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PLUMBING.INSPECTOR RECORD
<br />DATE ID/SIG.OWNER BUILDER DELCARATION
<br />I hceb, arrm !.d.r p.dhy of !.rjory thlr I am .r.mnr fFn ttrc Co"tr.cIoF Lians. tlw for Ih. followin8 ssn (Sc.?011.5
<br />Busin.s! {.d Profcsion Co&): Any Car, nr Cd.ry *hii:h Equircs & |rmn lo ensttocr. !h6. iilhw. &mlhh or rpai lny
<br />shcltrc. Irior lo its issu4c. abo rcqliEe thc lrpli.m lor ruch pcmit lo ik 3 si8x.d $!lcm rh.r lE or lhc h licoed pursrn
<br />lo rhe ,mvhionr of rhc Conneroar Liensd Lis (Chafl€r 9. ConmminS qirh Serion 7000 of Division 3 of rne BlsiEss dd
<br />Pmf.ssioos Codc) d lhll fi. M shc is cr.n{,' lh@f.om u<l rh. b&ri! f.r r,E rllcg.{ .rcnplhn. An, viol6rionols-lio.70ll.5 byoy
<br />tppli.afl fo,ap€m subi<lr rhc lpPli.a lo ! civil Frally of nol mE rh.n fiv. hundEd dolles {t100).
<br />-1.
<br />I owmr ol lhe lDlany. or ny cmployEs wnh wrScs &i rhcn $k odpcnsrhn, witl d., {r *o* &d rtE $nrrG ii rcr
<br />inleixlcd or ofcrcd for sh (5(.?044. AuriN3s md ftef6ei'6 Codc: DE Conru.lo i Ltcnc ltw .to.s ml rpply lo r..vm ol
<br />rhc tmpcdy whot ildr d inpmsr rhcen, id wtr ift6 tuh si( hinwlaor hc&!f or rhough hh or her ow.crployfts,
<br />prorid.d rnd such imnm\tm r e ml hrcn bd oroficr.d for sls. ,t now6. drc tNildin* or iry,fttu issk*irhinotu,@
<br />oa@trplclion. tlE Oqmr Buildq *ill hlE dE tuhn of Flvin8 rh.t lF or $. dn mt hrild or inFrk dE pbtdy for t r 0orlre of
<br />-l.6owncrolrhc
<br />php.ny. oncrcluiarclyconrlding *irh lien$d.oir&roB to construcr th. poifl (S(.7044. Bu\ircnr
<br />aid Pmfision Codc: Thc Conlm.loas Liccnsc tiw dfts not aprly lo .n own r of proFny wh. builds o. iqlrov.s ths6n,
<br />and wn coorers tor fl.h poicd. warh a C..r&ro(,lkci*d poNMr ro rhc Conr&roas Lixn* tro).
<br />lrar.lcnrDi umlcr SL\ri( .ll & P( lnrrhi\ rca\n,
<br />lhle O$ner go8trExs.tallrBsafxlts
<br />DEd AN,{TION
<br />I tcEby aiiirmud.r pcmllyof Fiuryorc of ln hlowingd(ldalionsl
<br />I hrlc mdwill trni.rJi', !Ccnilicit.fConscnr ro S.lilrsurc lnr {orlc^' conrFnsmiotr. 0\ provi(lcd lor 6ySccrion:lT0lroilhc
<br />lihtrC,xtc.lff lhcp..i.rn(nceollhcnnrlilhrshichrhcnrnnir Nis(ucd
<br />_l haE lnd will mrinrair sork.^ ..nt 6\ n,nan$r,ice.!\ rc+ircdh,s$rnrnl? r of th! tih.r Codc. lor rhc Flfotuc o,
<br />lhc wo l'or whicnr[nr.rnrn is tsncd. My*orkc^ srpcn\rrn inslran.c cnricr and p.lic, nu'nb( dc]
<br />c*,*,O* D rrnZ ir.rgrIAJeE qafaUrr/
<br />a^ttronq.1 3 vao'?D
<br />-l
<br />ccnify tlut itr rh. FrforNncc oflhc wort for whkh ihis !.rmjl k Lssu.d,I sh,ll nor chDk y rny p.Mn in any monmr
<br />so * ro b.oft sbjdr ro rh. woltcr' onncns.rion la$s ot Califomio, and asN rtar if I stnlld bccoE suhjsr ro rlE
<br />work*.onp.nsdion,'rovilionrofscclion1700olrhcLilrrCdc.Ishrll,fonhwirh@rl,lyenhrhocpbvhidos.,
<br />WARNTNC: laiturc lo surc lorkdi conucnsariofl orcri8{
<br />cnil iinr. un n' nrr hundr.t ltou.and dollqa rsl0o.Ot(J,, m
<br />serion I)76 oa rhe ljhoi Clic inr.rcsr lnd ono,rcy s fNs.
<br />bjd { cmploycr lo ci'ninallEtruhts d
<br />k) rlr .o{ ,'l (.Npcn\r|.tr drn &\ r\ t,r.!idr(t br rlr .
<br />t -a- 2a oorr-,
<br />IISq,lIAIl9!
<br />I tcrcl,y linr undcr p.nalr) of p.rjury rh l rm liNnKl uM& pr.virion ol Chinrcr 9 (.omnrmiflE qirh sc.ri.n 7(I)0) of Dirtiotr l
<br />ol llt Busirc$ Md Prclt*idrsCodc. u nryli..nsc n in fullfqcc rtolcllirr
<br />csb 10382a
<br />o^r", ?-24-U co"r,*ro,
<br />TONIiIBIICUQNIIXI)IN1iTI1iENII
<br />i\\u.drS( r(I)7 Civ (')
<br />AITJ,ICAIIDIILAX{UAN
<br />I h.R.by lnif,n und.r Fn,ny olFrjuJy oM orrh.lbllosin8 d(lurio.r:
<br />Dcnblllion P.nnir$ rhc{.s Norifi.artun Fcd.ial Rcgrhrions lTirlc.m- Pan6)
<br />-Rcquircd
<br />t llcrof Norin.ar on
<br />lccnilirh3r rfu r.dcrnlrcAuhIi,'nr csnrlirarsh.n.\ rcixtrrlrrc ior,'t),ronlc r, rhn Dm]c.r
<br />,ittrLUtrsnrl\r.rlr(\rclxr'rFr',hu'ld'nruNrudr,,, rlhcrchyrurhrn.rcpr.\cdrnc\('frhnCiryrtrdCounryhrir$uFn,rlf,
<br />ilarc f,nri(rr{Fn,Nnyfor
<br />Arpllcnnt or Asetrl Sisn.t 6t D"" l-3-zo
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area"/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Qas Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ivlain Drain/Pool Piping
<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 />t
<br />Rough Plumbing //a/*t.tA tq)
<br />Final Gas Test /
<br />Meter Release / /,4
<br />FINAL t /11/2.u f//4 *L/d?'
<br />Notes Remarks Eb!
<br />APPROVALS COMMENTS
<br />2\arc-
<br />L.ndq'r Addr.r: _
<br />Tub/Shower Test
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