|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping tl /t?ltr @u6n'-/tz--
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />IrIain Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Ro ugh Plumbing tt/tz/rt e izzor* /0z-
<br />Final Gas Test //r;1/r Qu*7/t aU't--
<br />Meter Release
<br />aravtt-FINAL tt lo h,l lk'
<br />Notes, Remarks, Etc
<br />(r1!Nf ta Bl,ll-DER Dl'l,CAR/ll lON
<br />t h.r.t', aflinn und.r n.nilry.f!.rjrryrhir r;n er.nrpr lmm rhe contacror'License LN i.r rh. folhwint rer$n (S.c70:ll5
<br />ausin.s3 ird PmL$tr,n C_r)dc) ny cny or aounry_ {hi.I rcqun \ , ,.nni ro m qrudr, ilrer. nnrnre. de mlFh nr r.?in iny
<br />$rucxr.. pri.r Io ils hsimc, als rcqures rhc .prli.rtrr for ru.h r'. nr ro nhi srsnedslir.hcnr lhd lEor sn. r li.ensrd pumml
<br />n, ihe ,r'lisons ol rh€ co.(rcro.s Licenscd I ac (Chirilcr 9. C.mmc.on-g {irh S.crion 7000 otDrrirnrn I olrh. Borine* &d
<br />Phtursn,ns cod.l orrnar h.orihe iscr.hfl rherclnrdrnd the h.nr,i, rhc alleld.rcnprbn A.tvnhr$ntrls€rhn70rl iI'y,ny
<br />lnplic. lor.rcnni subjc.llrhc applican' ro.civrlpcMhyofnor nDr.llrn nv. hundr.rl doll.rl(S500)
<br />_1. N ownd ofrnc pmp.dy. or my .mtloyle w h e!gc! a rh€n sb @hp.rclrkrn, will do rh. work !,i llE ,lnxr@ ic mt
<br />inr.rn.d or otr@d for aL (Sc.7044, BuriKr End Pmf.rrioor Cod.r I h. Conhcror's l-ier l-a* d6.r n6r drpry ro m os*. oa
<br />lh. p{opdy *rb bil& 6r irpm6 tlE6l\ .rn wth rh.. sch wlr him.llor h.ml tor lhmusih his or hd oM mplot€6,
<br />prolid.d rhar ilch itr{mltm.'r! ft mr hrdd o,nltu t r sL lt lhwe. rlE hildi,B or i,pmEed i st wnhin.r )€r
<br />ofcoo{,htion, th. OwRr Auild.r will IEE fi. hu&n ofpmrin8 lfial h. or rt. dil ml hild or iq,mE $. Fmtdy tu r plqmof
<br />-t.
<br />as o{rcr otrh. tm0dq an .iclusirly conrmrins *irh li.d*d coirBcron ro 6ndod rla ,ejd (Sft. 7044, Busik$
<br />.td ttutsir con. Th. Conlrrclolr Lic.ne hw do6 mt arply ro m.w..r ofpmpdy vho buil& or inprets lhcron.
<br />lnd qho orrBcr. for sch ,,ojcrs with r Co mro(, lictrd puMnr to rh. Comnclol3 Lk.dlc L.w).
<br />-l
<br />rm.xrhpr undd S.dion-. B. &1.C. forrhirt.ardn,
<br />WORI(ERS'COMPENSA'NON
<br />![ct aaau9N
<br />I hdcby !flim !nd.r ,.ehy ofDdjury o.. otth. followins ddlaEtio6l
<br />-l
<br />hd. atd sill mintlin a c.nifearc of coefi h sdf'le( for @l@ @Dp.nslioq &e pNvi,.d for by setion ll?00 oalh.
<br />Labor Codq for th. pcrfol:Mcc ol rlt wo* for ahich rtE Fnn ir is.d.
<br />_l hrt. a.d will maiotrm sortfl conrr.ns ion in,u6nc.. &r Equn.d $y sftton J70o of th. L,hor Codq for lh. p6fomnc. .f
<br />lh. worl to. which this p.mn ir iscd. My worka comp.ndior inDmc. cmicr atn Flicy numbq m:
<br />-l
<br />c.rlify thal in lhc lerforrom. oflh€ rcrk for vhich thh Frmn is k$ed.l stoll ml cq,loy any pcMn i. ahy nt.ffi
<br />s trs ro b.6m. subj.rl lo rh. roik6'ompourion hwi ol Calilomra rnd .erc (hd if I dsuld l'..om. sbjel lo lhc
<br />worlcl stpensr ion ljmvhioB ofsnrion l70o of rhe Latn. c6d., I .h,ll, todhwnh cor{,ly silh lir* pmvkion,
<br />WAININC ljaihrc lo *cur. trork.B n cover.sc h unla*f!|, ind rhnu suhlccr m mpl.y* ro aininrl r)aElr6.nd
<br />cMl fincs ur lo.rc hundrcrl tlFusrnd dol (S100.000), in gddnion lo rh. cffi of @ol.Mrioll| .,aru8.! .. povid.d lo. th.
<br />Mq<.o: lc-sa.\t.
<br />I r( I \\l r)( r)\llr\( r()R
<br />Dlt( l.ak,\ t,()N
<br />I hsehydfind und.r pcnalryof rl,ar I ur lrenki undcr r.orilon or Chi/o I {L! r.bc:.8 wnh sNrbn 7lr(ro) ol DivisLon l
<br />c L o?-10{
<br />I lEcby rltm unda Fuliy ofFiury
<br />hscd (56. 1097, Civ. C,),
<br />h.din! alacy for th. p.rfomrc. of thc xork ldr which rhir ,ltrir is
<br />arg,lcalr.llictaaAua!
<br />I hdlt,y 0dim und.r p.n.hy of p..jury onc of rh. lollowing d€clarono.s
<br />Dcnolnoo P.rdtu Asbcstds Norifi. i6n [cd.6l R.rrlalions I1irl.40, Pan6)
<br />_R.q!icd L.u.r of Norili@rion
<br />r.salarions ftE.rdins *h.nos rdnovrlarr nor lnrlr.tl. ro rhis ptuj{r
<br />srpplLcnnonn narernar rhcih,ve rnfomtri,,n n corccr lasrd.h.omrlyprhillCityonnCounrv
<br />mBconsrtocriorr rftl hcrch, nothri2.rpr.s.nr.liv.s.flhsC yandCounryrocnr.rulnnrn€
<br />Pohx.imm.6q
<br />of lhc Busin$ o.d Poadsions Codc, ond my lic.N. is r full fo.e rn cfIet.
<br />r
<br />tands!AddB.-
<br />t/klbL.H-
|