Laserfiche WebLink
MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCIRATION <br />I h.rcby arrm ud( pcDriy of p.rj'r, rhar I m c&trv,r 6!n rh Co .&16 Liene Liw for rhc loll6*j,8 r.s. (S...701L5 r <br />Businc$ sd Pof.$ion Cod.): Any Cily or Cdnly whih rluirc3 r p.rmn lo onstrucl. dls. improvc. d?mlilh or ErEir ey <br />rrocru€. lrior to ns issraftr, als rcqliEs tne applicrnt tor such Fmir to f c o .igtud n cmnl rhar hc or sh. B liencd lnBu{or ' <br />lo lhc pmvisiom of OE Conloclols Liccrscd tlw (Ch.flcr 9, Comn ncilg eilh Sccrion 7000 of Division 3 oithc Blsitrcss and <br />Pmfcsions Codc) or lh.l l{ or shc h cxcn{l lhercliom et thc bash for th. alhgcd g.oplion AnyviololionofSdlion?03l.5byany: <br />eplicanl for tr pcmil subjels lnc opplicmt lo , .ivil pcully of ior mrc lhe liv. hundrcd doll&s ($500). <br />-1. <br />as ownr of rhc tmFdy. ft ny cnlploylg wnh qoSci sr rhcn sb @mp.Bdion. qi! do the sdt and th. nMW is ml <br />inlcndad or orcrcd for elc (5e.?044. Susims rnd EDfcssion. Codc Tlrc Conlr(lor's LianF tiw do.s nol amly lo !n owe. of <br />rhc I'mFty wlD hr,lcs or inumws rh.,$n, a,n wh. .la sh trlk him\clf o. hd.clf.r rhDxsh his or hs ow. cntloy.ca. <br />pr6lided Ihd su.h im0o*mnls @ ml htcidcd oroffcRd lor sL lt hoM. thc ttrildiu o. trytum h sld silhin otre ,ee <br />ofomrh*,n.lh. owmr Buitld w h,r ltE budcn of pmving td h. o, sh. did nn build tr ir{,.rc llE poFdy lor ltI puFos of <br />-1. <br />$ ownd of rh. rmperry. am crclusilcl, contr.clin3 wirh li.nscd .onrmros ro snsrrcr tlr pDjet (Scc. 7044, Bu{irs\ <br />and ADtsim C.dc: Thc C.nhcror's Liccn* tls d*s mr 0pnly 16 a ow,f or nmpcny who huilds or nnpmEs thcr$.. <br />and who conrn ls for wi lroic.rs wirh r Cnntftro(9 lixn*i purMr ro rhc Conlmclols Licens L!*). <br />I 3 crcnr undcr S.cr B. & PC l rhk msn. <br />W(}RXF{S' C(IMPF.NSATION <br />IIEIIAXA.IION <br />I hceb,aflndu er penrlryollcduryom olrhc lollowirs daluarn,ns <br />hhtr (ixl.- rnr r [c Nri.r.u ncc ollh. "ork lar shi.hlhc lrnrii i\ i$u.d. <br />rhc sork ntr shrh rhistcrfrir i\ n{tJ Mysorkdr compcnv'innr in\urrn.c cfirr ndlolirynun$.r dc: <br />-L Ie-t-rI <br />I ccnify thar in rh. Frfo.mR. of$. wort fm which rhis pdmii ir i$ucd.l shall nor .mploy .ny Ftro. in any mnmr <br />$ as lo tE om $btrl lo lhc aorlc6'compcnsli,n lovs of Glifomh. nd trgN lhll if I stnold lEcom slbr.cl lo lhc <br />wodcs coryxnsalionprovhionsofScclionlT00oflh.t tbr Cod.,l shall. fonhwilh.on\aly wilh lhos imvirions. <br />wARNIN(; Frlilurc lo ycurc so'kcr.ontpctr\rri,nr corc[gc is urhwlul. rd shr]l{rlrccr , cnrrl.ycr ro.dni'xn "rmltics nnd <br />kr on. hutrdrcd rlhu\ri{l dolLrs (ll(X},lxxr). ir liri('n n, rhc .o{ ol ..nD..stion, damScs r d"vidcd for Ihc <br />lqz6 ot rlr trh)r C.<L. mrcrc#'*ll-r I _c(- <br />D}:!LAMIIOIi <br />I hcrchy rlrtflrunlcr pemlryolpcrjury rhrl I !m licctr!'d trn1lcr tmvisio oIChll)r.r 9lconnncncins $ilh Secrt,n 71xx)) ofDivtion:l <br />ol rhc Busi'rcs\ Jtrd Ptuf.\\n \ Cl)dc. nryli.cnsc is ni rrlln,Rrd cffc.r. <br />r€'i074Cto c,-o <br />o." 7*ll - lt'il;t^e- <br />CANIIIjJEII!)NTINDIII;rICIN!I <br />isucd (Scc. :t0i)7. Civ C.) <br />A.8ELI!:ANLIIESAAAIION <br />I hcrcty rltnm u.dcr pcn0lry oiperjury onc oflhc lolnrwnr8 dc.l0r0rions: <br />D.nn,lilion Pcrnrils AstEslos Norlficutioo rcdcolRcs!htions(Iirlc 40. Pan6) <br />-R.qtrncd <br />htr$.lNori,iolifl <br />-l <br />c.dify th,l th. f.dml Eguhriotu E8.Jdin8 ah.sros rmral @ nor .pplklbk ro rhis Ioirr. <br />l.ddityrhar I hn\c rad rhk i{,i a'rl nrrcrhrr rh.itxn. n,lnrnrrion ncom.r I !Sr( h conltll, *irhnllCiryind Cou.ry <br />ivc\ dfrhi\ Cir, rtul C.u ryhcnrn ul-nrh..Rlirrr cc\r {l Strrc Lnv\ rchring I <br />rtr'vc trrnri{,ncd frcpcny io! i <br />,". f')).^tiAptrlic!.l or AEctrr Signolurc <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 />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes D ryer <br />Residential Ranqe <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 tl <br />FINAL // ht/l {4*7q) <br />Notes, Remarks, Etc <br />Other <br />r [10f4' <br />----+--- <br />t---F-----r-