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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OW]IER IUILDER DELCAf, TION
<br />I lEr.by rllrm undcr p.dlry of pdury lhrt I @ cx.ht'l fom lh. Co.lt.cldt Lidnc L.w for lt folloyins @. (S.c ?0l l.i
<br />Buiiicr. and Pef.sion Cod.): Ary Cny or Cou y wlich Equi6 a Fmi ro otrrnc! !h6. inlcrcv., dc@lirt' or Ep.ir any
<br />lrrutuc Eir. ro it3 isaK. .ls EqliB 0. 4iplisr hr Gh p.rol b nl. ! rkn d 3t.l.mnt lhlr tE or th. ir li..dd por$.rl
<br />ro lhc pmvisios oldE Conlreloar Li@n3cd llw (Chtplcr 9, ConmNioS wilh S*lion 7000 ofDinilio.3 ofih. Butin $ and
<br />PoLs,on! Cod.) or rh b. or Bh. h .i.nfl th.efiom t.d lh. hsir lor ln sueg.d .r@paoo. Any violalion ofs6li.n ?01I 5 6y any
<br />lpDlicafl for . pmn lubjek rh. arplient 10 r .ivil p.Mhy ofd mE fi.. fivc hundr.d &lhr (t50{).
<br />-1,
<br />.i owE oflh. poF,ly' or ny .niplortd wnh wag$ s 0Ei. sL ohp.nsllio'! will <b th. soft orn dL sln,lE n rct
<br />inr.d.d or otr r.d ftr sL (Sc.ro4.l, ausiEs rnd PmfNiorc Cod.: rh. Co,nEclqt Li.tr lj* tIB tul rynly 16 & ownr of
<br />rh. For.ny who hil& or inpoB tE6n . who dG sch sb|t hi@lf or h.*lf or thmush tk or lEr om .mploves,
<br />,Dvid.d rh,i sch i,rqmm.ll m ml iitidcd oro,r.Ed forek.l( tnwffi. !h. hoilding or itpmEmt i. $ld within on. ]Er
<br />ofmqil.tiol in o*B auid.r will h.w th. h!d.n olpmvi,s lhd h. or dE dil d buiH or ir+6w tlE poFry 61 0r l{tl.c of
<br />-1,
<br />mown rofrh. pml'.ny. am dclu$v.ly codhcxng siln I co,IdcroN b onstruct th. poj.il (sc. 7044, ausinc$
<br />...{n.r.f nroD.nyqho huilds or inpD!.s lhersn,ard t\ofisih Codc: 'l-h. CDntrclols Lic.nk Liv do6 mt apDly
<br />a.d sh. comh.is aor 3uch Ixoj.ds wnh . Conr6cb(4 licen€d ro rh€ conlracrois Lftnre L.s1
<br />I ao cr.on{ undcr Sdl
<br />I h...by ofiim und.r p..all, otn rjrry oc ofrhe followiry d(h6l
<br />_l hav. Md will mrinrrin i C.nificate olco c.t lo s.lf-INUE for .c comp..elion, .. pmvidd for by S.dion 1700 of lh.
<br />Ldb, Cod.. tor lh. Dnforunc. o llh. K* for wnich thc pmi h i
<br />_l hav. ond will mainhin wortdr' 6Ep.N.tion ir$mx., os r.qlircd by Ser ion 1700 ofth. Lrbor Co&, fo. rhc D.rfomm. of
<br />th. mrk for wtich lti, nctuit is is.d. My worksr' orymolhn ins6d. omr t !d lolicy numb.r G
<br />P.licy Nuni.r
<br />-liin.s:
<br />I erlrfyrhar in rhc !dlor@m. oflhc vork lor shi.h thiF r,.dn h Gsued,I shall ret cqiloy ony p.NJn in 8nv mmkr
<br />$ ar !. beom. sbiftl ro rhc *o*6i cooo.nqi.n llwr ofcalilomi., a.d
<br />*qt6' 6mp.Miio. pmvhions olsfttion 1700 of rh. Lah6. cod., I *Bll,
<br />rnd ,fI rhiuld hdotr rubjal rolt
<br />.odply wrh rhos tmvtion!
<br />IVARNINC loilu.€ lo Kur. sork tr'comr.m on orcm8t is unlaw ana rhill subr..r .n oplorlr lo riniMl peMhns lnd
<br />civil lin.s o,' ro one hhd,.d rhousand dollnB (s100,00o), in .ddnnrn ro
<br />Sarion:lorrt.fih.I -. Cod.. i.t rd dnd cnom*t
<br />I h.Eby afllm nnd.. pcMlly oartrljury thlr I am li€€nsd undcr lovkion of
<br />of lhc Busims ond Pmf.$iods C.d.. ern my hcm* is in tull foc E i c
<br />Li.crs Clnr:-Lc.nr. Nunbc.
<br />D.l.: Co.t..torl
<br />coNirauqlaxJ:lDllc.AclNcr
<br />I he.ehytrftrnxnd.rFnrhyofr.qurylh.t th6.6a coodtu.li,rn l!.dins,sc.cy lor lh. t.rli,mncc olrlE "ork lorsfirchrhiilnn i4
<br />ksucd (Sa 3097. Civ. (')
<br />AITUSANLDICIJSAIIO!
<br />I hdlty o6m uidd t.mlty of r.rjury oc of th. f.lloving ddb6liont:
<br />D.mliri.n Pmir*Ach.ros Norifiqrion F.dml R.lul.tion ( l ill. 40, Pan6)
<br />Rcqtrtr.d Le[q ol Norincdi,n
<br />-l
<br />c.n i& rh.r rh. f.d.ol r.$hrions mbcaros rcmql !c mr rynlic.hl. h rhis DmJ..l
<br />-l
<br />cdlrry rhrl I luv. Md lhis rp ication !.d if,foffirion is oGr I rSrc ro oDl,ly wnh sU Cny .id Cou.Iy
<br />ordrnrnctr Md Sr cLa*srchlilu lo iurhorizer.p.cscnr ttsofrhhcityi.d(nunlylo.nr.rulonrh.
<br />.bovc me ioEd pmp.dy for
<br />,",.\t-2T. \/appll.!nr rr Agenl slgniltrr.
<br />P.rn,irre nnh,. (,*i',r) I Lt-7-
<br />UNDER GROUND
<br />Waste & Vent 'l-a4(v.qlo
<br />Water-Under floor l-A*(i.urul
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent 7-v
<br />'fi4d8
<br />1
<br />Water Piping
<br />Gas Piping tr
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOUSPA
<br />P{raplDrain Line
<br />Ivlain Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service l[-4'ly ,,r+at
<br />Water Service ll-a+t{'>,qaa
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap A
<br />Ltt-. GthI \€lY'z-q1y v"l{lto,
<br />Rough Plumbing "wVl lv)
<br />Final Gas Test
<br />Meter Release
<br />FINAL ,Ja'1"n
<br />Notes, Remarks, Etc.-r r 7- v
<br />Back Flow Device
<br />(L
<br />2/
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