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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OlINEl{ NUII,DT]R DI]I-C,TRATION
<br />liqchyrlliimuDrlcrtrtrilty(,f|frjfyrhrr I ur cicnrt'r rronr rhc Codh '6 (.iccnr Li* lnr rhc folk,sins rcxrnr lsc.70:ll5
<br />Bnsincs r.d ltofr\\i('n CRl.) Any Ciry or G)u r, trhi.h r.qrnc\ r lrnrir ro..trsrrucr, llrcr, iNn()vc. dc rli\h.. nBir !!y
<br />{fl.rurc. fiid r' irs is\hncc. trlso rcluilcs rhc.pllicinr hr !r.h F-rnrir h I.! \i8trcd nrrcnf,nr rhd h(or \h. is li.ctscd Nrsurnr
<br />r, rhc Fo!tn,n\ nl rhc Coitr.ttr 1 Li.cn*d lrw lChntrcr 9, Comnrn.i ! Nirh S.(tion ?0(r0 of Divi!t,n :r ol rhc Btrsin(s rtrd
<br />Prrfdssi( rsGnlc)or rhdr h- orshc,scxcmpi lhcrcliomrnd rh. hns lnr rhc nllcgc! orrnl]nnn, Atry vn,ld.onolS(rion70ll5hyoy
<br />rnpliQtrr li)rnI].rnrir\ubjccr\rtE rpplic!nrn' a civillrrnrliyotr.r Rrc ihad firc htr.drcd dollan (S500)
<br />-1.
<br />s owffi of th. pmncny. d my.mployes wirh wl8es as ln n $k odp.nsrio'r, will do *E woll ,td rlE sErxrr is noi
<br />inEnd.d or ofi.r.{ tor elc (sd.7ol4. B!.iNs dd Pmr6sions codc: TIE cnrlracro s Lirtrs t w &B mt +ply ro M oq&r of
<br />$cpropdy aho hrill! or ilpt B 0EEa &d vho dc sNh mtt hirelltr h.mltor lhrcud ht or ltr own cnplores.
<br />prcvidcd lhlt sh ihpownls N ml i"ldrhd MoflE d ln $h. ll howE, the boihinS tr inprMd issldoilhin6e)@
<br />oaodFhtiol! t rc Owmr Bdt6 wil hrw lh. bui!.. ol pmving rhd lE or sh. dil ml hoild or inprDrc dE tbpdy lor tlE purl[$ of
<br />-1.
<br />!sowrcrofrlE nmpcrry. ancrclusirely€oorracling with lien*d co racroNlo consocr tlE pnj.d (Se.7044, Bsinc$
<br />ord Pbfcasion Codc: Thc Conrerof. I-iccnsc La* doc. n6r aptly 16 an own.r ol prop.ty who builds or impmvcs lhcrcon.
<br />dd *ho .onrEcts for slct F)j.crs with a ContBciro(s) licnscd purs@nl ro th. Conr.!.toas l.icd* lru).
<br />-l
<br />smcicmpr u.dcr Sar
<br />uaaf,Ef,s:loMtENtAltaN
<br />PECIJAAIIAN
<br />I ncEby amrm utrdcr lcdlly of !*rlury otu of rhc l'ollowin8 .lcclarsri.nr:
<br />lhsvr rn'l sillnuinrrin r Cdilicrr.ofconr r b tuli:|tr\tr,c litr sork.^ .. rfc s.rof. s f^,vdcd lir hyS.sion lT0Oollhc
<br />Lrtxr, (iri.. Inr rhc plrlorNnEc oirhc *ork lnr {hic[ lhc |En'ir i\ i\{nl
<br />_l hrve aM will minmin sorkcr' .onwn*arion in\uh.c.. I rcquircd by Scrion 37m ol lhe L,hor Codc. for fie pqfortuncc .f
<br />rhc suklarshi.hrhi\ p.rmir i\ issu.d Mysurkcri com f\rri{,n i'r \uM!c .oricr orn ,olicy nuq$cr e.:fu. Furc'l.f ie cl la
<br />LL
<br />-l
<br />ccnify thol in lh€ pcrrormmc oltk work aor $hth this l)crnir h is*ucd.l Nhrll rel tmploy ry peMn in any monncr
<br />h N ro bc.om subirl & rhc wo,tds co,rF.sarioo liws .f Crliromi.. dd .Em fiar if I should tEcom slbjccr b rlr
<br />M*c( &mpen.{ioopovtionsofS€tion l?00 ofltu trbor Cod..I stdl, aonh*nn o,nDly withlfto* Dmvnioos..
<br />WARNINC. Flilurc to sure workc6' .onpcnerion !a*cEg. ii unlaerul, and shdl suhjd m cmploycr lo aimitul lt@hics ,M
<br />civil fincs un ro orc h!.drcd rh.usaod dotl,B 151 in lddition ro rhc con of cohFnsalion. dlnq8cs .s Polid.i r.r ih.
<br />Serion 1076.frhc LrtDr (bdc, inrcrc{ ahd an6@y xLs
<br />DECIJMI'ON
<br />I hcrcbysfirmundcr pcnalryofncrjury lh l aF lEnrd ondcr lrolisjon of Chapr.r 9 (.ommncin8 *ith SNlb. ,OOO) of Divhior 3
<br />of $c Busimssand PrcfcsiotrsCodc. uld myliccn* is ir tull aorcc tclri.r
<br />Liccnscchss:' L{cci
<br />coNsTRUct(lN r rrND|NG AGt:NcY
<br />I hcrchy arfin,undcr Fnrltyoi!.rjuryrhlr lhcrc h a con\rnrcrioD lcndi'rs rlcncy rn rhc pcrruiitun c o{rhc work nn $hich lhn pcnni n
<br />ir\ucd (Scc 109?, Cir C.l
<br />A.TTLIQTNLDtsCIJNA A!
<br />I lr tr$y.nnn urdfi Ntrrly ofp-rjury orc nlrhc lolkJq'nB dcc[r[n,nr:
<br />Dcm.lnn,n P.rnrir\ Ash.ios Notfi.art,n Fcd*rl Rc8ul i. \ (lirlc 40. PrnO
<br />Rcquircd tlncr.l Norii.di.n
<br />l.dify rhd I tuvc E d rhh 0rnlicnrion ord s.rc Ihlllhc,trvc inlbmurion h cord.I acr lo cnmply wirh ,ll Cny ,nd c.nnry
<br />odinam.s rnd Stal. tiws rcklin8 aurhorizc rcrrcsnrariles o{rhisCiry Md Counryto.nrd ulon tlE
<br />rh,vc rr riinrd pnipcnyi(tr in\
<br />!hre .h+g*ry8
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<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
<br />Final Gas Test
<br />Meter Helease /a-;)
<br />FINAL 7."-/E /t/r.uc,'oY
<br />Notes, Remarks, Etc.
<br />UNDER GROUND
<br />Area/Storm Drain
<br />Waste & Vent
<br />Fill Line/Back Flow
<br />fu,,thuoh rrn
<br />/ozg
<br />-l
<br />ccnifr rhlt Ihc fedcEl rcs{larions es{dinB.\bcsros rcmval arc nor ltplic,blc tu rhis pbj..r.
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