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Form Ds-107 - Certificate Of Compliance For Installation Of Cpvc Plumbing Materials -City Of San Diego Development Services - 2008

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Certificate of Compliance

City of San Diego

Development Services

DS-107

for Installation of CPVC

1222 First Ave., MS-401

San Diego, CA 92101

Plumbing Materials

2008

(619) 446-5000

ovember

I am licensed by the State of California as a plumbing contractor, and seek a building permit

for residential construction, which involves the installation of CPVC plumbing materials as

provided for under California Plumbing code section 604.1b. Pursuant to section 604, I hereby

certify that:

a. I am aware of the health and safety hazards associated with CPVC plumbing installa-

tions.

b. My company’s health and Injury Prevention Plan satisfies the worker training safety guide-

lines of the California Department of Industrial Relations, and includes information about

the hazards associated with CPVC plumbing pipe installations.

c. My company will comply with all of the installation and health and safety requirements of

the California Plumbing Code applicable to the installation of CPVC plumbing materials,

including the requirements set forth at CPC 2007 section 604 and Appendix I, section IS20-

2005 thereto.

d. All individuals working for this company performing work on CPVC piping, have complet-

ed a training course. Certificate of completion for this training for individuals working on

CPVC are available upon request.

PTS Project No.: ____________________________

Building Permit No.: ____________________

Job Site Address: _____________________________________________________________________

Name of CPVC Manufacture: __________________________________________________________

Contractor’s Name (print): _________________________ Title: ____________________________

Contractor’s License No.: ___________________________

Contractor’s Company: ________________________________________________________________

Date: ________________________

Contractor’s Signature: _____________________________

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DS-107 (11-08)

Form Ds-107 - Certificate Of Compliance For Installation Of Cpvc Plumbing Materials -City Of San Diego Development Services - 2008