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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNI]R BUII-D*]R DIJLCARA'TIoN
<br />I h.,cby nffiirn dMcr lthhy olFrury r[d I rm cxcnrpr lionr rhc Cofiichn' I iccn\c l.n* tur rh. nnk,]ing rcr$n (SN7lr.ll5
<br />Bu\nr$ rrl Profc\ri(nr (tr,c) Any Cil, or Counr, whi(h rcqutc\ r p.nnir b .oDnru.r, .ltcr, inPi(,vc. dcmoli\h Ltr Nnrn xny
<br />ntuchrc- tritr r,, ir\ i\\urn d. trlii rqunu(rhc rlfli.anr f(tr.u.h 8nn[ tu lilc! (i8ncd dlrcrxnl rhar lror \hc is li.ciscd Pu^urtrt
<br />b rh. provisii)n\ ofrhc Conkr.ktr \ Liccn\cd l-nw (Ch prcr 9, G,n r..nrB wirh Sccrur 7(Xr0 ol Diviri,r .l ofrhd Bu\nt\\ rid
<br />P(ncs\ionr Co,l.) or thrr lf or shc cxcnru rh$!,idnrn rh. l\rs^ tr rhc rllcgcd qcmpri,nr Atyvi,,ldi.iolScclirT0Sl5brany
<br />r!fli.. rt)r!ttrnnrsuhj(hrhc,0pli.anllor.Nilp.nalr)-,oi.orm,crhrnfirrhundtudd.lln^(15{n)
<br />-1.
<br />a. osrcr otrh. prcFrly, d my mv,loFr wilh *a8.s * th.n sb onwNdion. *ill do rlE wt and lhc cutE is ml
<br />iir. hd m oftrcn ftr sh (Sa.7044, Blsimss and EDfssions Codc TIE Conndd i Lic.n* t w&enol0pplylodowrof
<br />rh. ,mFny elb huildi or in+rcE. tluea rd who .kB Mh eort himell or tEs.laor Itmugh his or hcr own cm0Lr!.s.
<br />pmvid.d rnlr such inlroEmnts @ mr htoldcd oro,IiEn for Blc. lt noB!6. rlE hiuinS or inplwcnr Li sld vilhin * Jtr
<br />of@npktor tlE o|trm. 8ui!6 wil haE dE tod6 of Fwing tlEl lE c d. dit ffi h]iu r inPDw 0t popqty aor dE PEpos of
<br />-1.
<br />as owncr of rhc rm,'.ny. r'n.rchlivelyconiEcring *nh liccnkd io.r.cba !o onsrdct th. rmr.{t (S(.7Ou, Bu\iftn
<br />dnd Ptlrcssbncodc:Thcco.krcrolsLicc.scLowdosnor0rplytoanowncrofriop. ywh.buildsorimtovcsthcrcon-
<br />ud who c! ncrs tor slch t&i.k wnh d Conrsdon9 lk.n*d pxrsunl torhc Conrrdols Lkensc L!w).
<br />I dm cxcnrpt undcr Sd B. & P.C. turhii rcison.
<br />D.l.: OPm.:
<br />lloaf,E8s:l:oMfElliarx)N
<br />DICIdBAUAX
<br />I hcrcby.ifirm u cr pcnslryofIcrlryorcofrhe folloqi.S Jccld,'bds:
<br />-lhrvc
<br />aftl sill mainrrin rC.nin *cofcon\cnrtu s.lf lnsrrr ntr wrkcr( comFNari,n. ar lsrvnbd l.orbys.crnnr l7t{}ol rhc
<br />L.bo! Gnq ft'r lhc ncrlornuncc oalhc nork for *hich thc pcrmir n t\ucd
<br />-l na!€ and {ill minrain sork6 .onp.ns{tion insuum.. a r.{uircd by Sdion ll00 of lhc Lsbor Codc. loi lh. pcrfruc of
<br />crri.r, t 5
<br />k'n ansmMc trir ..d polty numhs ac:
<br />U
<br />o
<br />_l c.dirytMi in th. !.raormm of fic wort lbr whi.h lnis pomil is hsucd- I snallnor.nploy any Fmn in rny nlnrcr
<br />s 6 to h€omc srbjer ro rtc woAc6'oop.n*arion laws ofcalifomia, Md 396 lhal ii I should hcrom slbtf,l lo lhc
<br />mrtcG' compcnslrion pmvisirns of sdbn 37(,0 of rnc llhn c.dc, I srell. fonhwnh comdy wnh lho* pDlisions .
<br />WARNINC: Fsil!rc ro s{!c workcR ompcn*li.n covciaSc i* xnlawtnl. ,nd sldl subic.l on cmpl.yer ro sjnindl F.allics o|d
<br />civil fincs !p ro o* tlndEd rhousnd dou . (S100,0fl)). an lddnion k' ltu coe ofconlEnelion. damgcs .s provil.d tor rh.
<br />s..i '{r lr)76.1r1[ 1-rhtrOnl.. r!.r.(
<br />I h.Nby dflinn u6dcr pcn nyofFrjury lhnl I am lianrd undcr pn,visionolChaprcr I (odtu*iog wirh S*rb.7000) olDivnion 3
<br />oi rfic Blsnrcs and P,obsn,ns C.dc, old my 1i...* iq in tull f6rcc n cflei
<br />Z'
<br />IANSIBULIIQNI,IIDIIiI;-ACINII
<br />I hcrchyrflnnundcr lxn(lry ol ntrjur] rhrr rhcrc ir rcon\rru.rion lc ins rlc'xy ror rhc p$tunD rc.lrh.( rkli,r\hi.hrhi\nrmin
<br />k rtl(S....1097.Civ L- ).
<br />$&rrANLllECr ArlIlON
<br />I trrby nnnn u lo p!uh) of p.rluly rrr of rfu tu ldr nr! dc.ldrnr i(rrl
<br />l)cnrnii(r l'.nni( A\h((or Norifi.rrion Fcd.ful RcSulxr(nr\ lTi!lc.l0, Prn6)
<br />Rcqrn.d l.rrur of Norilic.ri,'n
<br />_lccnilyrharrh.lcdcralr.Aul,rionsrcGodineasb.slosrc.vrlmrcltrpllic,blctothnpoiecr
<br />l..nify rhd I hNc rcdd rhh ,ppltar io. a'n statc thor th. otrvc nrfomr ion ir.olmr I lgrft lo.omply wnh trll Ciry lnd Counry
<br />ldins con(rucr ion. aDd hcrcb, lurlFrirc rrr.*.hrivcs or rhis cfty and Counly to cnlq ula,n lhcodin.rc* llld Srtrt. tjws rcbriu lo
<br />.hov. m.tioftd pmlEny lor
<br />,\Dpli.tr tor /\Bu lsia lu *,,,O8-/./- ty
<br />UNDER GBOUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area./Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipino
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trapi Drain Line
<br />Main Drain/Pool Pipino
<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 />FINAL 7tlt3 t{EMNr otr (ft?ir,/
<br />Notes, Remarks, Etc.I
<br />o/- o/ -/;7
<br />D,,,, rq?^/.r- /8 Fo.ia--e.
<br />krlds's Ad.lEs
<br />-
<br />Roof Drain
<br />Tub/Shower Test
<br />Meter Release
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