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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oTVNIR BTIILDTJR D!]I,C RA'I'ION
<br />I lrcrehy iriinn under p.nrLrt oi 0.4ury rhd I am exetrDr ,mnr lhc (ifliclos l-ic.trse Ln{ Lr lhe !nl[ \m8 r.jr$r ls.t.701l 5 ,
<br />ItNincss a l Pn)ts*)n (({rI Any Crly d' (irunrt (hich Rqttr.s , ncnlir ro .oDnrucr. ilrd, npn&, d.nn'lnh or lcllrt in!
<br />qrrucrurc, pnorro 1r\ Nsuin.r, iho rcqutr* dre iFnl(.nl irslcin rn t, iLe r sisnc(l {{c.rN lh he.r sh. n lic.n{cd nurs}rant
<br />h rlrc ,lrovhions ol rh. (inrh.tois Licenscd !.aw lchdtro q. coflnn.ncina sirh s.crdr 7001) of Dlthhn I .rrtu Bur'ness and
<br />Itofc$ions Cod.)or lhar h€dr rtu s d.mlrrh.rcan,nr ond llre l'!ns tur rlr rlles.d dcnrnrion Anyri.lalionol sr.L.nT0ll5 hvinr_
<br />.pflunr liranero,r suir(r\rrr rnpllc.nr h.cnllrrMli,yolnol nrrcr)'ir nr. humn.d doll.r (t50U
<br />-,,isorkrolrhenn,p(dt.{r.rycnrpk,yErwhRrIc..
<br />lkir$l..oDnensir.n,s'llrI rh.s.rka rlf,srru!1ucr ,
<br />dcrxl.ioroll€.edior.il.(Sc?(N,l.Bu$ne$idlhlcssnne('o.le'lh.(inr.croisLiccnelntr&esnorrnplyk)anotrnerol
<br />rh. nf,)n dy rlr huilds o. ilrjrov6 rheBrn, ant who d,xs sch *)* hr Nollor hcnelf or rhmulh hN or h$ .\'n cd{loyt.s,
<br />nmvd.d rhxt such flpR,tnMrs me d {tcdcn .r o llik, Lr $1. I li lr,sn $, rl* hu] [l$3 or rqrBx€DEnr is sn wihr ok ,tfu
<br />.rconDlcnoc rhe os,n.r llr'lli.r willMlr rh.lltrd.nof pmvms rtsr hc or drc dxl dn build or irr(rc rlE rmFiy fitrnf, NrI$$ of
<br />-1.
<br />asownrofrh.trcrdry, m.xcluiiv.lyco Eclins wilh lidr$d o,lracrou lo otr{rucl lL noJ..l (S* ?(N4. aurr,K
<br />rrt Prf6hn Cod.: rh. Conmclo. ! Lic.n$ Law do6 6t .pply b M o*nd 6f prq.ny wlh $uildr or iqmv$ lh(oi!
<br />lnd wln o Gcr. fo, such pmjdls witn ! CoilEclo(3) li*is.d lusutfl lo rh. Conl cloa3 Liccn* tiw).
<br />_l
<br />I hcrch, rrliru und.r ltMhyofpdlu.yon. ofllE lol
<br />I rho' (n,1.. lnr rh. nc'nmrnr( olrh( {.rl iitr \rlnrll !he ncrmr N '\n'rl
<br />-l
<br />h.rc 6d will mrinloin workdt oop.nt.rFn aNut.ee! ai r.quiEd hySdtion 1700 6t$. Llhor Cod., for lh. ndtomEe ol
<br />rh. sort fo. shich thir nnft is iso.d. My Mrt.^ 6or..erio. in hre fftr ad poli.y ounh.r ae
<br />l'r'licvNu rh.r:--lixn
<br />I c.nify llBt in rhc llcraororm. ofrh. wort aor which lhir p.mil i. is t( | slEll ml .mrloy any ,,€M. in tny mnE
<br />$ ni h h.s,* flbj..l ro th. R*6 dhpms'lion l4 of Crlifomia, and asr thal if I rlblld lt com subjet h ttE
<br />wolt.rc comr.derilln tmvitioN of S..lion 3700 otrlE Llbor c.d., I slEll, lonh$ilh omlly wirh ttF* nmvishtri.
<br />IVARNINC: laihc ro kur. sork.R snpme0lion coveEs. ir lnlawtul. ,nd shall $bjecl an dtloFr ro crimin.l Dmlti* snd
<br />), in lddnio. ro lh. cost ofcomti.n*lio6. d.m8.s.r provid.d foi ri.
<br />I hdehyimrnunder penxlrt.l undcr pntiooo, ch6pte q (comNrcins *ilh sdtbn 701)0) ofDivhion 3
<br />.f lhc Busircss.nd P$IesionsCod., ad oyl
<br />n!.Nuhld:-
<br />colsrBlcuot-lllulliacrxcr
<br />Iher.hr0mrmuon.rr.n^lryofp.rjuryrh rherc is r con(rudron lcndirs agency fo! the li.r,inmincc .lrhc work ltr $hl.h rhr tEnn s
<br />rsud(Scc.1097,(iv C )
<br />t.ndq'3 AddEs.
<br />-
<br />AIIIICANLD!:CLA8AI!!
<br />lh6!l,yammunder p.n.hy ol p.r.iury onc oflh. finbwns d*limnns:
<br />Dem.lirion P.mrirs Arb.rm Norification lj.d.r0l Rellhtions(-lnk 40, P0n6)
<br />&.!uiEd L.tr.r of Norlic.lion
<br />I ccnit lhar rh. f.dctul r.srul.rionr Egdding rsbc{os i.fr)ul trrc not ,pplicabL to rhid lDjet
<br />-l
<br />cdifr lhal I h.v...nd rhir illlicrlion rrd $at. fisl ttu atnv. infor@tion ir corut. lssclo 6mtlywiih tll Cily.nd Counlv
<br />dnlinsnccs ind srrr€ l-r*\ toltun* k)ins c.n(rucrior and t r.by 6urh.nz. EDr.sntd iv$ of rhis Ciry nfrl
<br />aboir nEntiorcd popcny fir
<br />Appll..nl or A,l.rt Signrture:
<br />UNDER GROUND
<br />Waste & Vent 1/rll4.a *r-116,/%)
<br />Water-Under floor I U\
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<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{rap/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 />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL blrleoli qYrra '.7)
<br />Notes, Remarks, Etc.t
<br />A --\.\-
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