|
MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDET DEL(ARAAION
<br />I lErcby allrn und.r ,.Mlty of prjury lhal I m .rctr'pl liom lhc Conlrelo^ Lkd$ bw lor lh. fotlowinS orsn (Se.7011.5
<br />Brsincss lrd ftofcssion Codc): Any Cily or Counly *htt E3uires ! Imil lo onnrud. ,ll.t, inproE. d.mlhh o, no{it 6y
<br />3lluct!rc. !!ior lo irs hilme. {l$ rqlircs rhc .ptljcanr for sch Fmi lo ftlc ! ii8ncd srar.tu th.r lr o! sh. is liened pursanl
<br />h rnc provisions ofthe Conrractoas Lkensd kq (Cnnpr.r 9. Co.mxitr8 wirh Scction 7000 ol Divnion I ofthc Businc$ and
<br />PNtcssionr Code) or rhat hc d sh. is crcq rhcEfrom.d rhc tEsis for lhc Bl lcgcd .xenfl ion, Any viollri.nofSerion 7031.5 by {ny
<br />.pnlic,ni for a Fmn strbi(k rh. applicanr ro ! .ivil pcrahy of mt mrc rha. fiv. huidr.d dollrs (t5m).
<br />_1. as o*M of rhc psl'cny. or ny rnplores Dirh wascs ss Inci slc sn{En\arion- }ill .lo rli slt ard 0E srn,.rc h mt
<br />indd.d tr oltcrd t , eh 1se.7o14. Busircsr dd Protc$ion, Code: Thc Co.rrdor's Liccne L,s doB mr +rly lo a ovrer of
<br />lhc pmrcny who blilds nr impnEs rhcmn. dnd $ho des trhwrt hihsclfor hcrcllor rlr &hhisorh.rown.'h!loyccr.
<br />Dmvidcd lhar such impmrcmnls m mr inlcndd or oltcrcd for srt. li hoxE, lhc buildiry or imtmetufl is sld wnhin onc ,tr
<br />of.or{,hrbtr rh. Owrct BuiBs will hirc tlE hr.hn 6f poving $ar lE or shc dU m bdld o, ir{mw trc I,DFi, ior dE tltloe of
<br />-1.
<br />as owar oaih. pqf,ny. m €rclusiv.ly conieiing wnh Uc..*d onhroB lo consltuct llE poid (Se. 7044. Susim$
<br />lln lrtoft$shn Codc: The Conkacrols Liccns Law dmr not apply lo e o*ncr of prorc.ry eho blildr or inprolcs ,hcEon,
<br />and who conrEch for su.h tml.rls vilh a Clntacro,lo lienen tur@r ro rrE Conr@roas Liens Law).
<br />I {n.rcnrfl undn S r
<br />}OAf,EX5:COMIE$ITQNDICLAIATlON
<br />, hmby ofiirm udcr FDhy ol Frjlry onc of lhc lollo*in8 dehrarions:
<br />Lrli, Co c.lnrrh. |{r,ni,nrkc rl rltc wurk ntr1!h'.hih. t,cnnir n n\!cd
<br />-l
<br />hlw and will mainlat wortcc on cnralhn insuruncc. as rcquircd by Scctio! 3700 of lhc L3l,or Cod.. ro, rhc Frfomft. or
<br />rhe sor* lor which rhis lami ir ir$cd My {orls otr{r.srion inflMc @t, ad polk, numb.. m:
<br />Polic! Nuhbcr:JipiEs
<br />I c.nirrrhar inrh.,xrformnc.olrh. $ork Lr whi.h thi\ Frnir is iqsucd,I sh{ll nor cmrkyonyrcrsn in rnymanmr
<br />s es ro tEcom slbirl ro rh. tu BC compcnstion hsr of Californi!, and.8r rhd if I sholU ltom subjer to rll
<br />mrkcs' conDcnsslion pDvisions of Sclion 3?0o of lh. tibo. C.d.. I slDll, ronhwitn @tr{,ly wilh tlss pmlhions..
<br />WARNINC lailulc l0 scurc lo,lcrs onD(nsuri('n lrrvcrr8c i\ unllrvtul. n \hull subjccl ur qnploycr ro dininrl r.tulric\ dnd
<br />civil fincs un lo orc hundrcrl lhousurd dollss (Sloo,uD). in
<br />s.crn,n:1076.rrhe libo, Codc, inrcrcn n.d nno!tuy { tccs.
<br />,,,", -r lt<lt3
<br />I hcrcby amrm undci pc.0hyof!.rjurylh.r I m licnin undc.vkion ofChoptcr 9 (ommNing wilh Sstion ?()00) otDivhion l
<br />y-ffi
<br />-'t lrat lt&KT-T- Wf)t coNsTRrrt TloN \s\!rIN{: A(:!jN( v
<br />I hcrcby affinn und.r Fnalryof!.rjurylhar lh.rc is ! constd.rhn [nd'n8 Ucnc, for
<br />'hc Friormrc orrh. lorl lor which lhn [Ermil is
<br />ksu.d (sco. 1097. Civ C.),
<br />artucAlr.Dli1;L$aurlN
<br />I tf,nhy atnD undcr pcnilly or pcrjDry onc olthc rollowinS dcclff.rions
<br />Dcdolirii,n Pcroirs A\6c\ro\ Norificarion F.dcnl Rcs!llrion\ ('rilt4lr. Prn6)
<br />RLluncd llncr.t N.riffl ti(m
<br />-l
<br />.cnify rhal th. fcd.ml rcSulario.s rc8"rding rsbcsros Emvrl m mr q,pliabL ro this prcj.rt
<br />orllnxNr\ )n, srr. r 1\\ r..rni! ii h l(l tr!tucrn,n, ond hcrcby Nrktrizc rcprusnrdivcs olrhh Cirylnd C.lnrykr c.rcr uorn rhc
<br />rholc ni.nrtn,.d nrcpcnr_ tur in\n!{i onlurlxxc -lnl<Appli.a or g.nl SigM,
<br />I I
<br />Appliances
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes D ryet
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallalion
<br />F. D. Drop Test
<br />Above Hard Lid
<br />Rough Mech.?-Lb'1?'t0)J',-J, *.-- r-o-nJ
<br />Final Test
<br />Meter Release
<br />FINAL 6rt.tg z 7,.^,a,"<(2->\Notes, Remarks, Etc
<br />ID/SIG.
<br />Metal Fire Place
<br />Furnace
<br />Above T-Bar
<br />.f rht ausilcs\ dd Prufc*i(,nsCodc, dd nyli..n* n i', tull td.c lnd cflirr
<br />llnd.ir Addltss.
<br />^/
<br />--------T------
<br />i---+---
<br />tt
<br />tl
|