Laserfiche WebLink
MECHANICAL.INSPECTOR RECORD <br />ID/SIG.OWNER IUII,DER DELCAR TION <br />I hcrcby .mrm undcr penrlry of Frjury lh{ I m cxcmpl f,tm lh. C.ntEclos Lkc.sc L.* for lnc follo*ing dsn (Ss7011.5 <br />Blsimrs a'n Profes{., Cod.): Any Cily or Coonly which r.{uies o Fmir ro.on(dcl. !lrs. in mw, .hmlkh or EIat any <br />smcr@. prior lo ns n!um. !l$ EauiB lh. srrlicut for ikh Fmii b 6lc . si8tud slltcm.l lh!! hc or slE ie liensd PtNanl <br />ro ttE t'ovisions of rhc Co.lo.lols Lic.nscd L{w (Chcrlcr L Connrncitg enh Seclio, ?0o0 of Divhion I .lrh. Busincs lnd <br />Pofc*ions Codc) or rh0t lE or slE n crcmpr rh.Efromdd th. b{rh for rh. allcScd crcmplio.. Any violtrio. of S..liotr l0ll.5 hy any <br />aptlicanr lor ! p.mir subjccts tnc amlicdi roa.irilpcElly.fnol mrclhafivc hunlrcd dollas ($500). <br />-1. <br />,s oem. ol $e preF.ly' (, 6y cmplotts wilh wrycs s ltEn eb @n{E.salion. *ill {,o dx *n* ud dE lltudr b @l <br />inHd€d d ofcr.d for slc (Se.?044. Busire$ dd ftofc$ionr cod.r The Co r*rd s Lkck Llw doct mt +Ply 10 & oftr oa <br />rlE prolEry eto hoilds or trfmB 086n. .,n who dH Mh w* hielt o. h..slf or lhDus! hh or h( osn.nlloyccs <br />providcd ihd such in{mEr $ e er inlcid.<i or ofcEd rq $k. l{. k *lc. lt! hildiog q inproEmil k $td wilhii ore )Er <br />ofonpbriorl rtE Owr Au*hr wil hlE tlt bldcn of Foving lhd tE or she dn d hoild d inIrbf dE P'lpdly fo. tlt P{4Ds of <br />-1. <br />s osF of thc poFny. .n cicltsitly conE&ing vnh lened codra.loN to onsrrud rh. FDj.cl (sc. ,044. Dusirc$ <br />ond holcriion Codc: The Conr.&lor'i Lic.ns. lxp d6s tul rpply to M osmr ol ptoFny *ho boilds 6r inprcEs lfiercot. <br />aid who @flBcls for sh pDjcc& piln a Co.rrdcli) lie.!.d puEtul lo lhc Co r.dois LiccM Lrw). <br />-l <br />$rcxcnD' undcr SNI B. & P.C. fttrrhk rcNor <br />-l <br />ccnify rhlr in rhc pcrlor@ftc ol rhc {ork lor whi.h lhis p.rmn t isru.ir.l shollnoi cfrploy otry pcr$n in ony@mr <br />s as ro tEoft rlbjer ro thc vortc*'.orrlEnsalion lsws of Califom tnd a8@ lh.l if I stnold lx.otr sh.i(r lo lit <br />{orkcrs.ooDcneri.npmisionsofScctionlT(lOoflteLitnrC.dc,lshnll.fonhsithcomply*irhrhoslmvhions.. <br />WARNtr{G: FsnuE lo surc mrlcB' comFnsuion sveBlc is u.bwtul. and sh3ll slhjccr an onplortr lo sifrirul pcmhks tnd <br />civil lin s ut, ro oB hundrcn rhole.d doll s (Slm.Ooo). in rddition lo tnc .on ol conpcos,lion, damgcs as povidcd fo. th. <br />sccrion 3016 of rhc Labor CDdc. anrcrcs ed sllor y'sfes. <br />Llttx$rD_!:0NI&lcMB <br />DECIr$^IIA! <br />I hcrebrrllnnundcr Nn yofPcrtorylhal I n li..nsl unicr pn,!i\nr ol Chrfld , lcomntic'ns wirh su.r 70([, oll)ilirn,n.r <br />oi llN llu{irc$ r Pmf.$n,nr (hdc. trrxl nry liccn{c is h tuLlldreu cflt.r <br />COIEBIIqUAN',ENDNG.ACDNCI <br />I llrbya,Imuodcr fcralryolpcdrylhd th€rc ier oislro.tbt hidine !S!Ey forlt pdforljrc of lh. sd* lor which lhis FrnI i,e <br />Bsu.n {Se. 309?, Civ. C.), <br />a.8fucinlDr:claxAulrN <br />IllNhyxnnnrntlcr 0r]ry or lrrjury onc ol'rhc f(,lli,wi'r! dNhrr'idNl <br />Dc dir tu tr l,cnnils.A \hc(.\ Notificrti({ Fdd.fll Rc8ul.r nnrs ( l iilc 4lr. t'fi() <br />-Rcquircd <br />llicrolM ifi.nri,' <br />I .diii rhrl lhc lcdcrrl rcSularions rcsardios rttios rc,mvil ,r. nor nPplt lcloihir,mj*t <br />-l <br />enify rhd I hlve rad lhis rrplication ad shlc lhlr th. al,r info.nuion ir corecr. t s8c lo onplt willl all Cily and Counly <br />.dinrexr ord Srorc Laws Ehriis ro hdildine connn.ta.tr lrt h.eby Nlhorit tticenl.riEs ofihis Cil, sd Counl,lo c r up.n dE <br />ovc cnrioncd topcrry for inspedio. purpo*s. <br />Arplicrni or AScnr Sienhrurc: <br />I <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lvlisc. 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 />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc <br />APPROVALS DATE COMMENTS <br />EAatrEIN:.CAM8EISAIIQN <br />D[CtdSAu!]N <br />I hcGbr rfirnundn lcnally of ricrjory o.c orrhc follovinS dcclardions: <br />l h.vc d will neirrain ! Ccn inclrc ol c.nstrr b s.lr.lnsur. f(tr wo,kcN mn{E.\alion, N ,novidcd lor by S(ri.n l70l) ol rhc <br />htitr Qilc. for rh. lcribrmncc olthc sorl ftn whi.h thc p.rnir is issucd. <br />I hrvc lnd will flDinr0i. workcF c.hposdion i.sunncc. as rcquircd by Sccr i(,n l7m .f rhc Lahor C.dc, for lhc perfottutuc of <br />rhc {ork LrwhkhIhn prnnil is nst. My$orkcA cof,n nrorion insummc c!tricr,.d p.lky numb.r rc <br />Cricr <br />Appliont: <br />tridcr'! N&m <br />-