarc l,!s\ rclaring aurhorizc rcprc(nlorircs ol lhh Cir, ond County t cnr$ u|)o. rrE
<br />rlx,lc trrnri.dcd propcny f{n ii
<br />7Aprlicnnt or Agcnl SiSnarurc 3
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Ivlisc. Equipment
<br />Duct Work
<br />lnsulation
<br />Rough Ductwork
<br />Vents
<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 />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Hough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL r.l[. fl /2c27
<br />Notes, Remarks, Etc.
<br />Ivletal Fire Place
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled
<br />-l
<br />enifr rhat in lhc r.rformN 6f lhc wort for whkh rhat pemil is ksucd. I snnl nol cmploy an, Fron in a.y ME
<br />$ s t. t {o@ bjccl ro rh. wo*6 ompcns.tion hvs ofcrlifohia, and astr lhar if I should lE om sbj.{t lo llF
<br />w6rl6{ s"{Ensarion pmvirions of SeIion 3700 of lhc l2hor Code, I slEll- folheirh omdy wnh rhs povirhns..
<br />Liccns. Closs
<br />-lj.cnse
<br />Numhcr:
<br />-
<br />t ndcls Addrcs:
<br />-
<br />appr rc.Iiil iif frF
<br />I lBrby dlm hdcr p.nrlryofpqjnryonc ofihc rou.win8 dccldarions:
<br />D.n.liri.r Pcrmirr-Asb.sos Nolificarion F.dcral R.Suhtions (Tillc 40. Pan6)
<br />Rcqutcd L.ns.lNdifEoliotr
<br />----+---
<br />-------T------
<br />tt
<br />=
|