|
MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER'UILDER DELCAXATION
<br />I hcEb, lifrm lo.tcr F..Iy of Frjury thd I m cr.mfl fon lhc Co.l@roR Lims tis for lhc fnlloeing E&n (Se.7o]l.l
<br />Busin.ss o,n Pmfcssion Codc): Any Cir, or Cou.ry shtn nquircs s Fron lo orner alter, improE, dcmlist or Epat dy
<br />slturlE. rior ro its icsum.. ako rcquiEs lh. +plicanl tor sEh Fm lo fib.3i8n d sl.Lmnl lhll hc or slt is lieni.d p!6uMl
<br />ro ttE Imvisions of llE Conrdld! Li.€ned Lrw (Chalter 9, ConlmminS wilh Scclion 7000 o( Division 3 of tlE Business md
<br />Pmfcrsions Codc) or $ hc or shc it ercnl,t lhcEtoDand fi. besis for lh. sllcgcrl cxcnplion. Any viobtior ofselbo 7031.5 by tly
<br />,l,l)li.afl for a p.mil subjeB rh. lpplclnt lo a civil pcMhy of nol mr rhM fiv. hundEd dolles ($500).
<br />-1.
<br />4s owEr oaln pmFny. or dy cmplore$ with wage. rs lh.ir $k onqrcng|ion, *ill d, rh. wt ard ft srrur@ is ml
<br />i cnded or ollerd aor sh (S6.70a4. Busirc*r a Pmfcssions Code Th. Conr&br's Lk.M t w dms ml arrly !o m owncr ol
<br />lhcImllrry *b t{i!1sq inpoB{i6tr orl *ho dBMhw himsll or hd*lf or rhtuuEh hk or hcr own cmir,yc.r.
<br />providcd rh{ ru.h impmwmdsemli c'dcd oo,tscd for eh lt ho*cs,ll* t{ilding or in{noEG i!56wnhhotu)qt
<br />of co.plcrion. rhc OeM Buildd will h,rc ltE budcn of povinS lhll hc o! ihc did mt hoild ot nq,mw lhc pmtEily tor dr In4Ds of
<br />-1,
<br />d. own( oa rhc pmFcnr. m crclusircly contEdins wirh liccn*d .onrlacr.u k, onsldcl rlE rm.ier (Scc 7Or4, Busm*s
<br />ond Pnftsshn Codc: Thc Conl,acroa* Liccns. tjw docs nor snply lo on o*ncr offiopcnysho builds or imJ,mles th.!con.
<br />aod who N m.h ro, ru.h FoF;ls *nh ! C,ntE ro(s) liccn$d plBu.r brh.ConlEcloli Li.cn{ Liw)
<br />UOAS.EBIi:COIIIEdIAIIAN
<br />IIEII.AS{I'ON
<br />I hcrcby afim und ,.Ml!y of ldjury onc of thc followi.g dfthmaons:
<br />-l
<br />hav. ud Billnuinrd.dCcnilicdcolCon\cnrk' Scllrln\trc ltr *orkc^ .ornl)cNdion. ax pln idcd forbySu.lionlTmolrhc
<br />trhrr Oib. n rhc perfotun.e o, rhc *ofk rr whi.h rhc p..inir is hsucd.
<br />-l
<br />Mle and q ill Mioi,i! w.rtcnr compcnsution i8urrncc. as rcqlircd hy S6lion 3'700 of lfic L.bor Codc. fo, rlE Frfolrumc of
<br />rhc *o,k in *hth rhn p.nnir is issu.d My cornncnsrion in\!rR...rhr inn policy numhcr 6c
<br />l..dify$ar ir dcF.fornErcof lhcwo;k ror whi.h rhh p.rnir ii issucd. I sn0ll nor .nltloy ant Pc^on inany maoncr
<br />s as nr tEmm suh]cd ro rhc w.rlcn omp.ns.tion lows of Crlihmia. !.d lsft rhd if I should bc.onE sufi{l ro rhc
<br />workc conuEn$ri.n nfrvnjons.lsd6n l7mofrhc Llbor Code.I sull, n,nhwirh $nlPly wnhlhos provisn,ns
<br />WARNTNC: FailoE ro suE *orkcra onpcnelhn covcBsc is lnlo*tul and .hall subjdl .n sPloFr lo oiminal peNllix lnd
<br />civil fincs ot ro one hunded (huend doll6 l$ loo.ofii), in addition n, rhc cost ofcomP.nsalion. dlrsgcs s lrovii.n r.r rfi.
<br />Salion 30?6 of Inc Lahtr C.dc. inlcrcn .rd urlorrcy s Lcs
<br />,l',5/2-,/tt r,ffi Drc ro,,.i.)
<br />LTCENIIIIIQNITACIQS
<br />P&CI,AMIION
<br />I hcrcb, uffinn uidcr lcndlrt olr.rury lhd I rm lilrtrscal undcr tmvisto orChaprcr 9 (connrcncinB wirh Sdidr ?fiD) ol Division l
<br />of rh. 8usnf,\s rNl Pmfcs{ions Codc. dxi 'ny lic.n{ i\ ir rull f(tre ffil cflar
<br />'7ol4t?
<br />e
<br />CONSTRUCTT(IN I FNNTN(i A(:EItCI
<br />I hcrchy dfir6 utul.r,f,trdlryofpcrjurylhll lhcrc isac\,n(tucrion lcndnrg$cn.yfi lhc !.rn,roncc or rh wor* lor{hichrhisl)cnn is
<br />issucd (Scc.3097. Civ C.)
<br />A.ITUIAILUICLABTIIIJII
<br />I h.R.by l]jnn trtrd.r rcn li! or pclury onc ol rhe lollowin8 dcchlrrt,n\
<br />DcnFhrntr PcflnilrA\hc(o! Nolificrrn Fcdtrrl RCBUhr n\ I Iirlc,10. Pdr)
<br />-Rrquired
<br />linrr of Norirtdron
<br />-l
<br />ccniry lhd rh. rddc.r I rc8u lal ions rcssrdins rst{rro\ rcm)llldc nor lnPlicablc lo lfin Imi{!.
<br />-l
<br />ccnily rhll I h!!e rcld rhis amlicariotr and slft lnar lhc ahovc inlornulion i\ corccr I +m lo omfly *irh lll Ciry and Couniy
<br />odinrkcsrndsht L.rs rchritrs to tilildins con{tudn,d ad h.rbyaurhorir rcprcscnlarilca orrhh cn, d Counly lo .nrs rF. rtr
<br />dovc nxn.oncd lrolrnyt]tr inspccrbn
<br />AIf i.nnt or A&trrSi-lnrhtr.
<br />ll\
<br />a
<br />w 5/ze//8
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer 7-1-rb,to
<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 )-7 - ta )cSolr (,
<br />Notes, Remarks, Etc.
<br />Metal Fire Place
<br />Pre-lnsulation
<br />lnsulation
<br />4+/24
<br />I
<br />tt
<br />=
|