|
MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE rD/sto.COMMENTS OWNEN BUILDER DELCARATION
<br />! lErcby arfm undcr !.dt, r)f p.iiuy rh l d crcryr
<br />'rl]d
<br />rhc Co turoft Ltc!$ t w lor thc followir8 rcsn (Se.?031.5
<br />ausi.csr .rd Pref$saon Cod.)r Ary Ciry or Cou y which rcquies r Fmn b con(dcr,.ltd, irprew. dcmlnh or eptu rny ,
<br />sulcturc. prk ro irs issuanft, also reqlncs ltc applicot for such F mil ro filc ! sisftd srd.mr rhtl lE or slF ir ltcnscd pursanl
<br />io thc nrcvhiois.frt* Co.ts.lor's Lienscd ti* (Chlple.9. Co@ncirg wilh Scclion ?000 ofDivision I !f lhe Busincts a.d
<br />Pmfcssions Codc) or thd lE or shc is cr.trrpr rhcr.frem and lh. brsis for rhc llkgcd cxempdon. An, viottlio. ot Sc.lion rol1.5 by any
<br />opplio ror !p.mir sobj*rs rlr alplica ro.cilillcnalr,ord rcrcrlbo nvc hunded doll&s (S500).
<br />_1. .. ownf ol6c pmFny' tr oy cn:plor@s wilh wag.3 4r 6ci, slc conpcns.lion. will do tlE wo ( ad llE slnfi@ n ml
<br />inLn<!.d or ofi@d lbr elc (Se ,0{4, BusiFsr ed Pmlcssionr Cdr.: Th. Conhctols Licn$ Llw &,cs rcr aflrly b .. owmr of
<br />rlE loFny who l ild3 o. iqreE ilE6n, rln who drar sch sA hi'nscll or hc$lfor lhmuSh ht or h€r own crpl6y.cr.
<br />prcvacd rhal sucn inpmEmnh E nor hrcded o. oii:ed ior sb.li hoqMr. dE hriUin! 6r i,rqNwEbr is $ld vhninonc,cu
<br />olon{tb&tr rlE Own.r Buildc, wiu tBw 0E bold.n olt'ovine er lE or she dn lbl build or irpmr dr ForFry for iE purro$ or
<br />-1.
<br />is own(orrhc,rcldy, smcx.lusivclyconlracting qilh liccnscd conrsdnr b anstdcr rlr ttuid (scc.7or4, au,inc$
<br />nnd h)i:sion Codcr Ih. G,nta.'oas Li.cns. tjw doc* not rtplyro.nown.roipmpcnywho buildsor imtmv.s rh.rd,n.
<br />8nd pho o r.crs for such pmj.rls wirh o Conrmdons) lhcnsd lunut torhe Co.rBtor'! Lkctr{ Llwl.
<br />-l
<br />oDcxcnui und.r Scdio B. & P.C.lor rhis rcos,n.
<br />lro8f,lltLcllltEa$ro!
<br />lEqLA8AtrO!
<br />I h.rcby affirm undo l..llry ol po,lry onc ot !h. followlE dehnrions:
<br />-lnuvcu,l*illruirrri.rCcnificrrcorCon\cnri{,scllln\rrn,$orkor'c.i1lcn{rn,n.rslmviJcdlorhrScclnrn:l7lx)ofrhcL.hor Codc. Lrrhc |x onnonccol'lnc wort iorBhichrhc Frnrn h hsucn.
<br />-l
<br />&ivc und sill mi.lain eo*6 @opcnllrion i.s!ruk.. ar rcqlird by Serio. l7(D of rhc tjh.r Code. for lhc l,crfomMc or
<br />rhc qork tor whi€h rhis pcmit is is$.n. My w.rk6l comFnetion inslraec.oicr ad Inlkt numb$ m
<br />*t*t fittv/t
<br />05 7lo
<br />X,enify rhar in rhc l)crlorrorce ollhe work ror whkh lhis permil ir ijiu.d.l shall nol cmtloy any pcrsn in any Mftr
<br />$ s ro bc.om suhid ro rlE worlc6'omFnsrhn h*s of Clliaomi!. snd !s@ rh8r if I shotrld trsm subj.rl io ltr
<br />*orksl ompenslrhfl tmvhio r of 56r io. l'700 of rhc Lrhor Cod., ! rhau. fonhwnh 6mtly wilh tlbc pmvishns..
<br />WARNING Foilurc lo scuE Borlon slnp€nsrhtr covc
<br />civil lin.s u0lo om hundrcd lnous.nd dollon ($l0O.qJO)
<br />E8c is qilawtul, and shall .n mplorr b ainnnd Fflhts and
<br />compc.sario.. rt tuecs $ lrolncd for thc
<br />Codc- inrcrcst !d urrurer's fccs
<br />i
<br />DEC].A8AIIQN
<br />I h.rhy furn und.r !.ndly or prrjury lhar I trm liah$rd un&r ttuvnionofCh.pls 9 (onnEncins virh Sccrioo 7{Do) ofDivhiotr l
<br />ol thc Susircsslnd PmlcsionsCodc. and mr lkcn$ h inlullfitr$ d c[a{r.
<br />(,| 0t1q3 a
<br />!(Ait-8t1_ll1\r.!:\!]rN .iililL]ll
<br />I hcrcby !,ftm undcr pemhror$rFry rhnr rhcr. is a conntucri,n lcndin8 N8.ky lor Ih. n(rrofmNc oflllc eork li,r *hich !hi\ F rir i\
<br />issuc{l (Scc 1097. Civ. C.)
<br />AfILICANI.IIECLAEAIION
<br />I hciJ'y armr uMci pcnrhyol p.rjury onc oflhc lollowing dc.lu hns:
<br />Dcnnnirion Pcrmik-AslEsios Notincarior FtderalRcBUlorions llirlc 40. Pan6)
<br />_Rcqrircd lxrrcr oaNo(licdion
<br />-l
<br />ccnifylhtrt rhe fcdcrul rc8lhlions Esudin8 asl,c\ros rcff)!,lrt nor nprli.ahtc b rhis Dmjcd.
<br />\Ll eniry lnor t tuE cd fii! applt.don o.d e ctd i i\c.rar.I arre lo cotru,ly sirh,llCirydnn Counry
<br />icEcsnr0!ircs of $is Cily atrd C.unly
<br />rh'vc mnrioncd p(,|[ny r{tr
<br />tIt/
<br />Appliances
<br />It/etal Fire PIace
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />It/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<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
<br />FINAL $\r,c\r* I *,.4,f\t\<tit l ,l4isl
<br />Notes, Remarks, Etc.I
<br />tv
<br />L
<br />odinamc\ rnd Sutc tiws Ebrinero
<br />I
|