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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNT]R AUILDER DF]I,CARANoN
<br />I hcrchy ltlnD un(lcr Itnilly rn pcrJlrt rhd I nfr crcnrl lro'n rlr (innrd.kiN' I-i.cD{ t-rw lo! rh. folb*in3 rca{)n rst( rJrl 5
<br />Ilusinus\ rn PdUlnnr Co.tc)
<br />^tr,
<br />Cil, or Coutrry which r.qutrcs r Nnnir ro consltuc|. rlrcr. imp,ovc. dc xri\h or qDr itry
<br />{tuchrc. nri,trro ii\ i\\urnc., nl$ rcqutrc\ rh. Utli.dr i.tr (u.h Nnni o illL r sirncd {dcrmnl rhar lle or \hc Ls li.ci{d Pururd
<br />kr rhc pmvisi(ins olrhc Conrrrclorr l,icenscd lrw lChrnr.r q. Conrnrn.ira wi'h Sctii,rn 7(xx) orDivisirr:l ol'rhc B!siN\\ an,l
<br />Pr)Ic\\i,'nsCodc)orrhrrlEor\hcn.rcn,prrh.rfron,rndrhcl,$i\nrrhcallclucr.mpri' . nyrnnllionofSccrhnT0.rlShtrtry
<br />etlicrnr ror r l.nnn \ubjc.rsrh. nt,Ili.lnr tu rdvilpcn,hyornor nturcrhrtr l1\e htr rsldolhA($5OD
<br />-1.
<br />rs owncr of rhe pmFdy. or ny cmployes *irh wages !s rhcn mh .on{En*.1ior, will do lhc wk rnd ltE stiEr@ is @r
<br />iirc,'d.n or oficEn fDr ok (5*.70{4. Businc* ud Prefcaiaon. Codc TIE Conlrrclor's Ltcns lj* &Es ml aoply lo d owM of
<br />lhc lmFny wh.t ['ls or impoEs r]ENn, od *tn dcs sh mi( him$lfor hc*clf or rhhugh ht d hcr own.oplotfts.
<br />poid.d rhar such ahFoEftnB@ rci ided.d orofrcdd lor *t,lf. hoaN, ttEh.iHin! or ir{mwm issldsnhinmJqr
<br />of.oq,ldion, rnc Owncr Buildd will Mw rhc trrdo of pbvins thlr hc or ile did mi toild or irF.rc lh. pDpcny for tlE l,uqEs of
<br />-1.
<br />rs owncr ot rh ,,!pcny, amcx.lusircly conr&rinB wirh liccnsd .o.rados ro co.sNcr lh. Fmjct (Se. 7044, Bu\its
<br />and Piot*sbDCodc ThcContmtols Liccns. Liwd@snot 0!!lylo 0nowncroftropcrlywho blild\ or inprovus rhcrco..
<br />lnd *ho conrrcis for such rmj.{ts wjrh ! ConrEcrorls) liccnEd p!^u.r ro rhc Conuctor's LicM tiw).
<br />I anrrxc'npr undcr S(r
<br />^,",'.-"fzqf ll
<br />DECI.ABATON
<br />I h.(by dfirm undc. F.rhy of FrFry onc of thc folowine dccLmlhns:
<br />latitr ( onc. lnr lhc pcrlnnuN. rf rtu {ork tur $hi.h rhc t^-nnir i\ n\u!t
<br />-l
<br />h.r a.d *illminlain wortcro' comp€nsathn insu6mc. as EStircd b, S6tion l70O oflhc Ltho, C.dc, for lh. !.rfotmncc of
<br />thc wo* for whth lhn pcmil is n$cn. M, eorkeB' oq,cnslior insurore cet. ,rd Flb, nunbc, @:
<br />P(,li(y Nunh.r Exptc'
<br />-t
<br />enify lhlt h lk Frformre of lhe worl lor shich rhis Dernn is iislcd, I shtlt ml cmpLymy pcmi itr lny md*,
<br />$ sr.lrcom subjccr ro rhc worlcN mmpcns0rhn laws ol Californi,, and agrcc ltal if I sholld bEom $hjccr to rlE
<br />workm oopcnsdrion pmvisions ol sdion l?Oo o,lhc tjhor Codc. l nul!. fonhwilh ofrplr *irh lhoc lmvkionr..
<br />WARNINGT rliluic b sxr! workcs contEnsarion ovc.lgc i3 unhwf!|. md shall slhjcct in cnrnlotcr !o dimin0l lcMnbs od
<br />.ivir fircs ul, t onc hundrd rhonsend do
<br />Seiio. 1076 oi rh. hbor Cod.. ir trcs otrd
<br />hFnsdrioo. ddmgd as povidcd lor th.
<br />1 L+t8
<br />I herht ifttnrundcr pcnullrolFrjury rhnr ionolChsprer9(commncinPFirhScdt,n7fl )ol'Divisiotrl
<br />of thc Busilcss,nd Pror'cssiorN Codr, ad my liccns is in tull
<br />Dal.:
<br />salsru(:IlaxrBDMlcENct
<br />I hcreby {lttn undcr FnahyofI'erjlryrhar rhcrc h d coosocrhn lcndine tr8cRt for thc lcrformrmc oflfic wort for {hi.h rhh t).imn it
<br />ksucd (Se 1097. Civ. C.).
<br />AIS.TCANLDICLATAIIOA
<br />I tEr$y.fi'm lnds Fialtr of F+ry om of thc follo*inB dcclml iods:
<br />D.m,nion Pc.mit-AsLsos NolifEdhn FcdcEl Rcelhliotrs Onb40, P!n6)
<br />-Rcquir.d
<br />krr$ ol N.rifi cdi,n'
<br />l.cniry'hd rh. fcd.r.lrc8ul ions rcBordin8 islEsros rcnnvoltrc nor lpplic lc 16 thil pioj$r
<br />-l
<br />ccniry th l lElc rcld l,ris !i.n ud n,rc rhar rh. nlr,vc inlonndhn is.onccr I oBra x, conply wirh oll Ci' y ind counry
<br />odinamcs ald Slat Llws Ebtin8 ildiia .onddcrioi. dd hcrby anrh.riz epEscnirriv.s ofrhn Cny md Counrylo cme uFinrlf
<br />obvc mnliomd propcny for ion nu4r'*s -/'z-/&?,,-'7 Ztt
<br />UNDER GHOUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underf loor
<br />Building Sewer
<br />Area,/Storm Drain
<br />I nterceptor/ CIarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool HeateriGas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Tesl
<br />Meter Release
<br />FINAL ,'F1q ?-ct-l
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />l,iccn{Clas: Li.ens. Nrnbcrr
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