|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE owNl:R ul!l,DuR DEl,cARAll()N
<br />I h..rlt imrn unds r.n,lry ('fn.rlury rlrr I im crcnrnr rnnn rlr Conxacto^ l-'ce!sc trs aor lhc follo*rns rrl\Jnls{70115
<br />lru!in.$ r Pnntssion (( c): Ary(ityor coudy Nnlcl requires a n rnrir lo $nsrtuur, nlr.r. nndr., d.trrlh[.r qrt M]
<br />(rucllre, pnor ro rls Fsuarcc. nlv, rcqtrcs ltcanpl'cnnl it such !.nDrr er filrr {ryned n .mnr rh h..rshc h lrc.ns.it pur{.nr
<br />h rhc pnvsnns oirh. Conlnclois Liccnsed l-iN lchifle. g, Conmemrng w(h Scction 70m o, Dtrrtr,n I ofrh. LlusiN$ .nd
<br />tolession!Cod.)orrhalh.orsh.i{ekn,DrrhrretrcmandrhehN\,itrhe.ll.!ed.r.nDrion Any!i.l0rimolScclionTl) l5hrf,n!
<br />.F,rli.ininrilemnrrubj{rqrh..DnlMfllor.ivilp.'BlrvolknmoRrlunfiychundtcdddll..s(St(r))
<br />gq86E!S:c0MIl!SArO!
<br />DEq!AAAUq!
<br />I h.r.by .mm undd prnohr.fr.rjury o* ofrhc followinr ddhrd iodi:
<br />ll[\ciflqill tlimrnx(-cnrll.ricoiCon$rb\clllnstcli'r\vorkoiconrNnqridr,r\Irn,vklrdlitiyS.{rFrrrlr(r.irh.
<br />l-rh.r Cod.,,itrrfu pc'ntr'nin( ofrlr sork tur which rhc nd,n $r{rcd
<br />I haE and will nrint0in sork.rt comF6atinn inrldnc., as r.qurEil h! s{r nn 1700 olrh. Llhor Cod., for rhe pdfomtu. 6t
<br />rh. {olt for which rhh pchn is irs.d My $uk.6 coopen$rion im..ft. erid md policy numbc. e.:
<br />Policy Numb.r:-Exp
<br />_l c.nify rh in th. p.rformarc. ofth. wort for which rhis p.rmir is bscd. t ,hall .ot eoploy .ny ,,.60. i. any hMr.r
<br />s s lo lE$m suhFr ro rh. nodicF srnpdsrion lavs o f arlif.mia, ,hd rh,t ill slnuld b.c.m wbFcl lo lh.
<br />worteG' compcnsaronproris(,nsof SecrionlT00of rh. l.rhtr Codr, I h*ilh smnly trnn lh* pmvhioni
<br />WAnxrNG: I'ritu.. lo Eur. wo.ke' mmrEnstiotr mtms.
<br />civil fin.s un lo oru hldrcd rhousnd dolllN ( 100,000), in
<br />seton 1076 of (h. L6h.r Con., intd.sl rnd onomy s L.i
<br />lid {ull sbiri .n ophrq to simjEl ,'sEltii. l
<br />h. o$ of c.!t0.ni.!ior drd8.s os phvidcd for $.
<br />D}:CLAAA]ION
<br />I hcrby omrm und.r ncmllyolrerjuryrhir ! am l&n*d und.r pmvi$ionotChlrr.r 9{contuems w hsdion7000)ofDivisionl
<br />ol rh. Bftincss lnl P6ie.som Cod..6rd oylcens. is i. lull fiae and .rT.cr.
<br />/'3 -t4 ..,,^,*,
<br />colirBuclroxJ.llD]lclctitg
<br />I h.rcby a,liro u.d.r n elry ol p.rury tar rhce 6 a conno.rion h.din8 aSmcy for lhe Ddfolr1rme .f rh. mrk Iir shth thr Fmn ii
<br />issu.d (S(. 1097, Civ. C ).
<br />lrrucalr.tEct A8dua!
<br />I hfttryafmu 6 r.nnlryotp.rjwy6ncof rh. Iollow,n* dElrrrrio.rl
<br />D.ml(ion P.rmils-tub.sros Nolificirion li.d.ml Rqtlations { I irl.40, Pan6)
<br />-Requircd
<br />Llt.rolNotifslion
<br />l.cd'lyihat rht led.d I r.su l.t ions
<br />_l c.niry lhd I hav. Ead rhi.pdi.arion $ar U. aln!. infomrioo is coE..l. I r8r lo omrry *nh all cny td counry
<br />odiMnc.c lnt Stat. L0ws rcl.ritrs lo hlild tuctiol! and h€r.hy,nrhoo! rtrcr.nlrtivs of lhh cilyond counryro.nr.r ut.nrh.
<br />atnw mriomd ro!.ny for insr€tion
<br />Applldnl or A*.nl Slqn.ltrrr
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent rA
<br />Water Piping l--7-t1 y$11d
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/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 />Rough Plumbing
<br />Final Gas Test r\
<br />FINAL t-1"t1 Y.\&"1d
<br />Notes, Remarks, Etc
<br />ID/SIG.COMMENTS
<br />Gas-Underfloor
<br />Back Flow Device
<br />Meter Release
<br />l. as osncr ol'rhc nmn dr, orniycnrployccs *irL wtrrcs as rlr'r {n. .o,npcnsd trlr, $illdo ilE work ind rlE 3lrucrE r{ r
<br />rnrnxl.d or.rtr.d ntr ek ( se 7044. lrusircN .nd Pm rissom corle: I h€ a ontacr$t Liccnr Lan do€s nanrlytMo*.eroI
<br />rhr nmFny *ho hurlds or '!{,m16 rhcru)r! ind *ho &6 tuch sh& hm*lror h.r*ltor rhn,ugh hr or ier own cnrpl,,r..s.
<br />nmvdd nmr such imrmvunenls a e frn if,reBtn .r oflrrst Lr $]c l[ h)*r1er. ih. tnr]Uins or i,nrrRiuk i k $ld qrlnn oE ]H.
<br />oaco.rpldo( (tE ()w..r Buitltr will ln\r ln€ iod.n olpNvn-* ttul h. or sh. did mr hu'ld or tnpmlt rht rmpdy ,ix rlE tur,!,e ol'
<br />l.Nos,Erolth.rmpcnv,nm.\clusively..nrncnnsqirhlicenEdcontrcr.^kr.o ntud rhc pn)lLrl (S( TlB4.lrusine$
<br />lnd PDf.a*)n C.d. lh.Cotrtrrcio.sLic.ns.L.udo...orrnplyt'.n.rn.ro,nhnny{hohuikkornnp'o!.rrhem[
<br />trDd who contmcrs fitr such pmJ..k sirh ! c{nrmd,r(s) liccns.d r\uotrr t,rh.(onhcrois Li.e r. Las)
<br />IaDcrenrru crsstnnr .A &P.C litrhRr.,$n
<br />,.n,-L/:/1--
<br />L.d.r'! Addrcis:
<br />-
<br />aslxsrs rcnm$l de nol oDDlicablc to lhis omj.cl.
<br />-------r-----
<br />I
<br />I
<br />=
<br />I
<br />=
|