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PLUMBING-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<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 Piping
<br />Gas Pipino
<br />Boof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{rap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL -rU{re 'uh@)
<br />Notes, Remarks, Etc.
<br />oWNI]R BIJII-D!:R DEI-CARA'I]Oi\i
<br />B!sn,c\\ rnd Pi(,f.si('n CoJc) n, Cir, orCotrnry\hich rcqunc\ r lrn ir k,.otrifl.r. nhcr, nnnmuc. dcnDli$ ,tr rcPJ r Jny
<br />h.rurc. Irrntrt' irs ,s\u .c. d\o rcqunc\ rhc.ppli.ur r1r so.htrn r Io ljlc a \Encd {fllcL-.d rhxrrr orshc n li.cn'.d rur{rMr
<br />n, rtu I[xi\i{nrs oi rh. Conrrrcxtr \ l.ic.isrJ l.a* (ChaI.r 9, Co'nilcncn,s qih sc.riotr Tlxx) .i Drvi\ion .1 ot lhc lllninc$ rnd
<br />oppli.!trrforiFflnn \uhjccB rtr appli.rnt ro acivilltnllry.lnor nxErhxn fivc hrndrcddollu\13500)
<br />GK owE olrhc pmFny. or my chplolecs *irn wrScs ss thcn sk co,pcnxdion. willdo rtr wdk.!d Enntuk ml
<br />or oiIcrcd aor slc (S( 70,14. Elsine$ Md Profcssions Cods Thc O,nretor's Lien* I-lw do.s flol opply lo !n o*nci or
<br />rhcpbNny qh, huild\.r illq)rorsrh.Nr. i,kl *ho des .htr!,thm\clforhcr{lf.rrhroughhhorncro*ncnlPiDrc\.
<br />troridol rhar such irprovcf,.n( rR nor inrcnJcJ or olttRl for eL ll ho\d.r rtr hikl ins or i'lrPnrtnf,nr i\ v,Ll sirho oic }!Jr
<br />olc.nDlcliqr. rltOwn ! l,uilduruillhu rtut{dcn.r Dn,virurh! lEorshcd n.r huikl or inDn,lc thc lI,n(iy ror rhc Nlrc oi
<br />-I.
<br />as owncr or rhc l,mp€dy. .m.x.lusiwly conradin8 wnh lccnscd conedos ro cotrsru€r rhc pmifr (Src. ?O14. Busiics
<br />ind hsrssion Codc: Thc Co.rr..ror\ Licc.* Llw .tas .or appl, ro !o owrer ol pmp.ny who builds or inrrmws lh.rmn,
<br />and who c.nh.ls fttr such !,mFts sith a C.ntuto(t licn -:,bff8)t_
<br />"**.x L
<br />lla85E8l.g<EdralraN
<br />D[Ct /tBArtox
<br />I hcrcby afiim urdd pcr.iy ol p.riury onc of lhc folhein8 dccbrlrions:
<br />I hrv. tlldwillnDdrir i(tnii.dcolCotrsrtrrki Sclllrsurc ftr w.rkcr{ co |Enslliatr. is provtlcd forbysccrk,nlTmolrh.
<br />tihrCdlc, fdrhrp.rfon nrcof rhc woi( for*hi.hrhc p$nrir i{ h$c,l
<br />_l hlvc !trd will mainhitr work rs .ompcnsatioi insursncc. trs rcqlird by S(r ion 1700 of rhc tabor Codc. for thc FiforMr. of
<br />lh. vorl ftr whth lnis Fmil ir nsucd My vorts otrpcns.rion insumre a cr &rd Flicy numh( e
<br />qp-"
<br />fy tu' in lnc pcrro.mmc of fi. worl for which this Froit k bsu.d, I sh.ll nol cmploy sn, fcmn in my MM
<br />$ us ro hccom subjcct to rhe *orkctr mnDcnsrrion luws oacnlifomio, and alrc rhlr ifl should ltcom subFr ro
<br />'h.qoltcK onpcostiotr prcvhions ot Sccrion 37m of lhc Lihor Codc- I rhall. fonhuirhomply wnn rhoe pmvisiom..
<br />WARNINC: l{il!rc to Erc worlcr' comF.n ion cotEsc is lnlaslul. &d shall \ublr ,n c.Dlo)$ ro din ,rl lcnrllls und
<br />civil lincs up t. onc hundlcd lhouend dollan (S100.0(x)J. in addilin. ro .od ot conp.nrnri.n, drmScs a\
<br />c.
<br />DECI.AB61IAN
<br />I hcrh,rffir undcr!.nrhyofpdjuryrhrtlr li.rn$dxlldcr tri,vi\n,nolChilrcr9l.o.rnrrcing Rirh Scclbn7(iO)ol Divisi,D.l
<br />oI thc Busin \sa Prutcsnns Codc. und my liccn\c is iD tullhrc!trdcrlccl
<br />l,xrr ( onr,[r,r
<br />AIE,ICANLDECIT$A.IIIIN
<br />I hdEt, lttm undcr pcnahy ol prjury onc of rhc folLwins d(lnrri iooq:
<br />Dcmlirnrn Pcimirs Ast'csros Norificarion Fedcill RqulNiotr\ (lirtart PJn6)
<br />-Rcqutcd
<br />Lcuq of Notifi @lion
<br />qd,iryrhd rhc fcd.ri I rcBtrliio ns rcSdding astEsos mnmvdm nol $llt8blc ro lhn pmjd.
<br />dhvc innnn!'ioo is.oror. Lgre id.onrdy wnh rll Cny and Counryrhrr lh$c rcrd rhi\ rtfli.Jri(ra (rt rhd
<br />orJimncc\ md Srric ll*s rcl ing b buiUnrt
<br />u1*-,hovc ftnriomd rmpcn, tor inspccrion
<br />Aprliconl or Aaont Sianahr
<br />$h Ciryrnd Colnry r. cntcr upon thc
<br />,","..c7-/?-ltr
<br />I
<br />APPROVALS
<br />CoNS'I'RUCT(IN LENDIN(: A(;ENCI
<br />I hcNby nnn undc! Fnohy of Frjuly lhll thcrc is a con(ruclion lcndi.r uscNy tu rhc Il.rromn.e or rh. sorr for which lhh Fmil k
<br />issucd (S.d. 3097, Civ. C.)
<br />I ci,,l.,'\ \J,l,i*
<br />POOL/SPA
<br />Gas Service
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