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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />,*w *Waste & Vent 4 flfl,7 nr)
<br />Water-Under floor (u)'.
<br />Gas-Underlloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent I I ic, )
<br />Water Pipinq l1 t tqr,rlwc
<br />dt*td,';Gas Piping I .b/
<br />Roof Drain J\
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Linei Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />i
<br />Rough Plumbing
<br />;quPftn,Final Gas Test I \)
<br />Meter Felease I I )MAFINALAtttclq tlrt ,6)
<br />Notes, Remarks, Etc.VI
<br />.tl
<br />OWNDR BUILDER DELCANATION
<br />I herchy utfir undcr pcnllly of p.rFry rhlr I anr ercmfl fmnr lhe Conka.bN Li..n{ ljw Lr thc lbllowins rcason 1scc.70:ll5
<br />Brsinds and Pn,fcssi,n Codt)r Any Cily or Counly Nhich rcquncs , lrirnit to conslrucl. alrcr improlc. ddnblhh or on ir My
<br />slrxcruN. priorro its nsu cc. alu rcquics thclprlicrnt tor such rcnnil lo ilcr \isn..l {ar.mnr rhxr hcorshc is licctrscd lursudr
<br />ro rhc folicn,ns of rhd Conlrdcrols Li.cnrd bw (Chr cr9. Connncn in8 wilh Scdi.n 7Ul0 oi Division:l ofth. Busincss rnd
<br />PmlcssiousCodc)orrhrrhcorshchcxcullhcrcfron.ndrhebrskr'orlhcallcgcdcicmrrtrn.AnyvndionorS(lion70ll5byany
<br />lpllicanrnnapcrmirsubjccrsrheappliconrroacililpcoahyolnrnEcrhMfivchrndrcddolltrs(3500)
<br />*1. .s owncr ol lhc l,oFny, or my cmplorcs wilh wagcs as lhcir solc mmpcnsalio.- will do fr w6lk ,.d tlt slirhE is trol
<br />inrcnd.n or oficrcd lor sk (Sd.?044. Busincss rnd Profcssions Cod€r Thc Coor&iors Liccn* rlw dms aol lplly lo M o*ner of
<br />rhc pmltny wtn, bnius or ihpmB ilEmn. old who dms such work hims.lf n hcmlf o! rhmurl tis or h6 own cf,ployc.s,
<br />toiidcd thar such irpl@ftds @ B, i c.d.d or oflcr.d ror ralc. li how.w, tE brildins or nrq:mrcmnl is mld wnnin .m F-
<br />of@tr{,lelbn. the Owmr Buiklq $iU halc dc burdcn of proving $!t he 6r sht dk! ml bdld or in{,rcrc dc r,opcrly for llrc puqrs of
<br />E r"rrcr,,rrrrc r,runcay. "mr\rlunvclyo'nhr.,fl! wirh li.c.scd . o ntacron roonsrrud rlE pmicr tscc. ?044- Blsinc*
<br />,/htrd ft,hsrnn C.d. Thccotrr,crois Liccn\c LJwdocs not applyro m opnc! of Dropc.r, 'ho buildso, ionn,vcsrhceotr.
<br />and wno €onrlack lor such rmrc.ls sirh { conrndo(s) liccnsed pu^lanr ro rhc G,ntr..rof s Li.cns tiw)
<br />x,re 1
<br />DECIdBAIIO]J
<br />I hcEb, !ftm undcr pcMlry of p.rury orc o(rhc fouowine dNldlrions:
<br />-lh
<br />c oNl qill minllir a Ccn i[cllc of Conscnr ro Scltlnslrc n, sork. d,nDctr,r'ion.as pruvidcd rbr bySdn]o ITOO orrhc
<br />Lrhor Codc, rbr lhc 0crfomrrcc ofrhc wo* lhr qtichthelcmir h isucd.
<br />_l hrvc rnd sill naintain qork.s conp..sarjo, insurarc.. ar rcquied by Setion 3700 oa lhc Laho! Codc, for lhc pcraomee of
<br />rhe *ork for *hi€h rhis pcmi Lr ilrued My lorkdi @mp€n..lion inrueft .Mimrn pofty numbc! ae:
<br />I..nily$ar inthc p.rfoi mncc of lhc work for which Lhn pcirnil is ksued.I shallnol employ un, n soo io tny nmncr
<br />s as lo b.sm subj€l lo thc so*c6'ompensarion la$s ofcslifomia, dnd agt. rhlt ilI should becomc sunjal lo lhc
<br />qorlc6' con{cnsolion pmvhions ol Strion ll00 of lhc tabor tue, I shatl. fonhwith .o'ndy wnh lhos pmvisions..
<br />WARNING: Failurc ro $curc workcr ompcnetion covcm-lc h unlowaul. an'l snau sul,jccr sn cnrl.Fr lo annnDl ,sBlli.s atrd
<br />!rrl ,incs un ro orc hundEt !h,{\!nd d.lle, rtl00.0il0,.
<br />Codc. inlcrc( trnd artmcyt fccs
<br />F*I R
<br />LICr,'NSF I) C(INTRACT()R
<br />DF](]I ARATIoN
<br />Ihcrc!ydftrnundcr |tnrh)oilcrjuryrhrr Ir liccn\.{lundcrIrori\i{n,ofChnt,r$9i.onrtniDgwirhScclior7()(xl)ofl)ivnn.l
<br />or rhc ausilcss.nd PturisiorNCodc. aM nryliccnsc is ir tullrhr.. d.ri.cr
<br />l-ic.isc Ch\s: t-r.nr. Numbcr:
<br />X*
<br />CONEISUCIIONIENI}ING.IGENII
<br />lhcrubyafirnxndcrp.nalryorFrjuryrh0lthcrcisacon{flclbnlcndir8oscncyiorrhcpcrformdc.orrhc*orkforwhichthislicrnilis
<br />nnrcd (Scc. 109?. Civ C.l
<br />I c.dilylh.r thc rcd$al rc8Ulations Eg.rdin8 Nbcslos rc'rcv0luc.or amlicablc lo rtis l,loitr
<br />rh l hrlc rcad rhis npplic{ioi d srarcrhlrrhcah,vc iironnarn)n is.odc.l IagrccrocomplywilhallCilyandC.uniy
<br />ordinanccs and Srare L!*s Elari.C ro nrdivcsofrhhCnya.d Co otyto enrdr Llrlnrl[
<br />abovc m.riomd pmpcny for in
<br />A ppli.oni or Agenl Slgnnture
<br />) P.mtr@ Bn (p.tDt)
<br />tg
<br />TOP OUT
<br />..nlEnetion, daflgcs !s provklsd io rhc
<br />Co.lator
<br />ATIIJCANI.DDCI,IBAI(A
<br />I hrihy rnirn xndcr pcn,lry or rcrhry onc oithc followinS dcclafuriotrs:
<br />Dcnrclilion Pcrnrih-Asbc(os NDlificarion Fcdetul Rcglltrriois (Tirle,l0. Pd6)
<br />-Rcquncd
<br />lJtrcrof Norin.arbn
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