|
MECHANICAL-INSPECTOR RECORD
<br />ID/SIG.COMMENTS otvNtR atrtLDER DtiLcAt{A'l.loN
<br />I hcrchy rllirm uftlcr I'Cnllry i,t pcrJury rl r I ir crcnrnl liTnr lhc Codrr(tr\' I-iccn* lis itr rhc lnlk,wnt rcrrnr (Sc..70.11 5 !
<br />Bu\ir.\s an ltofcsi,'n C tr): An, Ciry or cou rt whi.h mitrnc\ n ti..nnir b .on{ru(r. rlrcr. irnlnrvc. d.nmlnh ,{ rq'rn . ry Infl(ur.. prinn) ir\ n\urnc.. dln' ruquirc\ rhr 4rli.rnr for \x.h Frnrn b ilcn sSncd {rr.nEnr lhrr hcoi ft is liccn{'l nuNr '
<br />r, rhr r{,ri!i,in\ ol rht Cotrrrr.tn ! l.i..n*d ljw rCirpicr 9. (imnrici'r! wirh Sr.ri.n 7lX)O ol Divisnn! :l of !hr ltu\inc\s rnd
<br />rpfli.rtrrttrr|xnnir$hJ.dhrhc.tllicrnrhrcivilNlrlrtornrrn*rh0nlivchundrcndolllrslS5ix)).
<br />-1.
<br />a$ owrr of $c FDtEdy, or my emplorr.s with wag.1 {s rhcir $k sn,..sarion. will do lhc wo* .nd tlE slr*!@ is mr
<br />intcdcd m oficEn for sk (Sa.7044. Businc$ snd Prcfcasions Cds: Th. Conmclor's Licensc lls docr mr alpl, ro oercr or
<br />rhc pDfdry wh. tril& or in mB rh.6r. rld stn &a su.h wlk him$ll o. hcNlt or lhou8h his m h.r osn edFlores.
<br />pmvacd lh.l such impmrcmnlsmnori c'i.i or off.Ei lor sh. Ir, how.w, rh. bilding m inprDmnl is sh Nitl , onc try
<br />orcorpLrir,.. rhc Owtrr Buildg will h,rc th. hlrhn df prDving fid tE or {E di! Ft hru or iq'or U* pEp6r, for tlE l!ryb€ or
<br />-1.
<br />as owmr ol rh. pmpcdy. m .rctusiEly conlreling virh lieD*d conlraclou lo snsrNcl ttf, prci(l (Se. 7044. 8!\ircs
<br />dnd Ph6$sim Cod.: Tnc Conk!.rols Lircnrc Lls des mr !!rly ro u osocr of Oropcny who buildi or iotmvcs rhercon.
<br />,nd f,ho 6 mk lor sEh I'oids wirh r Co mdorls) ILtnsd putru!trr ro rh. Conrrlcrols LtcnE Lr*).
<br />lxtrrcrcnrtn urld S..ri{rr .B &P( ntrrhi\r.r*[
<br />lA8trE8S:CAlIlENT6IlA
<br />DECl,1tf,A[OX
<br />I hcrcby nfilrm undf pcndry oa p.riury oB old. followin8 del,frlions:
<br />l.rh, (,rl.. nn r[c Ix o'numr of rtu sork lnr \hich rlr tLn r n'\{[d
<br />x hlvc and will mrinloiD sorkcr' comFnrllion insummc, al rcquircd by S*l ion :170{ of rhc Labor Codc, fo. ih. pdfo,rlmc of
<br />*ork for whrn lhis Frmil is is\ucd. My worken comFnsal ion itrsuEmc cMid oid ,blk, n!6ber e:?%s5.qDZ93 q
<br />7
<br />",K K,", ",,,,:.,,,,",,,,,,",-l
<br />enify rhll in $c !.rtormftc ol rlr sork fo, ehth rht p.ml i3$ a lo t.om subirr io ihc *oltm'omFnsarion |rws of C.liromir.m*s' 6n{a$ado. pmvisioBof Sslion 3Tmolrhc tjhor Codc. I
<br />snd u8.c lhal if I stntuld b.com suhjecr ro rh.
<br />shn[ ronhuilt @nrply qnh tk,s pdvhions
<br />WARNINC: Fsilurc ro surc wrl(crs oopcnsjrio. covc6B. is unlawtul. and sh{ll slbjcd 0n cmplorrr lo aimin(l ttMhtl and
<br />.ivil nncs ut, ro oft nundr.d rtsnsnn dolles ($l(x),(xlo), in rddilion ro ihc cosl ofcompcnsation, dotuscs !s rmvidcd for rhc
<br />LICIILTDDI;ONIAACIAB
<br />IIIiIIAEAIION
<br />I hercby annnlndcr rEnahy ol rBrjury rhnr I d licciEl ond.t Foviriun otchaprcr 9(.omnEncins *irn Sclhn ?(xrc) ol'Division l
<br />oi thc Busircss 8nd PK,fcssio ns Codc. od nryliccnsc h in aul, {ffcc ind.frNr
<br />o ry
<br />a
<br />COIEIf,IJqIIANII;NDINC.AIiENEI
<br />I hc.ch, !finm undcr pcnallyolFrjury rhlr lhcrc is a consrdcrion k dins a!.ncy ftr rh. pcrrannrncc ollhc work aor *hich lhi\ Iictnril i\
<br />issu.d(Sc. 1097.Civ C )
<br />1IIIUTANUISCIAX{ AN
<br />I tr', linnundcr r.llry otp.rjury onc orlnc t)lbq,inr dcchrnrion\:
<br />Dcnrnitr Pc.nrih A\trios Norilicrio. Fcd.tul Rcgulxrion\(Tirt 10. Prn6)
<br />-Rcqutcd
<br />lr cr of NorincJ,nnr
<br />-l
<br />ccnit that lhe tcdcral rcsnllrilns Egddins u\hc os ,cd,!al dc nor lpt'li$lc b thh liojct.
<br />I sdify lhd I h,vc rcod thk trprlic0iion o,n st0rc rh0r rhc ohrc informrion iscotur.l !!re h.onlJ)ly uilh,ll Cilyand Counly
<br />ordinaR-c\ !nd Sr!rc Ii*srcl ins h huilding .onstudbn- nl hceby JUrh,rn. rcEc*nlal ims
<br />ubovc nEntiotrcd pmrcn, for insl(lion
<br />Applicunt or A8c.l Sisnaturc:4_s
<br />.::v:/;-
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />It/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Delectors lnstalled
<br />Rough Ductwork
<br />Venls
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Ducl
<br />Fire Damper
<br />Openings
<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 />Notes, Remarks, Etc.
<br />APPROVALS DATE
<br />lnstallation
<br />L.ndcr'r N.E:
<br />-
<br />I
<br />fI
|