Laserfiche WebLink
MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNER BUILDEN DELCARATION <br />I h.Eby .ffrn uodft Dcndly of pcrjury lh l m erenol f&n rhc ConlracIoB Lk.ns L,s tor lh. followinS rc&en (Se.?011.5 <br />Busincss ad Prefcssion Code)r Any Ciry or Counry whth 'quircs a lsnil lo connocr, sllq. inttorc. &elish 6r dPu tny <br />srrudoe. prbr ro ns irsuare, abo rcquiN lhc lpplisl for $.h pcmi ro nh t siemd sl .mnl lhtl lE or she b liccnsd pumanl <br />b lh. povhions of rhc Co.ri.toar Liccnsed tjw (Ch.pt$ 9, Comm.rcinB qith Se. on ?Om of Division 3 ol lnc B!{ncis and <br />Pmfcssioni Cod.) or rhar lE o! shc is cx.opi lh.Bl6m and lh. tasis for rlE alhg.d cxcnprio!. ary viobaonofSdlbnT0ll.S by my <br />{pplicaor for r p.mjr suhjRls rh. applka ro a.iril pcelryornot mGihtr five hund(n doles (!500). <br />-1, <br />$ ovrcr of rh. pFp.n, or my cmployas *ilh *ascs t. thcn sL coopesrlion, will do lh. q,i ad rhc fitlr i! mr <br />inied.d oroltcr.d for sh (Se.7Ol4. Businc*..d Prof.si.BCo<ls Tn Conlraclols Liene Llw &.s nor spply lo 3n o*ftr of <br />rhc ropcny eho hoildt o, insbB ilEmtr gd who dc Mh s* linsllor h.Bll or lfiFu8h hi tr ncr o*n c'rployc.s. <br />pmvided rhlr such irymrmnls d Dl incodcd o.olt r.n lor sl.. li lbwE th. tlitdtrls or in+ftEr.t is $ld wilhjn otu )Ed <br />bl@ntbriu,L $c O*r. Suilds wil hlE $€ hdcn of ptuting ttEl lr or srE di] ml t ld or inPmk tlE Iolrry fo, dr purF$ of <br />_1, dower.trhc pmlEny. m€xclusivclyq,nrB€tins *irh liens!\d onrerm ro.onstrucl lhe rreitr 156. 7044. Busm$ <br />rnd Pn,ixsion Codc: Thc Codricroa. Li..nsc Law docs .ot apply io m ouncr oa poFny who builds or iflPtovcs ltdcon. <br />und who.o ack ror su.h l,o.jcch sirh a Co 6cro(s) licc.ied pu*udr ro lhc Cn rucloas Licctr* ljs). <br />I m ekmDr u.d.r Serion .A &PC lorrhBE.{n <br />lhtr (\urr <br />roxaE85lcortlEllArlaN <br />DECI.ASA:II!}! <br />I hceb, d!firm unrkr lcuxy of Fju.y orc of lhc fouo*ins dalsdlioml <br />-l <br />havc ari sill dinllin a cc iftllc of con*fi ro sclf-lBurc fo. wort B .onp.nsalion. e Povid.d lor by seli.rn 3?0o of lhc <br />t bor Cod., f@ tlE p..fq,t@c of thc *o* for whkh llE |Emi is irsued. <br />I h,vc rnd r ill minroin wo*crs .onFBarion insurancc. ,3 rcqun d hy Ssrion 1700 of rh. Lrtxtr Code. for lne I'. ormne of <br />rhc work for which thn pcmil is hsed. My wortcB @nFnsdio. insumncc curic. dd Iplicy nu 6bd m <br />P,,lic\ Nunjl-r' l-\ttrc\ <br />-l <br />anify lnar in tlE Frfor@Kc olrhc wor* for which lhis pcmn k isslcd. I ihall nol cnploy dny pc6on in dny MFr <br />s &r ro bcorc $bjccr ro llf wo*cn oq$slion loss orcdliaomi( sod aEI!. thnt it t sholk trom subiF to t,E <br />*o s c.rqEnsarion tmvhions of Seclion 3?00 of lhe Ijlhr tuq I rhaU. fonhwnh.omply wilh i!* pmvisions.. <br />WARNINC: tailurc to s_urc eortcr' onprnqrk,n mv.tugt i. unl,sful. ond shlll su$Fr ,n.q)lorr to niminll l.nalri\ nnd <br />civil 6ncs up lo one hundEd thols0nd dou6 (S100.00o). in addilion lo lh. <br />(bdc, iircrci und anorncy s fccs <br />I <br />I icEbyamrnondci pcnnlryolFrjury rhnt l3m li$ned ond.r t,6 ofchaprcr 9 (commn.inE wirh Sdh 7o(D) olDilhion:l <br />of rh. AlsiBs and Pmfc$io.s Codc, a,rl my lic.s is in tull for@ Ed cllel <br />4 t€ "-, <br />I hcrcby affirm undcr |Eolry ol Fdu.y lhar llEE ir ! Nnstruclion <br />issucd (se. 3o97. civ. c.). <br />lgcfty for tlE p.rfoturcc of lhe qo* f.r {hkh lhis Pcmh ir <br />A.PILISAILDECI,AXAIION <br />I MyafilmlMsr pcnrhyolpcrjury om of lhc follovitre ddhrolhfls <br />D.nx,liii6n Pfn 3-Ash.sros NorifE.rion [cdc6l RcEularions (Tirl. 40, P,n6) <br />-Rcqlncd <br />&trc, otNorin. ion <br />-l <br />ccn ify rh.r rhc lcdcBl ,.sllllions Esaidi.s !.t slos rcmrdl sc nor nmlk blc h thh pmlc.l. <br />-l <br />ccnify lhd I h,vc .csd lhis trpplicllion rnd slarc rh.l rhe .vc intnrL{nr is core.1. l lsxe ro .omply vnh rll City ond Cohlv <br />ordinlnccs lnd Sror. Lsqs rclarhg b bui <br />abor ftnlion d popcn, for i.sFclio. <br />ftnrc*ntaliws ofrhis Ciryand Counryro cnt{ upofl rh. <br />0+ <br />hy <br />I <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Banqe <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 />Rough Mech. <br />Final Test <br />Meter Belease I <br />FINAL SlzS Y tJ;4J))1 <br />Notes, Remarks, Etc <br />ID/SIG. <br />Smoke Detectors lnstalled <br />Other <br />L.ndc, (Nrm <br />- <br />----+--- <br />i-