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PLUMBING.INSPECTOH RECORD
<br />APPROVALS DATE lD/stG.COMMENTS OWNER AUILDER DELCAR IION
<br />I hmby aflrm und6 p.Mlty of pdjury lnrl I m cx.mlll non rlE Conrturos' Lh.ns t!* lo, thc fotopiEC Easo! (Se.7o31.5
<br />B!.ift.s dd Prctc$ion Co&): Any Cny or Counry shth rcquiEs r Fnn ro @nsrtucr. alr6, iEprolq d.mlirh or r.Fn lny
<br />sh.ne, ,.ior lo ir! i!s@e. ato quncs the qlpltanr for slch lErmn ro 6k o sigrcd .rarctrfl rh,l lr or 3lt ir liered ,lr$.nr
<br />ro rlE Ircvni,ns of d. C.nlracrols Liccnsd t2w (Ch.ptq 9. CoMcmin8 wirt Sc.tion 7000 of Divisiof, 3 of rhc Busin.ss und
<br />Pbfcssions Corlc) or rhlt lE m shc n crcnpr rlEEGDn ad dE h{sk for d. .lhgcd ermprion. Any vhLriof,ofS.nbn ?011.5 by rny
<br />applicafl lor d lcrmi subiers the lltPlicant b d civil p.nllty of mr mr thd five hundE{ doll$ (5500).
<br />-1,
<br />&s o*tur of th. prcFily, or my.,iployes wnh wa8.s $ ln t sh omFNlion. will.b dp rc* rn Ill. srnf,ih is ml
<br />i.lcded or o,Iered tor alc (5(,7044. Ausircsi and PmGssions Codd me Conrsloas Licns. Lrw doer ml ryply ro d own.. of
<br />thc poFrq who hild! d inpirB th.m( arld vho doc sh e,t hi@lf or ls*lf or llmug! his d lEr ou cnlpt yes,
<br />provid.d rhrl such irymlcNft e ml inLri.d or ord.d lor $L. ll howE ltE btrildin8 tr inprowmnt is sld wnnin om yce
<br />ofconpEtur tlE Owrcr AliBc. will haE dE b'!d.n ofproinS ihd lE or dE dii ml t[ild or i"p6r 0E p'$IEly for tll plrpo$ of
<br />-1.
<br />asoqcrofrne pmpcny. rhciclusirlyconlracrins wirt liansn co ndoF ro mn(rucl rlE Im.jccr rS(.7O+1. Blsiics
<br />ond k,lissnn Codc: Thc co.k.cror's Li.cnsc llw d..s nor apFlyro a.6*06 ofpmncdy eho huilds or improv.s lhcrmn.
<br />3nd who mnhcls f.tr such pmisIs sirh! coniBcto(9 ltcnsed puFwr ro
<br />'hccontEctols
<br />Li.cn* k*).
<br />Ir r.xc fln dcrsr.r(nr ,B &PC itrrhn.drvnr
<br />l) r ln,nrr
<br />UOBf,ETS:.COMIEIIAITON
<br />DECI,ASA:IION
<br />I hcreby am.o u.dcr pcDlry ol pe.rury orc ot $e lolloqiis dcdm o.!:
<br />-lhlvca
<br />willmintoinrCcnificrlcofConsc h Scla lnsurc lor *orkEi ompcnsatioa, os lovidcil lbr hy Secrion 17fi, oi rhc
<br />L€htr Grlc.lor rh. Friorroncc ofrhc worl forwhichrh. ptrnrir i ir\u.d.
<br />_l har and qill minrsin porlca @mlcnsari.n ins!6tuc. &s rcqlicd by Serio. l7O0 ol rhc Llbor Crdc, fo. rtE Ft),rllB of
<br />'iHu*"ion in\u6Ec .!dcr ud InlL,
<br />€M icY
<br />l..niryihar i', rhc lf,rlontutu ofrhcworlforwhi.hrhispcnnii\nsx.d,IshaunorcrrloyLny
<br />s slo t sm subj.rt l.llE mrtss orycnslk n l,ws of Californh, md a8E rhll if I should bccom sub.ist lo tlt
<br />wo*es'omlcnsalionprclisionsolScclionl?00ofrhchiorCodc.!shall.lonhwirhoq,lysirhtlbsnm$ions
<br />$ARNIN(;] Failurc b knrc wo.k rc'.omr.nqn,n orcEAc i\ unhwrnl. dnd sh.ll subir( an cmplorlr !o aimiMl tEMlics lnd
<br />civil fincs up ro.e hnndr.d rhousmd doll,^ (1100.000). in lddilion ro r
<br />S(hnn 1076 orthcl$orCrd., nrcrc$,nd dx,my
<br />,",", .IUl7 (. ,/n,,,,*,.4.-
<br />I hcrcby atfm undcr p.mhy of F+ry lhar I am licnscd ud.r pmvhion ofcnlllg 9 (comftmin8 with Sccliotr 70110) ol Divisi,n l
<br />oa thc Busie$ ed Phfc.rbE Co&.8rt oy liens is in tuU roc a.d.ret.qy2 I
<br />I hcrcby affirnr und$ lcnalryofl,ciuryth,t 'hnc
<br />n 0 snirudion LndinS 0g.my for th. F li"nEmc oflhc wo,k for whichltis rEmit t
<br />nflcd (Sdc.1097, Civ C.).
<br />AITIIgANLDIICLTBdIIO!
<br />l,Lnhy Imundcrpcnohyof nDrjuryorc of lhc followir8dccl 0lnnN:
<br />D.molirion Pcrnrirl^sh.nos Norilicarion Fcdcrul R.gulnrion. (TirL 40. Pnn6)
<br />-Rcqutcd
<br />Lcrrcr nl Norifrolion
<br />-l
<br />ccnirrrhlr rhs ltdcml rcEuarhns Esadins ostrsbs rcnov.l arc norrpplic lerDrhhI)rnj.d.
<br />)ar ftn,ryrhJ! rhn!c rcrd rhirrnrl
<br />ddmdn c(Jnd srorc lj*i RuhBro
<br />i.dn,n uxl sardhl rhc sk,vc infornuri.i n cond I agrli ro onrtly wirh dll Ci y snd Counly
<br />ofrhis Cn, md Countyro cnrc. uron rh.
<br />rlr,vc rR rio.rd lnrpcny fi, in\pc.rion
<br />,lppliennt trr,\A.nl Sitnulu
<br />AJ
<br />46..rO1-F-t?
<br />UNDER GROUND
<br />Waste & Vent 7174/ty TN/,r'1,,1
<br />Water-Under floor
<br />Gas-Underfloor
<br />B uilding Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<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-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Linei Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL
<br />No tes, Remarks, Etc.
<br />+
<br />Water Service
<br />Back Flow Device
<br />tq
<br />,U
<br />kndfl'r Addr6i
<br />-
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