|
PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS (,WNER ttuILDER DEI-CARATIoN
<br />I hcrct, lfno rtot.r rcmlry oI pcrjurt rh l n.krprlmlhc(oDkrt('*'l-j.cnsljwao,rherollo*in8rclvrrsrc7o1lr
<br />Busnr.\( nrxl h.r'csi.n Codc): Any Ciry or C. irt shich r.qrt.s tr Filnn lo c.nslrucr. rlr$ imfl)vc. dtmrlnh r Rnln .nv
<br />{rudurc.lnirlo il\ nrud...,l{,.cquncs lh. nPplicrnr r(* {kh trirni h lilc ! siskd sr cnrnt thlt tuor \h. s liccn{ puru!
<br />k, rhc l^,ri\iotri ol rlx Conrr(tt\ l-i.cnscd li$ (ChiPrct 9. Con r..i!r8 Bilh Sdn,n 7lX$ ol Divisn'n .r of rhr Bn(im$ 'frI
<br />Pbfc$nnrs Cod.)orlhrr h. o'\hc is cxcilr lhcrcriomlndrh.bd^lorrlrc.llcscdcxcnuion An!viohrioi.fsLtri('n70ll.5bvotrv
<br />.fflicrtrrlar ntrcnnir \!hJ(r*rl[ rPplic!tr1lo acivilPcmIyufnor nnmlnnn livc huMr.d doll.rs (S5U)).
<br />l.^sowncrolrhcnmF-dy.orhy.nDloytcslirhsnAcs*rhcnencconllcnsurion.wiudorhcso drhc{tururismt
<br />i erl.ll or oftrcd rrtr {L (sc 7or4. Busin.\s nid ft.L$ions Co<lc l hc conrD.ttr s Li.enc tiw d,k\ nor qlt'lv ln m owtur or
<br />rh. psp.ny wh) tn'ilt\ or i'lrorcs rhcNrtr. iurd stx, d,rs \uch vo* hinsclior h.(clfor rlrou8h his or hcr ovn cmphyccs.
<br />pmridcd r lN $ch impovdmn* d ftn imcfl[d or.lfcRl (r lilc It howcEr. rlf, tn'iuin! or in rovclrnr is srLl sirhin ''E ]ta
<br />ol dnnphrir rh. o*ncr Buildcr $ill nar. rr* bt.dcn of !$vins rh,r lt or \hc dil ft,l h'ill or in{nrk rrc pmPcny i', rhc t"'IIe of
<br />I.nrosncrollh!p'opdy,dmcx.lusivclyc.nh.lirr8wiihliccis.dontracroFn)coinrudrhcPmj€r(Scc 7I!'l B \ik{
<br />and thniish Codc:'lhcCotrnocrolsl-iccn\et-.sd.snotrpnlyl{'!nowicrofDroncny*hobrildsorinrEovcslhcrcon
<br />.nd {io co mcls lbr su.h pmj,-rls wil[ . Conrro.n(n liccnscd NnuMr ro rhc Contn.ktr s Liccnsc lls)
<br />l0mcrcnrpt undcr Ssrn,n-. B &Pc forlhnelson
<br />D.r. ()en.r
<br />lt0R|(FtLS' (:(TMPENSAT!ON
<br />DICLAf,AIIAN
<br />I hcrcby smnnondq p:naxy ol t diury onc olrhe aolk,$ing d.tlmlions:
<br />IharcmlrillnuirlririCcnificrrrufC.tr\cnrhSclfltr{rcn]rqorlcnconlxr\rt,n.islovidcdi hvSerion]7(Xloflltr
<br />hhn Cftlc. ror rhc FnanM.cc ofrhe Rork tu qhi.hrhc ncanir i\ i\{rc
<br />r'ics lrnrtrh(hrhi.r\1inr'Lr.JAlVy$, lfl..'{',r\1}rrntr '!{tr. krtr1tr1fdtr'cynu'nh.' rc
<br />O- ) --&
<br />I ccnify$sr inlicrcrlotmnccoflhc work for *hichrhisp.rnn n nsucn.l shrllmr cnr,,loylnyFcmn in vm,nmr
<br />s as lo li.o'E suhhcr lo lhc *ortsa d,nipcBtln,n hqs of Catifonia. and ,8Ec lhtrl if I sholld bcc.m subicr to llE
<br />w6*c6 conr.nsoriotr lmvisi.nl6lS.cribn l?m ollhc ttrbot Cdrql shrll, tnnhwirt oqtly wnh rbePmvnions
<br />WARNINGT Failurc b wurc *o crl onlFnsrion ewaSc ii lnhwfxl. d.d sh.ll subicr an ctDl.,tr lo oimidl pcMlri4s dnd
<br />civil fin€s !t ro otu hundrcd rhotsaid dollaF {Slm.ooo,. in lddilion b rlE.osl ol co'qcneri.n .t!d8.s as Ptovidcd ao, th.
<br />Sccrn,n.1076 orrhc trh, (odc, inlm{ und dttrry! Ls n/.,2 2o
<br />rr r k llurirtr\\ id ltori\\i(nr\ Corlc. rklrry |i..tr\. n i', hLlll(n( x (1.11.(r
<br />o3L 6f r5f
<br />...,2S-.
<br />goNuElqlr)N!E8Drlcllif,lcl
<br />I hcEt, ltlirm un&r pcnally of lcrj!ry th.I rhd. h . mnntudhi biding eecNy lor lh. PerfomN oflh. wtk for whkh rhh Fmi k
<br />nsucd (S( :1097, Civ C.)
<br />LxnJcr \ A,lJrc*
<br />ATEUISIiIDESAAAIION
<br />l,rehyrlhnunds p$trlrt or F-.rjuiy o.c nfrhc hlln"n,3 J.ctrrrri,,n\l
<br />l).nnn orPrn ir\ A\t\ (os Norificrrn F.dci lR.lnhrnrs ( lill.l{).I'n 6)
<br />Rcquncd l.cn.r.l Norificrri,,n
<br />ilyrhrrrhc f.d.tul rctubrioN rgflli'rg r\h.{os rr ori rrc nol nPpli.ahl. h rhi\ fojccl
<br />.cnifyfid I havc rcud lhh dpplictrion ond (!rc lh0r dE olnv. innrm0riotr iscord I qsre roconDl! *ili !llciry.nd cou.ry
<br />lrhi Cnyand Cou.ryro cnh uDo.llE
<br />D,t 2' lvzn
<br />odinaft.s und Slltc Liws ahrins ro buildin8 .onslrucriotr 0!d hcEby durhorizc rcPrcuurir.r o
<br />abok mn'bmd !mr.rl, fo
<br />Appu.ul or Ag.nl SlsEtu lllril,-^?
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underlloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Misceilaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq /-t4-2"frAa<,ot
<br />Final Gas Test
<br />Meter Release
<br />FINAL 2-t 4 -2,Erit ,of
<br />Notes, Remarks, Etc.
<br />UNDER GROUND
<br />*n, 2'l l- ?a
|