|
MECHANICAL-INSPECTOB BECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEX BUII,DER DELCANATION
<br />I herchy altiln under pcnalry of n rjury lhat I m cxcmDl fmn thc ConlrmloR Lians L!* for ll* folloahg ta$n (S.r.7011 .5
<br />B$incqs .,i Phf.sion Codc): Any Cir! or Counry *nich rquncs o lcm ro @nnrucr !lro. inpovc, &mliln or E air lny
<br />srrufurc, prht io irs hsu!tuc. ,l$ rquirci rhc !tu,licanr tor s!.h Frnat ro fi|. a si8ncd slaLmnl lhll lE or shc is liarsd n!6uer
<br />b rh. pDvisions of tlE Conlretois Liccnsd ti! (Chlptcr 9. Comfttui.s wilh sccrion 7(xn ofDivision I oflhc Busincs and
<br />Pofcssions Codc) or rhd hc or ih. h excnrpr theEfrom Md $. b6ii for lh. slkgcd crmplior. AnyvhlarionofSdiio.TO.ll.5bya.,
<br />lFpli.anr for o Fnnir rubrcck rhe spplicqnr to. civil p.nllryofml mrc ths fivc h!.{tr.d dolladi ($500)
<br />-1,
<br />!s owM of rhc ptnFny, or my .mplorrcs *irh w.!cs !s rhcir sL srnpcnsl ion. will do ltr wolt &d rh. itrlm n ml
<br />intdricd .r o,f.En 6r slc lse.?o44, Busircss ond Profcssions Cod.: Tlc ConrfiMk Liccns tiw d@s ml ooDly lo an .wer or
<br />rtc pFFn, slo hildr or inpmE rh.m...,i who dc h M,t himrclfor lE.slfor rhreu8hhk or h.r oRtrctr{,loyes,
<br />providcd lhci su.n iq'mmnis N nol i c'id.n or oilctn for s!. la, hosE. tE btrildirg or inporctufl k sld wnhin om yer
<br />oa @mplcrbl! $e OoM AtriUd wi[ haw $. bui.n ofpfl,vin8 tl[l lE or etc did rcl build or i,i0o4 dE t,DIEIy for llE prlDs of
<br />-1.
<br />asowmrof rlE lmp€ny. dcxcllsivclyco Bcring wnh lie.scd cont!.loN lo mnsltucl llrc tmjecl (S<.7044. Blsins\
<br />,nd hlltscion Codc: Thc Confulols Liccnsc ljw docs ml $,,1y lo M ow.s of t roFny who brild, or inprovcs ficrcon.
<br />and who onlEck for $.t rojeds *irh r Conffido(9 licciscd Nr!!. x, rh. Conta.lols Lianrc L{w).
<br />I 0n .x.npr undc. Salion- A & P.C for lhis taion
<br />D.t.:- o,Er:
<br />lo8trEl!:caMENSAfION
<br />DESAAAIION
<br />I hcrch, !fiirn uMcr p<n"lly of Frjury om ofllE following dccllElioNl
<br />-lhivc
<br />nlwillui'linnCcnili.arcoiCon\cdroSclllNurclbl{orksr.omltnrinnr.,\pn,vidcdlarbySc.liiinl?00ollhc
<br />Uho, Codc. tu rlrc lql'onuEc olrhc wdrk for $lrich rhd p.rmir ( i\\u.
<br />j/f,/i;c drl will
<br />'ndinkin
<br />wo,kcrl conrp.n\rr ion in\ur!trcc- i\ rcquircd hy srrnnr ]7m or rhc trhor Codc. Inr I hc ,rlimuntc .r
<br />ir i\su.\r Myworkcrs. collrl) i\rii,,i nNnn.c.ani$ Md,oli.y.un lc, rrc:C
<br />-l
<br />ccnify rhrr ir lhc p.rtor@nft or *qork lor which fiis p.rmir is nsucd,I shallnor cmployrn, p.r$n inany m0nrcr
<br />s N b h.om subj.{ lo ric mrtsr .omncn\al ion laws ol Calif(ni!. and 08tc rhar if I should tf,.om slbjcd to rhc
<br />wo crl conpcnsllion p$vision\ of S6rion 1700 of lhc tltor Codc. I dull, ronhsnh 6ry y whh ihos Imvhions..
<br />WARNINC: Frilu.c ro slrc *ork s'€rpcnsorio. .ors,B. is unhwtul. lnd shrll sobjd !n ctrqtloFr to dimiid p.MhLs cnd
<br />civil fincs up lo orc hundod lhouslld dolles (Sll$.000). in lddnion to lhc cosl of compcnsalion. damg.J ar,ovid.d r.r rh.
<br />ii.,.! rn xrknRr'\ l.d'
<br />,7
<br />LICINIEIIII]NIAACI9R
<br />I,}EII.ABAUAN
<br />I h.nhy rflnd und$ p.nnlry of p.rjury th0t I om lienEn u.dcr pmvhion ol Chlprci 9 (co rtun.,n! rirh SR_lion ?mO) of Divi\tD l
<br />of rhc Businc$nnd Pmfcsionr Cod.. xi nrli.ci* i\ i. aull nftt a,rl c,Iuct.
<br />ZO
<br />AITLI{;INLDIILAEAIIIIN
<br />I tIdrynmmr d.r Fnrh! of tf,ljurt orc ofrhc r'olbwin8 dcclnrolnrN
<br />Dcnnii(nr PcnnirsAshcsros Norifi$riod Ftdsrl RrEuhrio.s lTnlc $, Pnd6)
<br />Rcquncd Ixn$nl Noiifi.di,rn
<br />-l
<br />.crli! rhat dc fcdcra| egolor ions mgdding .shno\ rc@rnl e nor .mlic lc tolhh lroirl
<br />-l
<br />ccnify llEr I hlv€ rcd rtis lpplkario. aid 3btc ftrr dE ow irfomrion is cmel. I lgE
<br />odn.Ml.nd srsr. kws EhlinB ro bu,l4ing conmdion. lrd h.Ehy lulhorit rcpEendrhs o
<br />rbov. mnr.md pbFdy ror ir.e"oe,Ea*.
<br />rocomply snh ru ciry.nd counly
<br />Aplli.lntorAs. Sisnlruer_.<
<br />E
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />l\llisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<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
<br />"lr4t4-T
<br />)*.'a^4 D)
<br />Notes, Remarks, Etc ut
<br />Other Za)
<br />(:d.tur E
<br />CoNS'TRT'(] I(IN I TNI)IN(i ACENCI
<br />I hcrh, ifinm und.r Fiilryoipclorylh rh.rc h a cotrsrrlcl ion h(lins lscncy frtr rhr lcdontuftr ol rhc wort lbi $ hich rhn Ilcdir it
<br />hucd (Scc 1097. Civ C )
<br />L.nd.is Ncm:
<br />-
<br />tl
<br />II
|