|
PLUMBING.INSPECTOR RECORD
<br />DATE rD/srG.COMMENTS o\1NltR Elltt,DuR Dt:Lc,tR'rloN
<br />I hscny nm n unn.r n nalry ofNiurv (hd I .m.x.DDr lmn rlE Conlra.lo6' L'c.nse l-rw aor rh€ ft'lL{ins r.rsn ls.c 70:rl5
<br />lJusincss aB1 lrofes$on Code): Aoy C y or Counly whcn rcqur€s a p.m'r ro consrdcr. aho. mtft,lq d.hnhn or re|rtr any
<br />(rucrue, piorlo ils Fsumce..horequrcsrhcapplicanrl(lrsuchp.rnnr16filcr$8n.dnarcm. {ldh.orsheislicrnsc\l nur{inr -'h rhc nmvsions of rh. Conrlcloas l-iccns.d Lnu (ch.fl.r e, (_oNn.ffrns s ilh S.cli,rn 70l)l) ot Dr$ M ll ol rh. Bunncr .{i!! r
<br />I'rrassn'ns(ode)orlhilhcorsh.nexcnrprrherefinnan.llheh.nsturhc!ll.s.derelnrnn A yriohrnnolsernnT0:]l 5hyany
<br />arnlicanr lori penD subjecrsrh< aptl'.anr b rcivrlpenolryoffrrr mor.rl$h liv. hundi.d dollrN (55(m)
<br />-1,
<br />.r ouB of ih. pbFrly, or my .n'plorE! wilt m8$ s th.n sk od{EMlioi\ eill & tl* m* .ttd tlE !1.d@ b Dt
<br />iiidd.d or o,LEd tu sl. (56.7044, Bu.iBr dd lofe*ios Cod. 'I'hc Conlndoar Lie@ Law do.r nol .pply lo 6n owM of
<br />rh. propdry who boil.h or iipioB [E6o !d wlD dc @n s ,im.c,l6r h.Blfor ihmu3,l hir d hs os.,ryloy..s,
<br />pmvid.d lh{ @ch iopmv.Br,! E mr int d.d orolftEd tu aL. l[ l$utc. tlE blihing or iqlmltm it $ld wilhin orc ]t!r
<br />ofonnhio,\ rlE O'*rd Brild *iU Itsrc l,E hr&n ofFovi.g thdt h. or .h. dad Dl hih or inpmE tF IlDFry t r tlt pltt t of
<br />_1. Nowerotrh. rmpdn an.iclliivcly@lllr&rane * h liened conrmcroN ro otur th. psj€r (src.7(}14, BuriB
<br />s.d Pmft*io. Cod.r l h. Coalrlcloic Lic.nr. Lrw do6 mr mlyto sowB otrmpcnyaho laildr or inrpmv$ th.on,
<br />and sl$ dnrEcl3 for ,uch pEi..1. wnh a C6dscro(, lhdrd IxMd lo $. Co.lrocloi3 Lic.n* L.*).
<br />_l at cr.mti ualc. Sar
<br />la8f,E8l:CAll?jdsAllgB
<br />lllcLaSaltoN
<br />I h.r.by ,mm uido F.alry olpajury oE ofth. followin8 .hchEthro:
<br />-
<br />l h.!. fil srll m'nran . c€nr icar. of C'omcor ro sclf.l nsuft for workcG coopcnsalio., as pmvidcd ft, by ser io. l7m ofrhe
<br />l.hor Code, turh. pcrtonutuc.lrhr $olk fttr which rhe Fnnn i\ i$ud!
<br /><Z{h3'"ona*lttn'oi'ruln*o*c'conDensrrioninsu,anc..asrcqukcdbys..xonl70oorth.L.horcode.,irrrhepcrramrnc.ol
<br />rhe sork for uhich thh nemir G F$ed N1y worlea ompcn$r ion insuri(€ cari.r nnd Fn'cy numbn rc
<br />,*",,51^kfin4
<br />40D}177
<br />-l
<br />ccnify rhat in th. p.rformic. of'ha work hr whi.h lhh t'.mir is isru.d,I rhall ml e,nploy any r,.Mn i. any hm*.
<br />$ B ro h.otr $bj{E( to th. md{d'mm!.trbrio. lavs of Califomi.. atd nsE thd if I 3tbuk l*.om stlFi to llE
<br />vort E omr.netion,,nrvisionofSfttion 1700ofllt Labor Codc,I drll, fonhwiih coorly with lh.r. lmviliotri
<br />WAru,{lNC: l,ailurc to Kurc uork B' comp.nsdion covmrc is unhwtul. aod in ll su6.r.r m rmploy.. lo crimiMl p€mllis and
<br />civil Iin.s up to.re hund!.d tholeod d.lld (5100.1xx)). n.ddni6n 16 rh. co{ ofomr.rsti.G drmse os povid.d fo, rh. r
<br />Codc, inrcr.( md ilrornevt Ls.
<br />^"",,""",, 'r4r4-'' r rcr\slpfirificrnl
<br />lrlcLAaduoB
<br />I hercbyafilnundr.lcnalryolp.ruiyrl.d I i l'Rnsd rndo loriri,,n ol Cl{pr.r 'r (cmnrmiry w hSari{,n7000).fDtr1nonI
<br />ol lh. BusirE$.nd lhl.$i{,ncCod.. and mylrcense is rn llll litrcc r rfie.r
<br />4zs412l
<br />I o/,t c',,^,t, -h*
<br />catsrBrLquoIll:lulc.d(il;Ic!
<br />Ihereb!.iinnunde!Fnrhyolrcrjuryrtulrher.Fic.nsrrucrnnlend'nrr!.ncylnrrhcr.rtnnrn.Loarhcuorkior$hrhihtrnsnrilis
<br />Nsucd(S.. 1097. Cn C )
<br />AII!rcAIIIECIASAIIO!
<br />I hdbyafrmunder r,.Mhyof D.riuryoft of th. folloeini decladiotrs
<br />D.mh ion P..mtrs-AtlE ro. Nolificalion l.dml R.g!l,liom (I nb 40, PD.t6)
<br />-R.quiEd
<br />tltr.rof Mtihelion
<br />-l
<br />c.nify th rh. ,.d.nl aglbrbN E8ardi.8 .sh..t6s Eruvdl .rc nn applicabl.
<br />'o
<br />lnk pmj€l
<br />I c.nrtyrh l h,E r.rd thh aoplic.tiondi.r.tthat th.0hov. infoflMlion isordl.I urlo ohtlywith allCtyltd Counry
<br />.di.an.s and shrc Lrw6 rl,ling r. buildine conrodio^ rnd h@ty, h.riz. r.prcsdxativa orrhis Cily lnd Couory ro mrd up.n rh.
<br />ahrle d.nriokd pmFny for insp.cl VWADDllcNnl or As.trl Shn.lur€
<br />,UrrL,Lo l-a*r
<br />r
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<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 />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL /Z-r/-/9 &z>
<br />Notes, Remarks, Etc
<br />APPROVALS
<br />Tub/Shower Test
<br />L,ndo'3 Addrfl{
<br />-
<br />I
|