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PLUMBING.INSPECTOR RECORD
<br />tD/stG.COMMENTSAPPROVALSDATE
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor
<br />Buildi Sewer
<br />Area/Storm Drain
<br />lnterce orl Clarilier
<br />Waste & Vent
<br />Water Pi n
<br />Rool Drain
<br />Rou h Water Heater
<br />POOL/SPA
<br />P-t Drain Line
<br />Ivlain Drain/Pool Pi n
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn rinkler
<br />Sanita Sewer/Ca
<br />Back Flow Device
<br />h PlumbinR
<br />Final Gas Test
<br />Meter Release
<br />FINAL
<br />Notes, Remarks Etc.
<br />/
<br />([Vl\ I.iR B(I!!-DBR frnl-( A RA t ION
<br />I hcrcny ellnm utrdcr |{nalry.l t'crjury rhd I m cxcnru irom rhc co rucrots Li..nsc Lnw nn rhc n'hwing tcas'n rscc?o'll5
<br />Br\inN\ ard Prolcsio. Codc): Any Cny or County shi.h rcquit s I Pcrnir ti conrlrucr' 'lrd. nn[ort- & Flish or toran dtrv
<br />jrullulc.Pri{nloilsissuoicc-lln,rcqutcslhclp.licddnnsrchP.rnlillofilc!sigicdn,lcnrcnllhalhcorshcisli.ciscdt'UKunl
<br />k,rh.provtionsorrh.co.ka.toa\Li.cn$dtw(CnlPrsg.c.nnncftirrswirhScctionTm)olDivisn'}n'lofth'Busincs\nnd
<br />Pmltsions Codc) or rl ltr or shc is.x.nfl rhcrciro,,6d rhc brsis ri,r llt,llcScd cxcmPrion Anv vnnlinrnorSccrhnT0]l5 bv rnv
<br />Nmlicur lar r p.anil suhjcls rhc .Ppliclnl h ! .ivil Fnrll, oi nor norc
<br />'hrn
<br />livc hundrcd doll&s ls5m)
<br />L $ owncr ofrh. lroFny. or nrr.mPk'rccs wirh wss.\ us rhcir {'le cdmp.n\ihn. willJ' rhc sdk lnd rh' $nl-luc i\ 6l
<br />i,ft*l.d - .lTcrc,l i; ;t raN 7ui1, B;sirc$ rn'l ftotu$,om Codc Thc L-ontac'{n \ l-kctr* Ltrw doci nol antl, ro $ owncr o'
<br />rhctn)Fny who huilds or nqrcv.\ rhrGln. dld sln dms \kh sod( hinN.lf.r hc6llfor rhroulh hi\ or ficr oqn cnDirvucs'
<br />p'"iiaia ror .u.r, in,rmroEnb m mr intr cri or otllEi ir sak lt lFtr cE. rlt hoiklins or i'npmt'md is $kl !'ihin nm )tr
<br />;l$nll)!rirn, rtEOsir B!iu$ willhlu rl* budcn of,trcvinr rh, hc or stu did d huiU or nrytuvc lhc PRrPc{v r'r thc !u4ir{ or
<br />-I.
<br />!s oeacr .r ihc pmlrdr. a cr.tusnclycoitn.rnrE lilh licc.sc .onthcl{n\ k' coniflcl rh' pmrd (Scc ?(}$ atrcinc$
<br />m,l l',r,ri*ri,n Cua", th; cnn,r.kt s l-icctrsc Lls dors not aprlv ro 3n owncr ol PoP'n, ahD 6uitds or i'nProrts rho'on'
<br />ind *ho co.r h for such ltrl,tts *irh n O,h.ll'( s) lie.sed NNlrtrr I. rhc c.ntdckr's l,i'cn* L'81
<br />-l
<br />d c&mpl ulds setion- B. & P C. for lhir ta$n.
<br />rglf,ExllgMrE$ero!
