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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.
<br />UNDER GHOUND I I
<br />Waste & Vent (L,{ltB icl}-
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent ,*
<br />I
<br />2?
<br />Water Pipino
<br />I c7-rb
<br />Gas Piping tioo loz-tA 2e Art //4k/9//'i<.u?.*42
<br />Rool Drain 5A< .ba/arz- 4E
<br />Tub/Shower Test a)a^.t L^^^/
<br />Rough Water Heater /
<br />POOL/SPA
<br />P -trap/Drain Line
<br />Ir/ain Drain/Pool Pipinq
<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 la4t-tb Zc A1
<br />Final Gas Test
<br />Meter Release /z-f-/B 4e-z
<br />FINAL /2-3-/6 6c z-z a21 //rr/
<br />Notes, Remarks Etc e 27
<br />)
<br />,/z->-zD
<br />OWNOR BTJILI}T,R DI]LCARATION
<br />I hcrcby JInnD undd l.ndry of pr.,ury rhd I m cxcmpr fi.m rh. ContrckB l-i.cnsc lje lor rh. tolb*in8 rcasr (S.r 70ll 5
<br />Busines and Prolc$iotr Oicr A.y Ciry or Coutrly whi.h rcquircs . lcm ro construcl. alls. im!r.ic. dcfldish .r rcndt Jtry
<br />srucruic. prinb ir\ isluakc,.lv,r.qun(rhrrtplicrnrli,.{(hIElnirr(,fi[r\igmJdarcnEnr rhdr hc.r \hc i\ li.cn*l pu^unr
<br />k, rh. prori\iotrr ofrh. Conrrlckr\ Li.cn\cd l!, (Ctlprr q. Coalmcncitrr wirh sccrioo ?lx)(, d Diltn,n 3 ofrtc Bu\in.$ lnd
<br />l'rofcssn,n\Codc)oirhrrh..rshcis.rcmfrrh.rfromsndrhch\islorrhculklodcxcrprn'n. Anrv$lrtimofSc.rionT0Sl.5byiny
<br />qrpli.anr loru pcnnit subjcch rlN orDli.u l ro acirilpcndrrolnot nxrcrlM livc hutrdrL.ddollls (S5&).
<br />-1.
<br />ds .Bn$ of rh. r.Fn r, or ry cnrl loyccr wirh s+cs r\ rhrn s)h .onrrn\arotr. will do rh. lork rd rhc $nf,-lurc is ml
<br />inlmdcd or ofclcd tu $lc ( Sa 7l).1,{. lhsimss lnd PNfc$ions ctu]e lhc Conlracrols Licensc l i* docs nor !ppl, t, an .ei.r or
<br />rh.pn,Il.nt $ ho huild\ or nl\ton\ rhrtr,n, dwhodocs\!chso*hinsclforhcrscltorrhnrshhkorhcroMcmrk,ycc\.
<br />phvidcd rh.r \och imPlomr hmton idcndcd orottcrcn h. lrL llilr$c!cr. rhc tnildin! or imtovctuir t {nd wirhinuncru
<br />ol conlrLrir IltrOsncr IJuiUcr {ill tur rh( htr' dln.f !ii)!ns rhd h. ur shc dil,u t{rikl or inDNvc rhc pn,Fnr ln rl.. purF,*.f
<br />p(. o. n*,", ur,n" n,n*nr. un cxclNir cly colnraclirS wirh liktr{d .onriclor lo consruct lh! pmrcr ( scc 7(x,1. Bu\incs
<br />rtol Pnris\irn Codr ThcOnrrrcr{n s l.i.cnsc li$ (locx nor llpllyro rnosncroltropcnysho huild\or inrrrov.( rhcrcon,
<br />rnd \ho .onrd.r\ lir such pk)lccrs wirh. conr.rcrtr(s) liccn\cd prrnrair ro rhc conkkrr\ Li. sch*).
