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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS
<br />UNDER GROUND I
<br />Waste & Vent (L4 B (lc3?
<br />Water-Under floor | 'l
<br />Gas-Underf loor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT I I
<br />Waste & Vent 1
<br />Water Piping
<br />1-zt -rg 6ce
<br />Gas Pipino lo-z-t8 &zl /96-G4&{
<br />Rool Drain .//-z'tl Zr>z ^Tub/Shower Test /LJrort- ctzt o.,- /.t"/
<br />Rough Water Heater
<br />P-trapi Drain Line
<br />Main Drain/Pool Piping
<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 Plumbinq i6-t/-lB Qc2 7
<br />Final Gas Test
<br />Meler Release /z-y-/8 Vlzz
<br />FINAL /2-3-/8 (7c
<br />"'7
<br />oru Co</
<br />Notes Remarks Etc.?-G z2lf,o tA TesV- Z-tt la-<1b6-t1-tz)| ,4la? oU,--b
<br />t,,r-t-;<2,..r-/llet D
<br />I/arl a4 k,- F.z,t-*(-
<br />OWNI'R BUII,D!:R D!:T-CAlrATION
<br />I h.'cht rllirn unds p.nrlry,,r pcrjrr!
<br />'hri
<br />I m.icnU tmm rhc Coikr.t)^ Li.cn{ ljw lnr rhc i.ln,$in8 rq$n lsccT):115
<br />Bu\ilrc{s r*l l,rorc\soi G)dc): Atry City r Cuu ry whkh rcqutc\ | ff,nni k) oNru.r. ,lrcr, nnprcrc, Jcmolish .r rB't rflt
<br />slrlcrutc.,,ritr n) ilr tsu{n.c. als, rcqutcs lhc nppli.rnt lnr qrhlEirnilro lllc r srgncd \lnr.nrnr rh h.or \h. i\ li.cn\cd td6drlr
<br />!J rhc pnrvis.i\ ofrhc Cd kr.ny s l-i.ci\Lat lis (Chrprr 9. Coh rc.ii8 qnh Sc.rnr TUX} ofDni\ion:t oltl'( Bu\ircs\ ind
<br />PDt$n'.s Corrc)orrharlt orshc ir crcnu lhcrctonr rh. hrns r(*
<br />'hc
<br />rllcs.dcrcmorion A.ylioluliotrolScdit)n7lr.ll 5brxny
<br />lppli.Jnr forr pcnnir suhjcc( rhc ppli.rnri, rcivilfcnrllyolnor 'nor.rhm lnt htndrcd dollu\(S5m)
<br />-1.asowncrofricDmrErly-ornrycnrplolrcswilhtra8.s!\lhct$1.co'r,q\
<br />i(in. $ill do rhc sorl dl rrt \lturun i. iur
<br />icfltrl or o,r.'.d lir slc (SL{ 70{4. Bu\irr$ a.d Profcssn,nr CoJc:1hc Ornkr.ror's Liccn{ tjw des mt E dyro 0n o{ncr ol
<br />rhclmpcn! who huilds or nqNvcs 'l..Nn. rnd who dcs sNh s.* hnnsclior hcr*lfo. rhmush hn or her osn carplor..\,
<br />rRrvilc.l rirt such inuw(m.rs m m'l irlcxlcd or olttrln f.r qlc. li hwcvcr lhc ttritliry or iryrowmnr h sU wirhio om ,tr
<br />ol .ulrl)ldion, lh. Orncr Burlds $rll lDrc rhc idnlcn oa F)ving rhxt hc or dr did to, bxikl or infn,vc thc l,n,lFny ritr rhc purt[r of
<br />t l.sii{Nrrlrh I' ,Iflry. trtrrr.ld{!'ly."r., En hltrr !'J,ninJdrNL'ron{ru.rthcfmEcr'5!r 7or4. Bu.inrs
<br />(xl Pnf.r\hi C.dc Thr ('.nti.tr'\ Licc.\c l-0w dd! nor rptly ftr M owtrci oi prol)crry who hu ilds or nnprclcs lhcrcon.
<br />rnd *ho onthcr{ r'or such prorck wirh 1coflru.ror(\)li.cnscd Nsu,ni k, rhc Gtrrncrois Li.cn.c bu)
<br />-l
<br />m cicnfl lnd€r Sccrion- B. & P.C. for thii caan
<br />l!0af,Ell:g)gtENsarlo!
<br />TECI.ASAIIA
<br />I h.Eby !l,im und.r F.ahy of p.rjuy orc .I ft. lolloDing dcclaarioa:
<br />-l
<br />hlvc lndiill ruinhin rCcnificurcofConscnr ro Sclr:ln\urclhr workcrs d'mpcn\arion, as povidcd forhySs'hn lTmolrhr
<br />tihor codc. tu
<br />'h. I.rformn.e ol lhc worl Lr shah rhc trfln h Gsucd
<br />_l hlve ar{r will naamuin workcB' coopc.sadon anruEkc. N Equircd b, Sdio.1700 olrhc rjbor Ctdc.lorthc lErfollrwc of
<br />lhc eo* ior vhiiih rhii pcmir ic h{cn. My e6rkcrst orpcnerion an{r,@.Min d Flty.umlEr m:
<br />I enity rhlr in rh. p$ror@rc. 6f Lhc wort ror shi.h rhis poon L ilind, I shnll nor cn'ploy {ny pcr$n i. a,y 'norcrs lo bc$m subjNl lo lhc worl6' .ompcnsolion luws ofcalifoflria. ond aBN lh.l if I .IDUB t tonr slhFl lo llE
<br />woAss' cotrrt Nslion pmvisions or Sdior 1700 of lhc tnbor Codc, I shrU. tonhwilh comply silh llF* t otisionc
<br />WARNINC: Failurc ro *.ur. workcft ompcne'ion cov.rnSc h un
<br />ciril fin.s up lo om hundEd rhous.nd dolla {Slm.(] }). in
<br />Sdion 30?6 ol$. r,hor Cod.. intcrcs and flomy s lccst-€- (o
<br />^
<br />IIE!:I,AXAIII.IN
<br />I hcah] {mirnundcr Fcnrhyolpcdurylhlt I mr lien$d undcr tmvnn,n olChaptcr 9 (cobdn.ing *nh Sd.rion 7m0) ofDivision l
<br />of rtu Ausii.ss d Prcfcsbn\ Codc, r.d my li.cn* n in full16(dricnill
<br />o.r" F (
<br />LllNI[l(]IIONLINDlNQrr.GUllt
<br />ir{n.nis.. nEl aiv ( t
<br />ATPLICAII.DECLABAII9!
<br />I tEftby rJtm oalcr p.n!n, dfpc,jury om oar,r nnb*ins d.claarn,ns
<br />t)emlirio. PcrmirsAslEstos-N.rificurion Fcdc.rlRcsuhrn,ns (Tillc40, Prrl6)
<br />-Rcquncd
<br />Ldler of Norificalion
<br />I cMityrhar rhc fcd.rul togrhrtuns ftgaining ah.do\ rcft)vtrlrc nor amli.$lc tu thk pojdr.
<br />-l
<br />ccnify thot I hovr rcad lhn rypltat
<br />.rdinln.cs and Sllrc L3*s Elarins ro bli
<br />I lAr b.-ofrplywirh trllCiryand Counry
<br />6ilnis Ciry dnd C.xnryro cnr$ uF,' rhc
<br />atbE Bnliomd pmFny for
<br />AnDlicnnl o. Ar.nl Siqnal'rre:t- e- (g
<br />tD/stG.
<br />POOL/SPA
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