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PLUMBING-INSPECTOR RECORD
<br />OWNER ITIJII-DER DEt,CARA'I'ION
<br />I hcrcl,y afinr uNl.r rlc.rlry.f pcrjory rlur In cxcnDr fr.m rhc Coitmkns l-iccn\c trs i)r rhc folkrwi !r.Nrn(scc70lr5
<br />Busirc\\ inl Profc\si,)n Codc) Atry City or Counly *hich rcqui(s ! lf,iinir ni (n(d.r. rlror. nnlNc, den-lth .r ftr n uny
<br />{nkrurc. Driitu irs hsu.n.c. also rcqrnc\ lhc nnplic r Lr \u.h t(nnirb lilc s \i3rtd sltc.md lhal hcor\hc i\ liccnscd prn!$r
<br />ro ric pfl,vi\n,n\ or rlf, contrrct r l,iccnsln lj{ (Chspr.t 9. co nncn.ins qirh S.clion 70fi, .l Divistin I oi rhc ltu\irr.s ltuI'
<br />Pn'L$nnrsCdc)orrlrrhcor\hciscicmprrhdruliorrtrdrhchrri{lorihellhscdcxcmirn, AtryridrlimolS(rion7{)ll5bynny
<br />nfplicrtrr ntr u Nrnrir sulrccrs rh. lPIli.rnr to trciviltcnrlryofnor nxrc rh!. fiv. hundtcd dollat\(15(x))
<br />I. n\ owncrolthcpr.pcnr.ornryc Uoyccs wirhwr-qc\ !{ rhcir {ncro lf,.\dn,.. will do ltE work a,xl rh. n rmi\ n' .
<br />inrcnrllrl or ollcdd f,tr slc (S( 7(!4. Busincsr a Eolcsbns Cdlc Thc (t.rrrch \ Liccn\c l-nw doc\ tror rpPl, n, nowtrcr ol
<br />rhcpn,Fny q,ho huilJs or nnpmw\ rhc.qr and slu d{rs such sI)r* hi'n\cll.r hcr\tllor rhouBh hi( or hc. osnc'npk,tccs.
<br />pi(r idcd rhrr su.h i !rctqh-nG m nor i crhl .r oliirctl ntr qb ll hrNoltr. rh huil in8 or iq,mrcnr il v,kl wirhir utrr ,t.tr
<br />olc.nrrlcrion. rhc or'ncr auinh trillh.vc lhc hur&n.l pnrlin! ild h..r ft dil ml hikl or iryBnc rtu lr,ldy for
<br />'hc PurFEor
<br />l.i\owncrorrhcpn,!fiy.nu.xclo\iv.lycor.crinCwirhli.ctrsdconltlcr,,Fhcosrtucrrlf,rtDjd(S.c7Ot.13\i'r.$
<br />rtrdltolcssinrCodclhcCotnroi(Lrccn\cLrqdesnorarplyt.ano*ncrorlroncy{hobuild\ornnlmvcsrhcrmn.
<br />and qho coittrd \ tu such nmrcch wilh r A,nrrr.kn( s) lic.i*d IUrruMl h IlE Conln.kr'\ l-i.cisc Ltrw)
<br />lm.rmd und6 S(tnn . A. & P,C. for rhB E!s.n
<br />IOBKEBS:CAMtI SAI1ON
<br />DECI,IIBAEA!
<br />I heeby a,t,rn undcr p.ndty of ps]lry otu otlhc lollowi!8 del4orions:
<br />-lhrrc
<br />lrxl willnun ritrrCcdilicrlcofCoo\enrbSclfl.\xftfor*orlLr\'coflrPtn\rin,n,dlrovidcdlir$ySccrn,nl7{Dorrhc
<br />utxtr Oxlc- lor lhc p.rronun c ol rhc $o!t lor which rhc IE nrir n isu.d
<br />.in *orkcr' .onwBadoo iBu6tr.. rs Enuircd by Selion 37{x) of rhc tlhor Codc. lor rhc pctfffi. of
<br />t is.k{ Myworkns comp.ns.rion iNu.sncc cr cr, 1lolicynumbcrec
<br />A/.//'4/r'/
<br />-l
<br />ccnify rhar in rhc p6for@m of thc work ror {hkh lhh tcrnil h hrucd,I shall nol €@lorlnypersn in lnv mtrrcr
<br />e a\ lo tr.om lubjd lo lhc $orlcl conpcnsdion hwr of Califo.ni& snd s3N fiar if I 3h.uld t .om $bixl io trt
<br />*orloa on'pcnsarion tmvlsions or Salion l?00 oa lhc lrbo, Codc, I si.ll. fonhwilh coaDl, shh fios rovisions
<br />WARNINC: Faillrc lo tcurc wortcs con{tcnsalion @lcrdst is unl0wiul, 0.d shlll s!d cnprortr lo aimitul ll.olli.s ,nd
<br />nerion, danERe\ as povidcd for rh.t' onc huftlr.d lhous!fld dolhr (!100,000). in dddilion ro thc cosr n:::!1w::
<br />DEI].Af,AIIOA
<br />Ihckbydilirnu cr pcnrhyol p.rjury rlu I r lionscdundcrr()!hionolChtrpr.r9(connmrcinawirhSccrionTUXI).lDivi\irn:l
<br />ol rhc BusinGs Md Profcssions Codc. and my licen* i\ in fullldN ind cfli.r
<br />6
<br />IIINIIBJJCIIONIENDIUGIGENCI
<br />I hcEbt artrm undcr pnalry or Frjury Ihlt rhcrc is . onslruclio! bndios ag.ncy for lne lqfonue or rhc worl fot which rhir p6n r i\
<br />h\ucd (Sd. 1097. Civ. C )
<br />a.rrur NfDlicLlS u!)!l
<br />I rrnhy ritm undcr Fnilly olpcrjtrry onc orrhc h,lk,sinB dc{l.,alions
<br />D.molirion Pcrnirs sbcio\ Norifi.lti.tr ltdmlRcgllrri, s (Tirlc,10. Pan6l
<br />Rcquncd hncrol Noriliurriotr
<br />I.difyrhar I Mv! rcad rhis alplicarion ord $arc rh.r rhe io. ix.oNr.I aSre ro onply *irh.ll Cityand Counly
<br />ordinrrc.s ind srrlc&wsallling ro buildinS aurhornc rcpbsnhlncs of lhk Cny ald CoDnry lo cnl6 ut on thc
<br />,bvc mnriuncd poFny lor inspc{ion puqrs.q/,
<br />Appllc.nl or AEenl SigmltrE
<br />DATE ID/SIG.COMMENTSAPPROVALS
<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 Pipino
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Healer
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ivlain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />,,>.Lawn Sprinkler
<br />Sanitary Sewer/de6 6J C t-5-ly )r-Wk)Ap-CLt- ln 6.7
<br />Back Flow Devic6 '
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release A
<br />FINAL I -21-lY h.wfl
<br />Notes, Remarks, Etc.
<br />-t
<br />7'A/./
<br />/*qe fiz@s
<br />conlmcbrL
<br />t,rdd!Add6!.-
<br />-l
<br />ccnity rhlr rhc icd.ml rcgulol ions rcssdins orbcslos tmral m nor Dprltal'lc lo rhh nnrr.i
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