|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNDR BUILDI'R DI'I-CARATION
<br />I hcr.ny !fim undcr li.nally of pcrjury rhat I m c(mrr riorn thc G'niodo^ l-iccnsc t-r$ r(n rhc rollo*ing rc.qrn (Scc 70ll5
<br />Du\incss rl Prcic$ion Codcr: Aiy Ciry or Cornrv shich rcqtrt \ r Fn r io tun{fl.r, rlr.r. i'nptuvc. d.nrri\h ,{ rc0.n rny
<br />iru.ruic. tnkrr, n\ nsuii.c. rl$ rqxncsrhc amliclnr ru su.htcmirb ilc l siEncd slarcnEd rhll hcor nrc is licci\cd nurunr
<br />n' rhr pn)!i\n,ns.frtr Conkrctr \ l-'..i\.d l:a (Chrlrcr 9. Gnn'ftn.i.g sirh Sc.rion 7(X) of D,rismn I oi rhc ltusincs and
<br />l"ola$i.nsCodc)orrhrt h.orrh. is crcnDr rhcrclion lnd rhctu\is lir rlrc trl|Ecd cxcr.prion AnyvnnrriooofSErion?0.r15$yriy
<br />rprlicanr lhr! p.rnrir suhjccrsrnc rppliclnr h n.irilpcmllrolmt morclhrn nvc hundrcd dolh6lssm).
<br />L ownd orrhj lri,trdy. or m! cnyl,,trc\ wirh qrrd nlrhdr $L onrNNdn,n. wil,do rlE wort uld lhc sruluE i\ tri
<br />irlcrxL{ or olt'cr.d ,tr srh (Sd 7(}4r. Busims\ and ltd'csi.ns Cod.: 'rhc O,ntx.ttr r Li.n\c lrw docs n.r al)llly to on osncr ol
<br />rhcmrlMy who huild\ or inDn)vcs rhmn. rel wll' docs snch woi( r,inrcllor h.^elaor rhK,x8h his ot hf own cnDhyccs.
<br />pmvidcJ rhrr rurh i'npmrtunbrE ninrc lrlororl:rdfireL ll howurs. rhchoildin8or impmrm h $[l wirhin onc jqr
<br />oi conDhlion. thc Oqmr SuiEcr will I'r\t l h. hunLo ol ,arvin8 lhlr it or shc di{l mr hoitl or i!r{r t rhe prop.iy iv lh.IUrF,{.1
<br />-1,
<br />as owrcr ol rh. lmpdy. .m.rclusiwl, conr.ding wiln lien*d coninctoc ro mnsrtucr llE Faj.cr (Sd. 7044. Busftir
<br />aid PDftssion cldc: Thc Conrrcloa r Liccnsc Lrs d6c$ @t lnDly ro u o*nd 6t propeny who builds or inpmEs lncrcon.
<br />d who @nm.k ror sEh Foids wnh. Co.rndo(.) ltunsd pusuanr ro rlE C.nrn rois LicrE L!w).
<br />-l
<br />u .x€mpr undcr Sedon- B. & P.C. fo. Ufi Ea3on
<br />D.r., Ose.
<br />UOBtrEES:IIIMIEIIAIION
<br />DECIAXAIIO!
<br />I ficrcby lmrm udd pendry oI p6jry om of rhc followhg .t cldari6.1l
<br />I nhtrCoJ.- tnrrh. nrfoi,,utrc..lrfu $o,l tur trlirhrhc jrnnr iisuctl
<br />_l hawand*ill mainlain workcs comp.ns.lion ny Sd ion 1700 ot rh. Libor Codc, ror thc pcrfollrjm. of
<br />@icr !d Flky ntrnb.r se :
<br />L
<br />-l
<br />enify lhlt in th. FrfolmN of lhc wort t'd whth rnir pcrmil is issEd, I shall mt cmploy qry p.r$n in any MM
<br />$ as lo bcom subjcct ro the wo*c6'omp€nsution har of Cllifomia. .M !g@ rhd il I should bc.om subj.{l lo lhc
<br />wortds onuEnsnrion rovhions oa Scdi.n 1700 of
<br />'hc
<br />Llliq Codc I srEll, lonhwnh.omply wnh lho* pDvisiotrs..
<br />WARNIN(; Failut ro kdrc workcrs srip.nsrion .ovrn8c is unh{ful. {.d shal, subFl m cmplorr ro sjminal r@lrar and
<br />k) onc hu dr.d rhou\rtrd dollnr\ ($l(x).{Xx)). in jddirion r iotr. duqcs as provid.d ftr rh.
<br />serion 1(,76ofrhc Lr&r Codr, rnrcrc{ snddhm}r
<br />o,,", . A l'ru 14
<br />^,,,,-",,
<br />x'l 1r'ln ( r \l|\ rx)\
<br />I heEby {fiim under pcmllyolperjury lhal I am li.cnsd unds !rcvnior ofChapr.a9(on'Ercing wnhs.dhn 7{xn) ofDivkion 3
<br />ol rhc Busi,rcss d Prclcsions Codc, 0d mv lic.ns. i\ in 6,ll fom nn l.ff(rB J
<br />-T (r)Ns t Rrrc't't()N LlrNl)tNC ,\GriN( r
<br />I hcrcby Illltm undc. ,.nrlry oi psjury rhd thcrc is a coNtdcrio. lcndinS agcncy for th- rr.Tfoxumc 6f rlt w.rl ror which rhis ldni' is
<br />issucd (Scc..1097.Cir. C ).
<br />AITLICAII,I]ECI.ATAII!]N
<br />I h.r'by {ltim nid.r I.ndlry of Frjury onc of rh. folbwi'rg d(lrd bn\l
<br />Dcnlniion Pcrnrils Ashcnos Norirrclrion licdcrol Rc8uldions (Tnt40, Pan6)
<br />_R€quircd lxrre, of Norifi cdrioo
<br />-l
<br />ccnify lhar lhc lcdcml rcgllllions rcguding asbcsros Emwl m mr opdiobk ro rhh pbi,
<br />I ccnllyrhJ I hrvcr.rdrhi\ {plicin,nrnd\forMrio. h .om.r. I {ge ro onl|)ly vilh .U Cny
<br />ofllimm.s rn(l Si!rc Ir'{s rcLri',g k, hu, nr!Nlhorie rcprc*nr,tivca of rhis Ciry and C,unty lo
<br />lbovc nrctrlioncd pmlcny for insrcrion
<br />Appli.&l or AEenl Skn,lure:x
<br />UNDER GBOUND
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Building Sewer
<br />AreaL/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent {//6//f -.p4)
<br />Water Piping \--,/
<br />Gas Piping
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Waler Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 8/zrlr ."1ff2f
<br />Final Gas Test
<br />Meter Release I
<br />FINAL Q/6/ t f /vkh )
<br />Notes Remarks, Etc
<br />-s
<br />Waste & Vent
<br />Roof Drain
<br />Fill Line/Back Flow
|