<br />l omcrcmnr undcr Sftnon .8.&PC.forrhFE.sn
<br />D.t.: O*n..--
<br />'Pn'
<br />lQ8trE8I.gQMPiNlA:IIlrN
<br />DEUAAAION
<br />rmrm u&ln lEoly of ldiury oft of rlE follo*ing dshdrions:
<br />qi,hlve lnd $iU nuirrninaCcnificareofConrnr ro Sclf'lNurc ld worksi compcnsrrtun. as rolidql rr by Scdioo.lTfi) olrhc
<br />r Gic, hr thc lErforrome .I lhc w.rk rd *hich dc Ffldr Ls issucd.
<br />_l h8vc a.d eill nri.rrio w.rkcrs con{En$rbn in*um.cc. $ rquncd by S*iion 3700 of lhc tihor Codc. lor rll. !.rfoMc of
<br />Itc qrk fo. which rhh Fmir Lr isdl. M, wo*6 cdnpcBarion imu@c cmi( ard policy nunbq m:
<br />I c.nifr rhar in tu lctormn( olrhc work fd shi.h rhis ncrm is isiucd.l shEll nor .mploy rny p.Mn indnym.nmr
<br />$ s to tE onE slbrd b lhc workcs' con{Ensalion kwsorcdlifornid.ond tr8N rhol if I should hcco!rc suhicl lo lhe
<br />wo*crs' .ompcns.lion povnions of Setion 3700 ol th. titnr Codc. I sholl. fonhwilh cooq,ly vilh rlnc pmvkions..
<br />WARNINCT F8ilurc lo *c!rc workcB compcnsation otrlsc is unl.wtul slhjod rn.mpk)ycr t) di'ni'r! F_ruhi.\ trd
<br />civil fincs uD lo orc filndred Ihorsnd d.llas (5100.000). in addilior d!mg.. as ,"ovid.d for rlE
<br />- t.t
<br />DIEIdNAIION
<br />IhcRhyalllr unarrt^-nrlryoIF-rturyrhiIimlicctrrdu rrpR,vnionolChJpl.r9rco'nnf,ir,!sihScdi({7(XXr)nfl)lvisi($1
<br />o, llr llu\irc1\ rnd Ilolc\\.r\Codc. ud nry lr.tr\c n ir,ulll,r.c:!rl.llc.r
<br />5'ts'13
<br />APILICANI,IECLASdIIIN
<br />I lE6y afiim undcr p.nliy of F+ry om oa lh. lollowing d.chroihf,s:
<br />Dcmlilion Pcrmils-Albcslos Nolificalion k.ral Rrguhlions (Tirh 40, P!n6)
<br />-Rcqunrn
<br />Lcncr ol Norirro'ion
<br />I
<br />triFl cEriI tho' rhc rcd.ml ,c8lktn'N rcsa'd'nB ostriosrcmralm nnrJpnln$hro rhn nmrc( I
<br />-l.cnifylhal
<br />I huic rcod lhis lpplic ionerd I lgre ro.{mply wirh dllCily.nd Coutrly
<br />ordinln.csa Srarc liNs rcllliry l{' huildirg rd C.unr, k, r rr trt,nrhc
<br />o6o!c nrcnliorcd pmpcdy for inspcclio.
<br />,\ptrliunr or.\X(nr Silnnturr:
<br />COMMENTS
<br />Fill Line/Back Flow
<br />S..ri.n ]076 oi ihc khr C.dc, i crc{ aod lrrorry's rcc\.
<br />CONIIBI]I:IION.I,EBDINIiICTNIJ
<br />I tcEl,y affrmunds !'cnaltyolrcrjury th lh.rc is0consrru.liotr hnditrB n8crc, for lhc,crfnmtc ofthcwotk for shich rhjs txmi is
<br />issucd (Scc. 1097, Civ. C.l.
<br />l.ndcr'iN,mc _
<br />*,., i 9-rg
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