<br />DECI.IIf,AUON
<br />I hcrcby rflirm undcr Fnalry 6f pdjury orc of rhc rollowing dal4ltkrns
<br />-ltuvc!dwillmsintlinrCcnilicarcoacon*flloS.lf-lnsu,cads.k6con.6sorion..s|,ovidedtorbvs'crionl?morrtuItbor Codc. to. $c pel.omErc of thc wo* to, shicn
<br />'h.
<br />p.rnir h hsucd
<br />I
<br />Vt no* nna *,tt *i."in *otkcG cnnt!..crr nn hrurlmc. ,r rcqutcd hv S(t ion ll0o of rhc tihor Codc r'r thc Pcrrommc of
<br />rle rork for which thh pcmnl Ls isscd, My worksl odp.Nltion iflsurt..d.mis lDd poli.v numbcr oc:
<br />.Tr-vl
<br />V<ql,
<br />1..,,,
<br />k o-7 o4l -4
<br />iy th.l i. lhc Fnordmc 6l lhe wort ftr *hkh rhic FYmn !s isrucn. I shall nor oqloy any F..on in any mnNr
<br />ud lsrec rhsl il I stould b6om subitl lo ihc
<br />stull tonhwilh comply wih rlns lfovl\iotrs .
<br />subiNr lo rhc eorkdr compcNtdoo ltrws of Californi..
<br />norkcs Nmp.ns,rion pFviri.nsolSdi.n lTmolrhc Lntnr Codc. I
<br />1,VAnNINC: Flilm ro scue wo*cs' ompc.elion cowEgc is unl.*tu!. and rhall sultjd sn
<br />'mploFr
<br />lo diotll FMhts dd
<br />civil 6ncs !n ro orc nlndr.d ttDusd doI; ($too.ooo). in addirio. to rh. cosr ot compcns$i6n, dlE8gs !i pr.vid.i for ihc
<br />Codc.n crc{.nd{ionry \ lcc(q
<br />I hwby arrm ufllq !.@Iy ol pdhry $ar t .n lieMn uido dvtion of C-h.ttls 9 (.on1!l@i!8 *ih Selbn
<br />'000)
<br />ol Div
<br />of rhc B!.ircs .nd Pof.$ions Codc, atd my licnsc is in tuU fore ad cft{r.
<br />,r.-O-.lg 18
<br />caNsIEullIlaN!EIDINc-&OEBII
<br />lhcrhrdnnund.rrculryorp"tl,,yrt,rrr,*i*trru.ri.nLndirsoBctvrorrhcpc!t'.@'rcolthcw"kforwhi'hihisFrniri'
<br />isucd (S( :ltl97. Cir. C )
<br />t nJ^r', Nrnf,
<br />AEITCANLDECIAMITON
<br />I H,, affm unrhr Fnally of pctjury orc of llE followi.E dal,ralio.s:
<br />Dcmohion Pcrnns.Ash.slos Norific&rion Fcdcral Rcgul,lions frnb 40. Pd6)
<br />Rcquircd Ix(d of No,ifi .aii{in
<br />l.cnirvlhoi rhe fcd*trl Esuld k'ns Bgddin8 rsbc(xtcn,trlrc tror sPpli.$lclo rhk Projdr
<br />Jll ccnrryrhr lhr\c rcJd rhFrmlkrriqJ,n ndcthal lhcrht lreNrnc mll,
<br />oidinin.cs;nd srarc t-r*s rclariru h buikline con\ldcrion.,nd hcrchv lorh.rizc rcprcrcrurivcs oithis Cirv
<br />!bo!c mmio.cd proFny lor irspcclion pu{mscs.
<br />md Counry ro cnls utbn lhc
<br />,dEt,g
<br />t
<br />grmlre me tprinrt: F \
<br />TOP OUT
<br />Gas Pipinq
<br />Tub/Shower Test
<br />Gas Service
<br />I
<br />lol2g lb AA
<br />o -.-oJ'fun'a, z' lr-..u*" t"n.,.J ta
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