|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS (,.I1NI]R IIU I I,DER DEI,CA RA'I]oN
<br />dn trr., trkru ir\ i\{r..c. rl$ rc{ltrvcs r[ rp,rlir fn \uch Nnnn n) ilcr \L8tcd {ricNrr rh hcor dr i\ liccn\cJ rur\umr
<br />ro ihc l]nni\ion\ ol rhc (rdroctr'r l-iccn\cn lj$ (Chrprcr 9 ConnncNi',c\ilhSccri,,nTrxx).rl)i'i\i{)trI.rrh.Btrsi'ics\ad
<br />rmharrturrtxlni\!hilrr\rhcqrtlicrnrbL.irilfrrlrrorDornn,crhrhu[undrcddoll]r\(S5(Xr)
<br />Lr\oshcroirlrpn,,f,ny,or yclllloycc(sirh\r8c\r\rhrn{rc.omtcn\[i( .silld.ihttrork rlrhc (riuai\ nor
<br />inrcRlcd or.lLrcd lorslc(SL{.7G!- au\incs( otrd lint\sotrsc(nc Ihc(tnhcui!.iccn{Ii$doc\norlprlyhnnornrrof
<br />rhc pnln.ny {tu, 6uild\ or i'\x,vt\ rh.r$n. dd*hod,i\\u.hso hnnsclforhc^rlr.rrhn,u[hhitorh$dwtrcnployccs.
<br />pn,vi,lcd rh.r su.h inn.r rtrh c n.r ir .dd .r.flaRi ntr {t !l h.su cr. rh. huiklirg .r i'qm[ rnr i\ $tl rirhin {! )rJr
<br />otunvLriotr,rhcOs.rBnildcrtrillh!\crhchnrdcnofpfuivirgrhrhcorshc,ldnorhurld.rinpxxcrhclmplnylbrrhcpuqi'*of
<br />-1,
<br />asorncr ofrhc pm,rcny.0mcxcllsilclyc.nlr.crins wilh lic.nscd conrradoh ro.on(tucr rhc Imiccr (S(.7044. Burinu*
<br />srn h.fcr\ion C6dc: Thc Confa.roas Li.cnk kw d@r nor anply b o.sn r or lroFry who builds or inprorcs lher@n,
<br />ond rho conlrucu ior such pm,cds qilh a Conlmck(s) liccnFd nusua to rhc Connacbis l.i.cnsc liw)
<br />-,amcxcmpl
<br />undcr S(t
<br />D.tc: Orner:
<br />uoxf,Ef,stcoMrrNtAllo!
<br />DECI,ASAIIIItr
<br />I hcrcby rlfifln undcr pcnahy of lErr!ry o* of lhe fouowin8 d$lsr.rions:
<br />Ihrr.r'ld$illnrinrri'rrCcnli.rrr!lCon\cmL,ScllLsurclnr$orkch.onl|rctlxrt.asInrvnhdli)riySc.ri{n,.]71[)olrh.
<br />l-aIxtr Cod.- lnrrho pcrionnrnc. olrtu sork lar which rhc !cnnir is lstrrd
<br />_l have and will m0inlain worlcs com0c.s ion !s rcquidt by S(l ion 1700 olrh. t bo. C.dc. for lh. rErfmm. of
<br />l,li6n ialrdc @ic. rld policy !u"$.. @:rhc wort nn *hich rnhrcrmir irn cd My
<br />I ccniry rh.' ir rhc lErfonMB. ofrh. work for whth lnis psmir is i$Nd, I stlllaol caploy any pcnon in !.y mm,tr
<br />e !s lo becom ruh.iccr to rhc vo,kcs'codpcnsaiion ldws ofcllilbrnia. dd nam rh,i irl should lx.om subj.rllolnc
<br />$o*c6.otr{Enslrionpmei(ii,.\orScrionlT00olrhcLahrCodr,lslk'l.rodhsnh.o.plywnhllF*pDlirions..
<br />WARNINC: Failurc lo wrc wortcn o,nlf,nsarion ovcsgc is !olu*tu|. and shall sutjc.r !n mploy.. ro dimiml pemhG and
<br />civil nncs up to one hoidlcd rholend dolldr3 ($l in uddirion ro rh. cos of con{Ensarion, dsmgcs !s potidsd for lh(
<br />Sccrhn 10'76ofrhc Lhtr Codc inrcrc{ lnd
<br />-,.,/ ilt)tl(-T-
<br />DI:!L!]!AIIQ[
<br />ol rhc llu\inc\\rnd Pn,fcs\n,i\ Co.l.. rd nry lic.n\c i\ id lillturcc ri .lfccr
<br />Nun'bc! C ,;
<br />':l'7rtt'"T--7-'-1--+Ita-Y>7 t(1ti\s ttctl()N t.t:Nt)tN(i.\ t,:N(]\
<br />I h@by {flin uld.r Fmly ol ldjury rhsl lhd. n a oNMthn Lndin8 !8crcy for th. Itrfomtue ot llc vork lor which
<br />'his
<br />Fmn i!
<br />isslcd (Sa. :1097. Civ. C.)
<br />E-tfLlCANLDIrgzlSIIIOIi
<br />Ilrrhyalhnrri crpcnrlryof ftrrjuryotro.f rhrt)ll,irir!d.chrrrnnr\:
<br />l)cnn,lirnn, turn,ir\ A\hn.s N.rilicdi,nr l:cd rl Rr!trlri,tr,r al irlc 10. l'rn6)
<br />-&cqtri'(l
<br />l,.lr.r of Norili.ariur
<br />_l dif, $ll rhc fcncful r.Solarionr Eg.rding Lsbcnos rcmvd rc not ol)plicahlc Io lhis pmi{l
<br />-l
<br />c.nify inar I havc E d rnis applic,rnr !d sratc thor thc a&,w infomrt,tr is con a1. I asG ro 6,nply wirn .ll Cny rnd C.un'y
<br />ordinanccs and SIolc tj*s rclolin8 buildins c.tr(rucrion. $d hdcl,y curhoriTi lcliescnrarilcs orrhis Cny dd cou.lylo cnlcr uron lh.
<br />gbovcnrdion d pm!.ny lor in
<br />.+-*'-$/a/1s
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under IIoor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping rh< lr,?zme*l/D-
<br />Gas Piping k End*tA-
<br />Tub/Shower Test I
<br />Rough Water Heater d19tP (4\tr0l*-' I (f1-
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain 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 />Rough Plumbinq I tllr</tr "4nnn D-
<br />Final Gas Test
<br />Meter Release
<br />FINAL Klt€lr*119 _
<br />Notes, Remarks, Etc.
<br />r1^,,,r+9,rh
<br />knd.is Add,rs.
<br />-
<br />l
<br />Area/Storm Drain
<br />Roof Drain
<br />f/vt/t6f/
|