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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.(,WNI]R B(III-Dl!N DALCARATION
<br />I hcrcby rntn nnds |Enllly of pcljury thnt I um cxcnDl rior rhc (in ia os Liccnsc Lnw ntr lhc r'ollowins d q,n (S(70:ll5
<br />Businc\s $d ftofcssirtr Cr c): Afl, Cir, or Colnly *hich rcquiEs ! Fmli n) c.n(tocr- !lrc,. idpn,v.. &'frr$h ot rcp.r tny
<br />dru.rulc, frin k, ns i\\u!tor. ,ko reqdncs rhc lmlicinr L. surh p.mir h fi L n \iAncd nrrctunr rh L or *lf, is lic.nscd pusuant t
<br />ro rhc Jmv,sion\ ol
<br />'rE
<br />Contrncrois LiLTnscd t-rw lchnlr( 9, Comnrmnrt wnh Sccrion 7O(x) ol Oivhion :l oflir Burircs! and
<br />Ptrdcsi,'nsCodc)o.rhrlhcor!h.ncrcnrrlrhcrclromlndrh.tu\isLrlhclllcgcdcrenprion.Ayvinhrn,norsdr$nToil5htrny
<br />aptli.rnr 6r,p.nnn rublc.rs rh. rtpli.a.r ro a.ivill.nrkr.fnor nDrcrh nvc hundrcd dDurs l$5t[,)
<br />I.r\o*nrrofrhcpr.lrn!.or.rycmnl.yrc\sfhsrgr\r\rhc'rv'ld.ofctrsdnnr.ailldolhrsDrkatulhc(uluEisnor
<br />i cfrlL\l or nllorcd li,r klc (SN.704,1. Busincss and Pnni\i(,ns ('.dcr Thc CoMacktr s Liccnsc Ii$ docs.nl !ml, xr an o*ncrot
<br />rhe pmpcrry who huikls or i.lpnNcs rhcKrn. ud *ho do( u.h *ort hin,lcll.r hcrcllor ihrorgh l,h or hcr own cnll,Lyc.r.
<br />ol.onDlcriir drosncr Bulldn*ill h.vc lhc bu dctr oi lnrviri! rh r hc or $c did ml build or i !{,vclhc pmpcny lirr ihc NrF)* ot
<br />_1. trs owncr ol rhc lmFdt. m crclusivcly.o.racrin8 eirh liccnsd contu to6 ro s.sidcl lhc pmjNr (Sc. 7044, BGircs
<br />dnd h,lissir Codc: Thc Contturols Lic.nsc Law doci nol lnrly ro s.*ocr ufprop.irywh. buildr or inpmv.s rhcrcon.
<br />aid who conlmck fo. such psi(ls wirh o Conrrrlorlt la.nad p!truni b rhc Conrncrols Liccne Ll*).
<br />I mcrcmDl und.r Sen.n . B. & P.C. lor lhs r.asn.
<br />Date
<br />IABrISIIIjQMIEISAIION
<br />DECI.AXATON
<br />I n eb, affirn undr pcMny of lerjury om of th. following dslmrionrl
<br />lhrvcxttlwillnrinrri"rC.ni,l.nrcolCot\cnrn,Sclllt{Rt'*o'lnaconrJtn n ,r\ l,n,!rdcl lit hySc.rirtr 37(x).lrhc
<br />Irho.(itr[. i(trrlI tdrlitrnrxn.colrl]c*o* lnr*hlch rhcF-nnir i\ i\{rtl
<br />_l hnv. .nd *ill roinllin vorkcs comp.malion insuBmc. as rquircd by Selion 3700 of lhc Libor Code, for lhc 0dt6r@cc of
<br />rh. mrk for which lhis Frnil i. ii$.d. My worlG .ompcns.lion iNurffie cstr aod txricy tunbc, @:
<br />-l.cnify
<br />thlr in rhc pcrformmc ot rhc sork for shth thn rrnr n i\ucd.l shall n.r chpk yrny p.ron i, ant Mnn$
<br />* as ro h..m subjd! lo rh. workeK .o.{EnBrio. trwi ofcalifomia.0nd oEN lhll ifl snouu tEcom subJcrl toIh.
<br />works conDcn{rion povi\ions ofserion lT0o ofih: Lrbdr C.d..l shtrll, fonhwiin comrly with rho$ pmvisions,.
<br />WAXNINC: l,rilurc b $curc sorkcn compctrsation i\ urh$n,|. rnd shrll suhi.i n cn[],)rcr tr ritrrirrlJi.trrki$ dnd
<br />civil fin$ ut' Io onc hundrcd tholsand dolluc (!l
<br />Sccrion 1016 of thc Llh)r Code, inrercsr and lrromy s{-e-t{
<br />DIarl.,tR,\t t(rN
<br />t hcEby .rm un<hr I ..dry ol pcrFy rhd I m lieG.d urd.r Fovtion of qrrlls 9 (ollmmin8 with Sc.lbn 7000) of Divislon 3
<br />of lhc Busims lnd PDfcsio6 Codc, a,n my Uccns ir in tuI fore !n cfirty'
<br />_e>,",,9r'€-t(
<br />culslal]clloNlJNDlNcililr!.e.I
<br />i\nrcd lsc.. 30i)r, ('iv. ( )
<br />A.tfLlCdNfDECLIf,AIlllli
<br />I tEEh! ntnm utrdci p{mhyolp.ljurr onc ofthc lolloq ir8 dc.lmriotrr
<br />D.Enirn'n Pcrmi( A\h.no\ Norificarn,n F.dchl Rcguhrn,n\ (Tirlc10. P&6)
<br />Reqrncd krrcr of Norildiio.
<br />I .cdity rh rhc ldlcful ogul,rionr ngrdide db.{os rcnmvd drc nor artlicahlc lo lhh rr+cl
<br />-l
<br />ccrrilyrhar Ihlvc E lrhisrF
<br />ordinanccs nnri Stulc tra\ allliis
<br />rDd nrrc rhxr rhr rh,vc inlannxri,m i\.orcrr I alm lo onrl,l, wirh all Cilytrnd County
<br />hcrcby luhoriz. rcprcscnralives ofthh CirFnd Countylo cnlcr upotr lhc
<br />obovc mntiomd,,m|xnt for i
<br />*n. X- 4')IAppliunl or Aacnl SigBtld
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underlloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Meter Release \
<br />FINAL 7lu tv ,d/,{q n)
<br />Notes, Remarks, Etc I
<br />COMMENTS
<br />V"rrUrru,*rr,W**",L -q -tq
<br />ro rhc cosr of.onFnsalion. den.ecs 0s Drovidcd lor lhc
<br />t.1'J -'. N, Li
<br />I
<br />^-!
<br />(l
<br />Waste & Vent
<br />Miscellaneous
<br />Final Gas Test
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