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PLUMBING.INSPECTOR BECORD
<br />APPROVALS ID/SIG.COMMENTS OWNEIT AUN-DiJR DI]LC RATION
<br />I hcrchy ollirnr undcr jEnrlry ol pcrjuiy rh! I m cr.mpr riom rhc Cotuactm t-i.Msc lr* ror rhc folloNin! rrw. (se 70ll.5
<br />Itusincs snrl P,oacsioi cdl.) Any Cny or Counr, whi.n tcquic\ r Fr.rir ro .on(rucr. ollcr inPovc. dcm)lish nr rclEn iny
<br />srrucrurc. pri(rb ir\ tsuan.c. ako rqlncslhc appliclil tur \n.h r.rnn ro ilc r si8lcd (urcmnr lhll tt.r shc ir lic.n\cd puNrnr
<br />h lh. provisnnN oflhc Conrr.ttr \ I-i.ctrscd ti* (Chrflcr 9. ConIrurcins sirh sccrion 7fixr of Division I orrh. Businc$ and
<br />ftolu$nnN c('dc) or rhnr hcorshc is cxcnrrt lhcrclr.m,nd rhr hNis lot rhc dll.Scd c rc m,,t ion Anyviddrn orscdionTrr.ll.5hvan,
<br />q,plidnr i.r rp.mn NhjNis rlE 0t'0licrnl b scivilpculryolnor xre lh.n fivc nundrcd dollars ($500)
<br />I. $ owncr of lhc Doprrl y. or oy rtupbJtca (irh s.!cs .\ rhcn srb conrP.n\dio.. sill d. ttE wor k and thc {eih i\ tr.r
<br />inrcfllcd or olfcrcd ror sL ( sd 7L!a. Busircss rnd PDa.$ions Cixr. Thc Conhdols Liccn$ ljr dds no( .!lly to !n osncr ol
<br />rh. F)IEdy sh. tlild\ or inrl,R.vd rhcNn. dld wlf,l d(s suh tr! hims€Uorh.rslfotrhou8hhisoth.towncntpk,rc...
<br />!rt'vid.Jrh such irprornEnls m mr idcnlcd d oflir.d ror $lc. lf. h'v.w. rhc huiUi'rg or in lNmnr is sld Nirhin onc ,tr
<br />of coEplcrion. rbc Osn.r Bxiu.r *ill haE llE hrdcn o, povi',E rlBr rr o. shc dd mt huild or itrwoE rhc pmFnt nn tlt pu,F,E ot
<br />-l.
<br />n\owncrotrhc pmp.dy. a crclusirly€onl,aclins*irhli.cn*dcot0.tonroco.slocrrhcptr,jc.r(s..70'1'1.8u\irtrs
<br />ind Ihrli\sbn (tdc: Thc CoDrracxx r t-i.cn\. Lrw des nor lt,Ply to 0n o*ner orlrt,F.i'y*ho huilds or nnrovc\ rhcrcon.
<br />!.J sho.onra.rsforru.hprojcchwirhaconrrrbn9liccn*Jprrludrrolhcconrlckrrl-icn\cbw).
<br />-l 'n cr.mpr und.r ssr B &PC roi rhis EasD.
<br />l)ifu ()sncr
<br />WORXT{S''OMPf,'\ISATI(TN
<br />DEII.ABAITON
<br />I hclcby !flirn und r..![yoflErj!ryoflcoflh€ lbllo*ing dc.lu,rio..:
<br />-l
<br />haw od will trinl0i. ! Ccnificute of Conr. ro Sclf- In.urc for sorkal sry{nqlion. a pmvidcd for by Scclion 37()0 of rh€
<br />Libor Codc for thc ,trfolrMcc ol lh. wo* for *hich rhc ponir i{ irsucd.
<br />-l hlr !.d will mai.rain wortcB conpcnslion ins!6rce, $ rcquilld by sel ion 1700 of l& tltor C.dc, lor lhc pcdoM. ol
<br />xrvh(hfir mnni! n nsucn M
<br />, ^:,Lwrt V
<br />y wo.kcs cor.pcis nrnnr\ur E.Micr lrn rnty numbcr dc:
<br />-t
<br />c.nify ih&l in th. pcrrbrmncc oa lhc sork lor whi.h rhir !.rmil is nsu.n. I ihlll not Nmploy any pc$n in 3ny dnN.
<br />s as lo hcsm subjsr Io rhc worhc.s comp.nsrion law! of C.lifodi!. and agN thtri if I should t .om {bj*r to llE
<br />sortc6'compensrionpovhionrorseli,n3TurofrncLlhorC.dc.ldBll.tonh{fthsq,ly*itnlhoclovirio.s..
<br />WARNTNG: Foille 16 surc w.rlcc' con{rnsalion otB8c is unhwtul. and shlll slbifl an cmploFr lo qinitul Futic.i u<t
<br />:"JtAt"'
<br />,t$t,1.$m dollars (51(xr.(xx)r. in sdJirnr\ ro rhc c.{ oi compcn\dn,n. ddnrgcs us povii f(r rhc
<br />DticLa&uroN
<br />I h.ruhy rmnnrnddr pctr.ltyoIlt juy rha, I ao lienwt undrr pn,lNiotr ofChatrcr I (cofntncins wilh Sccrion 7([x)) otl)irrrnn ]
<br />ol lhc ltu{ine$and Pnni\\n,nrCodc. i,:l my liccnsc h in fullnx.t d.lrL!(.
<br />t\2oT .6'1
<br />A
<br />{.:ONEIASJI{TNTENDIXGAAENS
<br />I hcrchyrlfirmundcr pcnulr! oa r.rjnry rhd lhcrc ir. conslru.lhn lcndins asctuy ror rhl nr.,n,marcc ofrhc *ork lor whkhlnis Pm n
<br />i!\0.d {sd. -{}97, civ. c )
<br />krdcrs Nam'
<br />-
<br />AIILLC NLDECTAEAIIO!
<br />I lt$y rtlinn undcr pcnrlry ol tcrj(y on. ofrhc f(nb*nrr ddlnritions
<br />I)cnnilirioP.rmi* Arh.{osN.riicdion Fedcral Rc8uhtiqn(fnL,l(). P.d6)
<br />_Rcqutcd l!(dr or Ndifi .!rn!
<br />Ensvol!rc nol amlttrhlc ro
<br />I rsrLr r' .ooply wirh all Ci,, rnd Counry
<br />""'""''"ffii''"i''7 "'**'i,
<br />rtnlc innnnurnrn is corcur
<br />!h,vc mnrioncd prorcrly rbr inspecrion
<br />Appli€nl or Aa€nI SianaluF
<br />P.mile mme (p.int)l
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptori Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Floof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/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 />Rouqh Plumbinq 5z Ylq',>e Uf17t44
<br />Final Gas Test
<br />Meter Release
<br />FINAL I t4?-/,J)zt>/@
<br />Notes, Remarks, Etc.
<br />DATE
<br />pnri"y n,.t*@e.*ni..,\.\
<br />ValE<tra-
<br />kndc, \ Add'.s
<br />P!';.{
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