|
MECHANICAL.INSPECTOR RECORD
<br />OWNf, R BUILDER DELCANAIION
<br />I hcrcb, affirm ondr pcn0hy of tErjlrl rhd Ln crcmfl fiom rhe ConrmroE Lktne Llw for $c followinS Ersh (Se.7031 ,5
<br />Busir.rs and Piotesiion Cod.)i A.y Ciiy or Cou.ry which Blutci { lEhri ro onsMl. rltd. iir{,rove d.mlkt or Epan any
<br />srtudlrc. lrior ro its issuamc. lho rcquircs lnc q,plica for such Fmir 'o
<br />filc 3 si8md sratcmnr rh,r lr or dr i lien*d tus!.m
<br />ro rh. pmvisiooc ol tl* ConrEcld\ Lhcrsd L{v (Cnlplr 9. ComminS wnh Scclion 7mO of Division 3 of th. BlsiN$ and
<br />Pmfcssions Codc) or thal lE or sh. Ls crctrpr rherciior snd rhc hlsh for thc rllcgcd cicdprion. A.y violrrion otsc<rion 7031.5 by a.,
<br />Elrplicant for a pcrmir sut.i(ls rlE aprlic!trr to , civil p.flalry ol nol mrc rlw' fivc tlndrcd dolles (5500).
<br />_1. ,s owrcr of rhc poltny, o. n, .qllorfcs wlh sagcs !s rh.ir elc 6rqE.salion. will do dE wo.t lrd dc nBtft h ml
<br />i.lcrH or ofttrcd tbr slc (SE.7iX4, Bushes lnd Prcftssions Cod. Th. Cootreclols Liss Llr do.s mt lpdy lo e oqM of
<br />rhc,,stfaly wno hildr or tulibB 0E@.. ald who do6 sh $o,t hinsclf or hrclf or rnrcugh hh or hc. oM .ntPloyc*,
<br />pmyided lhal su.h inproEmnls m rcl int nd.d orofr.mrlr., eb. lt lnwcB, ia huiHi.g or inpl*rnl t $U ethir om Fdof.lqlbii,i. ltE OwN Buildm wiu haE lh. b{dcn of rovins Ulll nc or shc dU er bild or nrrmr [!c ppFny ror tE 0uqE. or
<br />-I.
<br />rsowmrolrhc tm!.ny, amcrclusiwlycoffd.ling wilh lic.nscd conlr&toBloconsltuct lhc l,rojer l Sec. 7014. Bu\inc$
<br />snd ltlDtcssir Codc: 'l hc C.nrra.toa3 l-kc.sc Llw doc\ Fr !ppl, ro do owner 6l prop.fly who builds or inp,ov.s th&con.
<br />and qho conlncls for such pmjc.rs eilh u ConrBro(9 liccnscd ,ucu.nt ro tlE Contftktr s Ltens L!w)
<br />-l
<br />amcrcrpl undcr Scct
<br />WORXTTLS' C(IMPENSATION
<br />IIECLIBAIION
<br />I hcreby rf,nnundc. pcmlryolpcrruryorcoafic tolLwiry dEluolio.s:
<br />_lhlkm(lsillmliniri'rrCcnificrrrorconscirhS.llln\rrcn,{orkcnconprn\dn,n.NttuvdL'droriysccli lT(x)orrhc
<br />l,0hr Cadc. thr rhc Frionnirccoflhc rort lor*hichrhc pcrnrit i\ tnEd.
<br />-l
<br />hulc ond eill mainhin wo*cG cohpcn\ ion in$rancc. as rcquiE"d hy Ssr io. lxx) or rh. Labor C.d.. lor lhc p..ionMo ol
<br />rhc wdrl tn*hiLhrhis pcmir is nsu{ Mywolk B conDcnsrnrn inslBmcclric, rd Fni.t nuob.r a.:
<br />PolicyNumb.r:Jxrirci
<br />! c.nif,
<br />'hur
<br />in rhc !.rformm oarh. wort fr which lhii pcrmir ir hsu.d.l shall nol cmrloy lny t son in any nunr
<br />so {! lo bcro'm subicct b tnc workcn smpcnsrlbtr laws of Crlilornia. and aBN thrt if I shorld becotu sulrer ln lhc
<br />works{ ompcnsaliotr pmlisn'ns ofS.dion 3700 ot thc Lahr Codc,l slEll. l'onh*irh.nmnl, snh rl.e povisio$..
<br />WARNINGT raibr. h surc wMtrc sn{E.slion orcaqc is nnh*lul {d shall su an cmploycr lo crinri.trl p.nalris dnd
<br />.ivil fincr ut
<br />'o
<br />o.c hundEd rhouslnd doltri ($100,000). in NdJiri,n lo lhc cort of
<br />Se-lion 3076 ofrhc t hr C.dc. i,lcresl ond altormr's fNs.
<br />C/\t+
<br />uqiN$IiDl:(lNtB (:roa
<br />DlrlLd8tlll!
<br />.i rhc lru\incr\ und Pmnssion\ Conc- &lmr liccn\c n in tullrbr.crtulcic.r
<br />a\)>ltz,^,
<br />I h.rcby aifm und( Fnalry of perju.y rhrl rhft is a connru.rion &ndi.8 4cncy for rh. pcrfoMc of lhc atrl for whi.! lhir lcdi n
<br />issud (Sec. 309?. Civ. C. ).
<br />AIIIII;ANI,DIILAEAII!]N
<br />I lln$y,liinnund.r Fnalry ofFrjury onc ofrhc followir8 dNlrnri rc
<br />l)cnnniio. Pcnnih.Ashcsros Notificalion Fcdcrll Rc8ulllions l'rnb {r, P!n6)
<br />R.quncd kricr of N(nifi .drton
<br />-l
<br />ccnily lhir Oc Ldc6l reuhlions egardine {sbcalo, rcnrvdl nc nol llplic.hlc lo tht p$j.rl
<br />-l
<br />cenify rhar I hrE Ead rhir lldicdion anl {arc rhar rlE ltnvc irlbtr@ion b .orel. I r8xe ro onply wirh 0U Cn, nod Coutrlt
<br />ordinan&s lod Stalc ljws mlaring Io buildiq consnudio.. mi n Eby luthoriz rcpresntarncs or rhis City dnd Cohr, 16 cnrd ur.n rh.
<br />APPROVALS DATE COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. 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 Range
<br />Other
<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 Release
<br />FINAL //-/9-/5. ,?r z-,7
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Furnace
<br />Ddle l)*nrr.
<br />oborc mnriotun ,mpcny fm insn€tion l)!q$ss.
<br />o*r"*,* nu*"r"**-, A lr''-< I "1 ? nuv,=l ** ot/ ? f /q
<br />I
|