Laserfiche WebLink
MECHANICAL-INSPECTOR RECORD <br />APPBOVALS DATE ID/SIG.COMMENTS <br />Appliances <br />lvletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />It/isc. Equipment <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouoh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <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 />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL 't'1''t'1 1 <br />Notes, Remarks, Etc. <br />--t <br />OWNER BUILDEI DELCTRATION <br />I hcEby rmd ondd pcMlry (,r Friury rld I m .r.rTt fion ll* Co't66o6 LeM kw fo. lhc follo*ine llen lsc..mll.5 <br />alsin s 0,n Prof.ssion Cod€): Any Ciry ot Coury shich rcqut* . Fmn lo @Bmci .h6, improE &mlish o. rr{n uy <br />snu$rc. rior lo irs hsure. abo cqutcs rh. .pplicml for sucn pcmi lo lih . siSmd slllcmnt thd h. or .h. ii licctred Pursul <br />ro rh. Foltio.! ol tlE conrkrols Lie.sd trw (chrlrd 9. Co@mint *ilh sccliln 7000 ol Diviii.tr 3 of llE Businc$ .nd <br />Pblcsions Codc) or rnlr hc d shc ir cxcnlll rlr.cho6 d th. ha\is for lte allcSed ctcnqtion- Ary viohlion of Selbn r0l l 5 by my <br />appliclnr for ! pcrnit rubj6l. lhc amlicant lo r civil p.nally of not mt $d nvc hi.hn do0ds (S5001 <br />-1, <br />&s o*rcr of rhc lhlEny. o, Ey cnplorBs wilh wagcs s ltrt elc omFnelion, will .lo th. wort ud It slllrl@ h mr <br />inknd.d or oflcr.d for slc (Sc.r()4]l. Blshcss and Pinfesions Code Thc Conlraclols Liensc Laq &cs .or alply b e oqrcr of <br />rlE prbtdy who btrilds or inFm6 thae( old wtb dc au.h w* himsclfot hcmllor llrugh his ot lE own cmPloycca. <br />polAcd lhlr such imploEB.rs s ml inlcnd.d or otu for sb.If. horM. th. hildin8 or itprowmnl is $ld *trnin orc Jur <br />ofoqrhrhn. tlE Owncr BuiEcr will have rlE bo.dm of Fovin8 th.l lrc or shc did nol build fr imtmw tn. PmFtty for tlE plrlDs or <br />-1. <br />a$ own.r of the rror.ny, er ex.lusiv.ly .onlacrins wilh licc.sd conrBcto$ lo conntud thc ,tolYr (scc ?044. Busims <br />lnd Elfcssim Codq ThcConro.ior's Lic.nsc L.w do.s nor.nplylo dovrcr orDmr.rly *ho builds or inprov.s lhcrmn. <br />ud who onhcr3 for slch lmlc.h shh ! C. 6rod,ltc.sd pu6u lollrconfdoa. Licnt t u). <br />-l <br />an.xempt lndcr S(lio B &PC inrrhistc*on. <br />trQBr[x.tjiouPiltarraN <br />DECI.ASA:IAN <br />I h.rcby olfid undo p.ulry ol rdiury om of lhc foll.o ii8 dclqali.ngl <br />-l <br />h3u n! uill nrinrdh tr Ccn ili. c oi (rr{nl to Sclfl tr\urc tur qorkcA conrFn\ar ion. r Polidcd tui by Sccrion l'7(X) ol rhc <br />Llhtr Codc- for lhc perf{n tudorrhc{ork ri,whi.hlicFn.ir i\ n\ud.l <br />-l hlvc ond sill m6inlnin sotken conpcnsarion insurtrc. s rcquicd by Scclion :lT00 of rhc Labor Cdc. for lhc rqio.runcc of <br />rl* &rk foi whhh rhir F nil is is$cd. M, *o 6 orlrtns io insur.re caicr ed Flicy numbq m: <br />Poli.yNumb.r: ' Er/rcl <br />1l ccrrify rhar in lhe llcrfo@m. oflh. worl for whi.h lhis Ddni h jssued.I shrll ml cn{,loy !.y tEMf, in my Mn*. <br />$ I ro bc.o@ slbi.t ro llE &*m on xndion l,M oaclliaomi.. snd !88 lhrI if I slx d h.om subi(t to llc <br />workcc on{Ensllion polisions ot Sc<1ion l70O otthc t b.r Cd..I snall fonhsilh oq,ly wilh ltbs Pmvisio.e.. <br />WARNING: FaituE b se M*cs onqEnslion swE8c Lr lnh*tul o.d $ill .ubirl u ctlploF lo oimiotl F lrts dnd <br />civil rincs up lo o.c hundrcd thouend dolls ($1(x),m0). in <br />Sc.ri,r.1,'76 or rhc Lrbry C,dc. inrcrc.r and Jtonrr\ f.c. <br />iotr. damses !s providcd for lhc <br />-.". . (-2n-lSro,rr*r <br />I h.rchy rfiirm uid.r tr. rlrr.tr.ri'ry rhnl l0m lienscd undcr l,o 6lChaplcr 9 (ommftinE wirh Sc.rb.7000) of Division l <br />or th. Eusincss and Pmfcssioos Codc. srrl ny 1i..,* is in lull r.rcc uxl cfl&l <br />at, c4 el/1 74b' <br />I h.rh, dfijrn undfi FMxyofpcrjurylhal lhcrc n ! c.nerucrion hndinS o$ncy for fic pof.nMn.c ollnc *ork for whichrhis,tc.mil n <br />A.ETId.NI"PECLAXAIION <br />, h.rcby nfijnn und$ pclllry or pcrlury onc ofrhc folbwnrs dNhlaiionsl <br />tknk,lirtJn Pcrmik.Ash.stos Norificalion redqal RcSrhrn,ns (Tirlc.1O. Pnd6) <br />-Rcqutcd <br />L.lrcr.a Noria'cdio. <br />I c.nify rhar thc fedcrll rcsuhrturs EEardins $h.slos rcm)vol rc nor lpplkahh <br />'o <br />rhis l)lolccl. <br />}(ccn r rhd rh!\c rcrd,hnupnl <br />ii,rin;n!c\rftl srorc bw. ELrnsro <br />agmroomtlysirtdll Cirysnd cou.ry <br />iv.! or$t Cn, atrd Counly ro cmd ulbn rtr <br />athve n*nrbncn I'lopcny fo. in\!6iion <br />rxr., r 5'2n <br />o,,/,t 14 <br />-a <br />Duct Work <br />Above T-Bar <br />/..-..' <br />Drr.: t <br />-- <br />C.nrodo.E <br />hsd (S(, 3097. Cit, C.).t nd.lrN!m:- <br />ApplicMl or Agcnl SiSnatuE: <br />Pdhit@ nanr (rrio:-L <br />Y <br />I <br />---T_- <br />=