|
PLUMBING-INSPECTOB RECORD
<br />APPROVALS DATE tD/stG.
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough 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
<br />Final Gas Test
<br />Meter Release I
<br />FINAL
<br />Notes, Remarks, Etc t rl I 7l
<br />()ttNuR IltrIt,DFiR DELCARA TX)N
<br />I hlchy rrrlr trtrd$ |f,rilrt .r Nrjry ,rrr I r crcnr[ rt,n rlt Girrr.rod Li.cn\c ljs n)r rhc nni,wiDE rcJvD rscc 7).]l 5
<br />lrusirlcs\ iM I'rolc$iiu C(xlc) Any Cir, or Coutrry shiu[ rcqui.c\ a Nrnir l,' dD{ru.r. rlrcr. ]r|no!., dc x)lish,r ftln rny
<br />|o thc Imvi\nnrs olrh. Connn.rors l-i.cn\cd l.aN (chrntcr e. (-oNncmirE silh Scdion ?(xx) or I)ivi\i.n.l or rhc Bu\i'1rs\ rnd
<br />Itoli$iutr\Codcrorrhrrhcor\hc i! *cnrpr ihcrcionan(lrln hr\is fttr rlrrllca.J c\rmfn)n Aiy\i(,Lrn,tofS..ron70ll.5hyint
<br />rtphutrrf{trrprrm sohJcc(rhc rml'.rnrb rri!ilr(nrlrrormr nnnc rlu livr hundr.d doll \(15m)
<br />_1.ar oe@oflheprcF y. nyerlploter enh w!gc.8 rhcir $lc @trpcnsrtion. wildo ltl *ort8rd lhe(tul@ is ml
<br />inr.flLd or orcrcd ftr sL (Sa.?044. A$iEss Md Pmfcsionr Codq TIE C!'{.a.rols Liene t:w rlo$ ml .pply to .n owmr of
<br />lhc |,oFny who hilde or i,poE tffi)n, dd *ho des sBh wl* him{lf or lEtulf or lteugh ht o. hd ov..DphFs.
<br />prolid.d rnlr such imp|svmfi e mr hrcdcd oi otu for eb. lf. hoqes. tu trildinS q in+roE@nl is $U vilhii orc Jta
<br />ofonpLlioi, 0E o|,M BuiUd sil h,E dr h,nc! ofpFvi.g 0Er tc or rt. did rcl h'iild or inprct lh. pmFrty lor lh. purpos of
<br />-1.
<br />&s owncr of rhc Fopcny. am cxclusivcly conrrucring with li.cnsed conrrEror lo oanrucr rhc pmF.t (s.c. 7044, Bu,ims
<br />lrl I,lr{6sbi Cod.r Th. conituror s Licc.s t:w docs oor.rply to d owncr ofprcFny,ho blilds or improtr rh.lc.n,
<br />and who @nrE rs for su€h I'oj<rs *nh a Co ack (s) ltcn*d nusu ro th. Conrrcloas Lic.ose Lrw).
<br />-l
<br />amcicftpl undcr Scol
<br />UOBKEBS:II}IdEEJIAIION
<br />DECIdAAIIIIN
<br />I l*rcby dffirn ondd pcnllly of !.rj!ry oft of lhc folloqi.S dccli$liotrs:
<br />Lrtxtr Codc. l(tr rhc rnnnnri( ot rhc $.* lirwhich rhu prnnir ( nnrcd
<br />_l tule and will nuinhin workds .onpcisarion i.orum€. ar dloird by s.crbn l?m of rh. l,bor Codc. for lhc !'.rfomre of
<br />rhc work for whth rhir Frn ! iriucd My wor*e6 .or{$sa oo iisure. cdicr at polty nu6b.r m:
<br />Policy Nun$.!r-Dr rcsl
<br />_l.cnifyrhsr inrhe pqfor@.cc dr rhc aork ror which rhh r.rnir k hsucd.l shtrll nol cmrloy.nylcmtr in rnt mnrcr
<br />$ !s ro h.€m subjer to th. sorkcB onFnsalbn hws ofcalifomh. lnd !88lhal if I iholu bc.oft subjd btlE
<br />wortcN smpcnstion r,ovisio.s of Sction l?0O oa thc L{hor Codc. I slEll- font*ilh owly *ith rho$ povi*k ns .
<br />l{Af,NlNc, FailuE ro ecuE eo*c6 ompen lrion oveng. is !.hstuL ald sh,ll subjel o qoploFr lo aimiml pEhts lnd
<br />civit iines u! ro orc hlndrd thousnd dolla ($!00,(x)O). in ddtion lo $c co.l of.on{Enslion. damA.s ni pro,A.d for ln
<br />Serkrn 1076 ol rhc t hor Cod.. inifts1 ..d .tbrfty . les.
<br />Applldnl:
<br />I tcFNSltD c()N',rRACIlrl{
<br />Drgr'If,lIllQN
<br />I h(dhy d ft , u i .r If,tulry o l If, rjurt rhnr I n li.ctr{d uddd flov'noi of Chnprc. 'r
<br />(..DrnEN rn! sirh Se..ri$ TdXl r ot l}irisi{,n .1
<br />ol lhc lrusiocs\! l'retcsii,n\ Codc. arxl myli.cn* is in lnllturcc mdclli{r
<br />LieNc Chssr Lic.n* Nurbcr:
<br />Drr.: co tulor
<br />caNsrf,lJcuaNtllllNciotiNr.r
<br />I hdohy,ltrnrndci linslrrort'.rury rhnr rhcrc is, coNrrucrntr lcndine n8cnc, ror lhc pcrro.roncc oirhc Fork fff shich rhis p.nni n
<br />i\s0cJrscc 1rr7. Cir C l
<br />_l .dify rhdi th. fcd.ral rc8ruhrnrns EBrding astEd.s rnblal ,i. not ,rpticrblc ro rhis tnjdl.
<br />-l
<br />c.aify thd I h,vc rcld rhh rpplicalion erd iror. lhll rhc stoE infomrion G corer. I !!ru to oqn, wnh .tl Ciry md C6Mly
<br />oldinrr€s and sr.rc L!*s EhriiS ro blilding.onnodio 4d h.rcbyllrlbriz. etEsenllliv.r ofrhb city ud cou.ty ro..lcr uFo rtE
<br />ohow mnliomd pEFny for inspclion purpo.cs.
<br />Appllonl or Ag.nt SI,lIduFl
<br />P.mltc 0m (pdnl):-
<br />afrifi[tfrNg.uuEDl-
<br />COMMENTS
<br />UNDER GROUND
<br />Area/Storm Drain
<br />AIEIICAII.IICLIAAIIQ!
<br />I hdry anim undcr Fnllr y or ltrjury onc.rrhc follosing d6.'lr,rn ns:
<br />tlmninrn P€,nils Ashcsros Norifiorn,n Fcdcral Rclllarions (Tnb40, Pan6)
<br />_Rcq!nud llx( ot Norili@rioo
<br />f------T------
<br />f------T------
|