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PLUMBING.INSPECTOR RECOHD
<br />APPHOVALS DATE tD/stG.COMMENTS ()wNtiR Irut LDtiR tltl-cARAltoN
<br />I hcrrhy aflnnr utrd$ pctrilr, oiFrluryrld I dn cxc |n fio'n rhc aotrtr.ton Liccnsc Llw ri)r rhc hll,,*inr rclvD ls1c 70.]1.5
<br />Burirc$ rNl t'roltssi,)n Onlc) Any Cily.r Coo y q[i(h r0quirc\ r Eraril h d)n{ruc|. llrcr. inrltrolc. drnr,lnh r rtnJn rny
<br />ntudurc. nri,, t, irs is{rE"c. nl$ rcqutcs rhc t'pplicln| tu slch IEnnir r,' nlc a \ ignu.l naknrnr rhrr h. or dr is h.d scd lur suMl
<br />ro rhc F)vhirnrs ol rhc (onlru.rois l-i.cnscd tiw (ChrDr.r e. Comnrcmine yirh S.ction ?(xx) .l Divirion .l of rhc Bu\i'rrs trtrd
<br />P(,lis\nnr Cod.ror rhrr tL or\he hcrctrrpr rirr.lionud rh( hli\ tur rttr rllegEd .rcmprn,n nrvi(,lnri(nrofStdinrT{Bl5hyany
<br />,npli.rtrrf(trrt.nntsrbjdsrlr.ptli.rnrror.ivilt,cnrlryornor src rh n fi\c hrn,lrcd dolhts ( J5m )
<br />-1.
<br />er owmr ofrh. poFnr. or my coplorrc! wnh *agcs as lhct $1. @mD.nsllion. will do llx wt !d 0E sln.tn ic mt
<br />i.rc,icd or ofcrci for sh (Se 7044, Ausircss and Pmlcs.ions CodE: Th. Conlrdols Ltcns Lrw d..s mr opply ro o ol*r ot
<br />rhc FbFny sho t{ildr or mpEc ir@tr rnd olh doB nxh e,t hituclf or h.elr or rhmuEh hL or lffi own cn9loy..s.
<br />p.ovilcd rhlr slch itrumEEnrs e nor in|crded oroftu forsle.lf. ho{lf. d. tdiuiig or in{rorcE.l is$UvithinorcJ{a
<br />.fconplcliotr ltE OwN Eui!.r wil lEw tlE hifthn ofpovi.e Ua, lE or shc di] ml b'rilt or inpmw ,E pbpdq for d. ptrpoc oa
<br />l..sowncrolrh€ lmpdy. ancxLlusiwlyc.at,crine wirh licc.scd conr0ctusroconslrud lhc pmJccl (S.c. ?044. Lusins!
<br />lnd l\nlissbn Code: rh. Cotrrrrtol s t,iccnsc tnw docs mr olply ro an ownc. ot tmfny *to blilds or iop,6rr rhcmn.
<br />rnd whd conrDclr for *u.h Frlrh wnh . Conh.rodsl ltcn\.rr plrsmr ro rh. ConrEdols Lian$ tjw).
<br />I ancx.mrl und.r S&li(,n ,B & P.c. forrhis rci$n
<br />O$r.c__ _
<br />]TOATEBII-CI}MEENIAIIO!
<br />DECI dn IOrt
<br />I thBhy !af(m undcr F.rlly of ,,qjury oe of thc folbwide &claorioB:
<br />-lhrvc
<br />dqrllrroi 0mrCcnific c ofconscnr k, Sclf-|tr\urc {or "nrkcc conll}cnsalion. ac ImlidcdfttrhyS.dion]?fi}oflhc
<br />rrh.r CMc.lor lh. l). onMmc olthc work lor whi.h rh. Nrnrir ir nsucd
<br />_l hlvc and lill minroin sorkcn cospcnsarion ins!6Nc. as EAoiEd t y Scrion 3700 of rh. Lrbor Codc. for rlE p6for,1are ot
<br />rhc *orl tor which thn Fmrir is issurd. My $orkcr' omt nsarion insurrNc @Ri.r a&j Flky nudbd e:
<br />Polic, Number:JrriEs:
<br />-l
<br />ccnifr rhar in fi. Ilcrtoreftc orthc w6rk (ol whthrhhFrmir h is\ucd.l rhxll @i cnl9lty,ny p.Mn in.ry mrcr
<br />s tri ro tE om subj.lr io rhc *o*c^ conyx.eion l,ws of Caliiomaa. .nd rgN rhd if I sk uld bc.oe $biel to llE
<br />workcB compcns,rion perhionsofselion l70oolthe trt r Cod.. I shill, lorlh*nn mryly with lhos F,vlsio.s
<br />WARNINCT fuilurc k' scua rorkcF compcnuliofl olcm8c n unh*tu1. and shtrll
<br />civil files ur lo orc hu.drcd rhousund dollm (3100.000). ifl lddilion ro the .o\l of
<br />cmPby.r 6 dininrl ttmhi.\ rnd
<br />ns|ioo. da@Bca 8 providcd lor rh.
<br />inrcrc( and orfty s fccs
<br />z7
<br />DECI"{NAI]ON
<br />I hcrby rflnnr uidci N alry of p.riury rhd I M li.ctr{n un&r tR vi{nr or Ch{tc. 9 (.omnBtrnr8 wirh Sc.tbo ll](l0) of Divnion 3
<br />of rhc Busnr$nnd P!'ld*n,n\Codd. ml ryli.ris. is in l lllnr( trd cll.cr
<br />I)rlr (,n rnrnr
<br />C(TNSTRT]CTIoN LI'NDIN(; AGENCY
<br />I ncrcby amirnxndcr pcnlllloapciury rh.t rhcrc is ! cotrslruclirn lcndin8 lscncr Lr lhc pcriortun c otrh. wotk rM whi.h rhis Fnnn is
<br />issu.d (Sc..l$)7, Civ. C.)
<br />AfTITANLDECLAIAIA!
<br />I $nby,frnn undcr penahy of pcrjurt onc oaltu rolbwing dccltrllions
<br />Dcnrlirio. Pcrnrih-Asb.nos Norirl. ion Fcd.rll RcSul.rioni (Tirlcrl0, Pan6)
<br />-Rcquncd
<br />larlcr or Nolifrcarion
<br />I c.difyrhnr rhc fc&rrl rcguhri{,n\ rcA{ding r\b.do\ rcmoralrrr.or aIplicftl. n, rhisI(,J..r.
<br />l..dilyrhd lhivc fuad rhis rpnli.!rl.innd nrrcrhd
<br />onlin,ncc\ md Srrrc kw\ EIrrinE ro h! ildiiA .o.nd(n)
<br />$c !t vc info@rion h cotrccl I llre ro on'ply wnh aI City and County
<br />ebole mrriomd prcpcrry for
<br />AppliGnl or Aa6l siaMlo
<br />hrrcby rdtxrizc rprcscnrdivc\ of r
<br />:::.',W;Ty
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas{ffier{leer ldle\l y-zslg UIL)Lt
<br />Buildino Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<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-trapi 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 v.-fll6 V,t,oL
<br />Meter Release u rx
<br />FINAL r-*"1y y,wfi$lzqwt o/vl.r
<br />Notes, Remarks Etc.
<br />tx Jciq
<br />^dJrc-
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