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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor
<br />Buildinq Sewer
<br />AreaL/Storm Drain
<br />Interceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain 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 />Sanilary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 8/n/ff z vk1tt,
<br />t
<br />Meter Belease t,0
<br />FINAL I
<br />Notes, Remarks, Etc.t- 1UZITT
<br />0WNER BU!I,DI,R DBI-CARA'f ION
<br />I hrr.by il,n tr d$ |rnrlr)_ ol Nrjury rlrrr I m c\c ri,r nofl rlrc CotrtrMa Liccn\c l-trv f.r rhc tnlbuin8 rcr\on ls.c 7o.ll 5
<br />Bu\itrc\\ r iPn,L\r.nCorlc) Atry Ciry or Co!trry shich rcqui.c\ r Fnnir l,i..n(ncr. rltcr. im!trnt- dc'to,|i\h or htrn ri,
<br />nrucrur.. I)'rrt) ik i\surn c. ]lv, rqrncs rhd qrplicrtrr lnr \uch pcmrir t, ,llc r !!ncd iarcnrnr rhrr hr.r rhc i\ lrcns.J pur\umr
<br />r, lh. f'visnnN ul rtE Co nr.rtr \ t,icctrscn li* (( hrfu 9. Connncmirg wlih sccri,in 7(Jtn ol Di\isn,n .1 .f rhc arrnc\{ ond
<br />rltli.rnr ftrrt^-^nnn !1hjc.i\ rh. rnfl'u.r k, rcivilp.fulr),otnor nbrcrhri ftc huidrtrl d.lln( r55{D)
<br />-!.
<br />N oeftr of rhc pmFrrr. or ny chployes Nith *!8cs &s thcn sb comp.nsdion. *ill do tlE wl .rn UE {.aie is mr
<br />inrodcd or oflc'rd for $le (s6.?o14, Busim$ ed Profe$io.s cod.r Thc c.nrmrors Li...F kw doca nol arply ro d owrcr of
<br />llE pnllcny *ho hrilds or inprcB thce( ,!d who dc rnch s* himrcir o. hcBlror lhDuah his or lEr own ct{rlor*s.
<br />r,rcvidcd fiar such imprDwmnrs @ tur inrsd.d oroffe,Ed lor sb. lf. horE E lDildins or ir{erft is sld wi{u om rsr
<br />of@rpl:rh.! dE Ownfi Builb sill hrE 0E h!&n of rnbviie rnd h or lhc did rcl hild or inprDE the popcly for dF pulDs of
<br />_1, N owrc. of rhc tmpenr. M crclusiEly conlBclin8 wirh li.ctrcd .ofidoR lo mr.ld.l llE Fmj(l (56. 7OU. Busim$
<br />rd Eofsiof, Conc: Tnc Cotrtrcrols Lic€n$ Lav d@s mt lpply to ai owncr oftrcp.ny who builds or impmv.s lhcrcon.
<br />-I
<br />*ho .o.hck tnr su.h Inrirk wnh o 6mmcto(9 li.cncd puBunr b rhc Codndtr\ l-iccnE lj*l
<br />I hcrcb, affinnund.r p..ohy of pcrjury onc olthc rbllowing dccl&ations
<br />I rtxtr (nd..l,nih.t{rl.nnrrd ofrh. $.rk lnr qh'ch rh. t^-nn ^ ^\urd
<br />,, hsvc ond will mintrin workcft compcnsarhfl insorsm., os rcquiEd by Sdlion :l7m of lhe Lrb6t Co&, for ltE FftlrMe oa
<br />lnc work for which lnk pcrnil is iseEd. My wort6 @rrFns.lion insurue ceid t t loli.y .umbo ecl
<br />_l ccdifyrhd an rhc Frformncc ofrh. $ork ro. shi.h thn FmI k issu.d.I rnrll ml.mploy any pcrsn in uy tuM
<br />v, s to bccom subiLrr ro rhc wolknc conp.nsarion laws of Californi&. lnd oEEc rhor if ! sholld h..oN subj.d lo lh.
<br />qorl@n' onlFrelio. pmvirions of SNtion 3?00 of lic L.bor Cod.. I shlll. fodhwilh @nply wilh lt s lmvisio.s..
<br />lurc to surc wortcrs' ompcnso'ion covcm8c t nnh*tu|. and shnll sub }[r b fininrl Firhf,\ md
<br />onc huhdr.d lhousand dollac (S100.fiD), in ddniotr ro lhc cosl d!m96 I prcvt.d ior rh.
<br />I hcreby aafiirn utrd.r ,Enahy ol Frjury thar I um liensn ondcr Imrilioo ot wirh Sdri)n ?fir) ol l)ivis n:l
<br />of lnc axin ss lbd Pof6sions Codc. ard my liccn* t in full aorc ud cffccl
<br />Li..NcCh\s l-ic.nsc NumlEr:
<br />Dele Conlrrclor:
<br />cQNra]JcloNrflDllcicl)NcY
<br />IhrchyalirnrundcrncmlryolFrjuryrh rhcrc i\ r connrurlioi Ltrdiig r[cn., rorrhc t ]tfDrnrmc ol rh. Eotk br *hich rhis n rnl n
<br />i\sucd lSec. llr97. Civ C.)
<br />AIIIICANLDECI,IBAIIO!
<br />I torty dim undcr pmalry of tErrrry onc o, rhc foUowing d(ladions:
<br />Dcmlilhn Pcrmirs-Asb.sros Norifi@rion Fcdcdl RcsularioN (TilL ,o. Pan6)
<br />-R.quircd
<br />L.ttcr o, Ndifrurbn
<br />-,
<br />enilyrh0t I hlvc rc.d rhnarFlt nnud {alclh.t rhc rmr'oF n.nn..r l,g'e r" ouInl) uirh JllCir) Jntl (-,,un,)
<br />ordnrtucs md Sbrc tiws Elnling to huildingconsh.t rc!rcscnrsrivcs ofrhh Ciry ond Couoryt, cnru ull)o trr
<br />alxnc Drnrioncd pn,pcny td i'!spc.rion
<br />,\ppliMnl or,\xrtrr Silnrl &za4L
<br />It ufriala,zal
<br />Final Gas Test
<br />*r.?'
<br />t tr&i' Nam.
<br />-
<br />I dily rhn rhc fcd.ml ESuhrioff Eg.rdinS Nsh.sros rcmvd m nor lpplk.bk lo fiis ,rmFr.
<br />I
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