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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG,COMMENTS OIVNI.iR B(JIt,DllR DII-CAR'l lON
<br />Ihcrhy fln'n rndcr !.naht.f Frlury rhar I rn crcnfl liorn rhc (in r! nl l,icdn\c lrw fd rh.foll.wing rclson (Ss70ll.5
<br />tru\i.c$ i Prolc$n'n Gxlc) Any Ciry or C,rtrry whirh rc{lriru\ I ,.rnir r. .oinrud. .lrc,. imprDc. dcnolish or rcprn rny'
<br />ntucrlr.. pritrr, ic issuank, d!$ rcrtuncs (hc n!fli..d lir. (uch tEnnf h liL r \i8md {dcmnl rh3r h.or sh- i( li.cnq] Pu(urnl
<br />b rhc pmvhion\ ol ltE Co.rru.lor{ t.iccned liv lchxprrr S. Conm.n.in! wirh Sc.rion 7U)O ol Dirhnrn I ot rhc 3o\ cr\ nnd
<br />PDfusions Cod.) or rhrr h. or shc i\.r.mlrr rh.rcfrun ind rh. bdsi\ ror rhc.llL8cd c\.nrflnu An) ridiionofS..rbtr?0115 tyany
<br />l,)pli.nnr forrptmn \uhJLr( rh. rptlic0nt ro acivilpctrdllro, not nDrcrh!tr lirc hundrcddollr^ (55U)r.
<br />yJ4. ,. "**, "r,r'"
<br />p",p"n y. o, my cn,plojrc\ siri wrgc\ a\ rhcn v,t con,,f, isootr. w,ll do rhc Eolk lnd rhc srMrr i\ ft,r
<br />inluulcd or o,Icrcd iff $lc ( S( 7l!.1. Btr\tr\ atrd B.tis\n N C.dcr Tht Co rk!tr's l.i(c!\c l ,rs ttoc\ nor amly t, dn smr of
<br />rh.tinJ|Iry uho hikh or inrrrotcs rhctr)tr anJ wl'ir docs ch*orkhinscllorhd^clfnrrhn)ughhnorhctown.mlloycci
<br />pn,vid.d rhrr \kh nlllro!. rnh c,sr ir ctrdudoroflarrlfornrlc ll, hotrcv.r. rh!hiildi',!ori'npn,v.rf,d hsold eilh n.n. }[Jr
<br />olcomdcrion. rhe ONrcr Buikler willh"rc rh huftlcn olruvinE dd h. oi shc did tror hnild or imfl.t thc preFny turhc Puqx,sor
<br />-1.
<br />os owr of the I,ol&ry, m cxclusiwly .ontrerine wilh li..n$d conhdor lo snsltuct rh. tmrer (Scc, 7Or4. BEift$
<br />ffd PrDlNbn Codc: Th. ConrEcrols Licens. lja des mr.pply to ano*icr of[openy {lt buil& or imprcts thso..
<br />lnd *ho @ Ers for .eh prbj.rts wnh ! C.m@b(, li*trkd ptrtsMr ro fi. Conlrlor's Li.cnrc L!w)
<br />-l
<br />amcrcmpl undr Sdlh
<br />qOB6EBa..CI}IIIE{IAIIO!
<br />DECLABAIIO!
<br />I hcrliy arfid !nd€, Fnrlry ol pojury on. of the followi.8 dRlrolions:
<br />I hrrc xnJ*ill nBi ai', r('cnifi.rrcofC.f\ctrrtu Sclllnnnc lor Norkcr' corFn\rrion. r! !r,ridcd ftr by Sc.tion :l7U) ol rhc
<br />LrhtrC.n..lorrhc l]cnhnurcc o1rlt k.rk i,* whi.h rhc PCfl ir is i(\ucd
<br />_l hsvc and {ill m.inuin workcs comt'cbsolion insursncc. as rcquiEd try S(t ion 1700 ot lhc tibor Codc. lor thc pdornwc of
<br />lhc erl lor ehkh rhis p.mn is iliNd. My wo.kdl conpcndion i.sumrcc cuicr !d lolky nlnbq mi
<br />Poli.y Numh.r:-Eipnc\:
<br />Ull .cniry rn0| in rh. p.'formE ofulE worl ror whth rhis pcrmir is L\$ed. I shdll nor .nploy .nt FRon in any Mnner
<br />s us ro bcom subFr ro rhe so*cF ompcnerion l,Bs ol CaliLmia. and a8tc lh8l if I shou6 lEcom sliitr lo rlE
<br />qorlcR sr4xnsrion rbvisionr of Sc.rio, !rO0 ot rhc t$or Codc I srEll. fonhwilh Lor{ y wilh lhos poliqionr..
<br />WARNIN(;: Fxilnrc k, sue wor[cr' coarEn\lrbn covca-qc ir utrllrlul, Md \hall $b].dr r .'nrh'ycr ro niminal Iicnllri\ !rut
<br />cjril 6n.s up to onc hDndrcd rhou$nd dollur ($loo.(xx)). in addirin ro'h.c.n of.omr.nqlion. drrMses as p,ovidcd r rh.
<br />Sccrion 10?6 ofrlE tjhor (ldc. inrcrc$ and onomy\ fcc\
<br />,*., - t'tttr ^,ow"cyel* 4/4&rtLrfFNsEpc(,NTn c riJR A
<br />DCCIAf,AION
<br />Ihcrchyarfirmundcrpenahyorr.rjuryrhlrItrrli..n*du.d$tn)!i\bnolChrflcr9(snnitnirg*nhSc.rion?ur0)ofDivision:l
<br />oi rhc Busnrs.nd Pftrtsion\ Codc.ond ry li.cn\c n i! fullnnen"d.ff..r
<br />Liccnsc Chss:-Liensc Nun$.r
<br />Drr.: Cont
<br />COiiSItrUEIPNIIBDIIQIC}:NII
<br />Ihctuhyrf,lrfludcrFtrilry.fp.,iurylhllthcrcisrcon{ru.ri.nhndinsrlcicyrorrhcrr,ntnn.co(hcwotktir*hi.hrhi\Fnnirn
<br />isucd (s( :1097. Civ C )
<br />AfELICANLDECIA&UIAN
<br />I h.hby lilmuMcrlcnnlryoltf,rjuryotrc o, rhc nnhqirE rjccl rliors:
<br />l)cnnnIion P.nni( A\bc{o: Nori,icdion Fcd$rl RcEUlrti( \llir]c J0. Pin6r
<br />Roqdncd Irncrol Norifi.nridt
<br />-l
<br />ccfliry thd rlE f.d.ml Egllirio s rgar,ing alt.ros rmrl 3e mt atdh.bh ro lhi! pDird.
<br />E4.*r, ,", r r,* *a ,rrii .rnlicdion rrld tr.rc lnll E aboec inaolrErioo k.mr.I l8B ro o,pl, qirh !n cnyaod Counry
<br />ordiorcs.nd Srarc ti*s rchdng ro hoildin8 consrncrio[ rrld hcEby.ltho.ia EpE$nl8lircs ofthis Cny ald Cou y ro..rd lpon tlE
<br />sbov. ,Entiorcd pm,cny for i,spcclioi
<br />Appli(8nl or Agcnl SiFMloR .r-t4'l(
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Water Pipinq
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P-trap/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 Plumbing
<br />Final Gas Test
<br />Meter Release I
<br />FINAL 1/tt,/t*-W-.///
<br />Notes, Remarks, EiC.
<br />D",",. tr-tq- If
<br />Lan lcr', Adtlr*
<br />-
<br />Waste & Vent
<br />POOL/SPA
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