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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS owNER AUrl-DFrR Dtil-CAlr]\ noN
<br />I icrchy rlrtm u cr p.n lry.r ltrjury rhrr Ln crc ]|n ln,n rhc Cr rr.106 Li..nrc trs lnr rh. tullosirB r.rwn lscc.7o:ll5
<br />Br\iic\{ rd Pi(,fc\\idr C(rlc): Any Cily or ('outrly $hi.h rcqutcr r ltnnir k, .on{nr.t, rnd, nnProrc. dcmlish ,tr rcf.rir rn,
<br />{rcrulc, rriu h n! i\surNe,0ho rcqdnc\ ilr applicrnt for \u.h p.n}irto lilca \isncd nrlcntnr thrr hcor\h. i\ li..n\cd lunninr
<br />h rhd F)visi(nr of rh( Conrdols l-icco*d L!s' lCnrnlcr 9- Co.rnrncing uirh Sc.rir 7(n0 of l)ivi\ion .l ol rh. Btr\irios\ ri{l
<br />Prctus\nnr\ Codc ) or rhd hcorshc i\cicmpr rhcrcfromand rhc br\i\ f{trrlr rllcScd cxcnrtli,tn Anyvn,hrbnofSLtrioD Tlrll 5hytrrl
<br />rnllicunr larrpcrnir \ubjrcrsthc rfirli.rmtur.ivillrcnrXyoinornrncrhulilchdddrcdd.lld6lS5(x,
<br />-1.
<br />E osmr of th. pmp.ny. d mycq oJr.r with sa!!! s llEi. eh snlPcnslion. *ill do llE w* a.d UE slruiE ir ml
<br />i cndcd or orced for ole (Sc.7044, Busissr af,d Profcssions Codc: Th. Contt&ln t Lhens. lrs do.s noI .pPly lo en owno of
<br />trr nqxny who boitLr or inpoB llto[ aid *no &E tuh *rd( hirell o. hsFlf or lhmugn his or ltr o,n cq'loyo$,
<br />p.ovidcd rh.l seh inpb@.r. @ rct ided.d or otr ed fo. sL: [. howE llE huildi,s or in+oEm ii $ld within o'E Fr
<br />ofdnp,crbn. d* Oftr Buitlr wiu h.w ilE boden orp,DvinS thor h. or dE did ml t{ild or irymt lnc potEly lor 0E FirFor or
<br />-1.
<br />ar owtur ofrnc F,p.ny, m.xclusir.ly co.tm.linS wilh liccnsd conrtrlo6 to @nthct ttr rmj.tl (Se 7044. BlFircsr
<br />snd Eofssion Cod.: Thc ConrErois Li.c.* tlw docs nor.ptly ro.n o*ncr ofnmpcny who builds or iFpmrcs rh.rco..
<br />und vho ..nrndr ro. sucn poids wirh o conracto(o li.cnsd puNu ro lhc co.lr.clols Ltcns uw).
<br />-l
<br />dcrcmpr und.r sNrn,
<br />}IOAf,EBa.I;IIMPJNSAIIAN
<br />D&CI,ABAIIQN
<br />I hcrcbt arfi rmundcr pcMltyof pcrj!ryorcollhc tduoeiog dcclu0rioN:
<br />-lhnvcrtrd
<br />will'roi'nrin rCcnili.rrdorCon\cnr t() Sclt"lnsurc liJr workcr{ c.nlrtrs nn'.r\ pn'vidcd tu hySciion lTtX)oirhc
<br />trhor (idc. tirrhcnsltrnunccofrhc krt ftn *hkhrtu Fflnir N i{\trcd
<br />,, hsvc and will Mintrin qork ^ .ompcnsalion iBumrcc. G equi(d by Selion 1700 of 6e L.bo, C.dc, lor th. Frtolrlec of
<br />th. wort aor which thi! pcmi is isn&d. My worL6' @qMsdion in$amc ci.r oIn loli.y nunbc, el
<br />Srh'tle firn<l
<br />5 zb/
<br />-l
<br />ccnify ihtrt t rnc !.rforMne of th. aork lor which rhir p.rni is hucn. I shall nol .n loy ,ny peFon in n.y nMncr
<br />$ s b tEoE slbi6r ro rhc B0r*6 .on{E.slion ls$ of Califomi!. lnd oge lhd il I *lbtrld b..om subj.tl lo llt
<br />$olke6' conl*osrhn fovi.ionr or Selion 3700 of lh. Llbor Codc. I shdll. tonhsirh on:ply with lhos pmvisions
<br />WARNINC: FailuE ro scN {ork4c' @mFnerion 6EEB. is urhatul. and sh.ll sbj.tl a oDPlortt to aihitul FBtil t d
<br />civil fitus !p ro o* hundrcd rhous.d doles (Sloo,O00). h lddilion to ih. cort of conp.nslion. d.,Egcs !s rovidcd for rlE
<br />Serion 3076 of rlE Lalor Cod.. irhen .rd .nomy\ fei
<br />a
<br />o&gLaSarloN
<br />I hcrchy,fllr uMcr r.n0llyofpcrjurr lh0i I rn lien$d utrlcr pn lisn,n oaCh.Un, (connrcrcins wirh s$rbn 7Om) ofDivnn,tr:l
<br />ol rhc Blsincs !.d PoL$i.nr cod., xt nry licnsc is io tull luc! a.d crL.r
<br />to(773
<br />CONSTRIICTION I rNDT\I(; AGqNCI
<br />I hcrcb, armundd lEtrahyofpcriurylh lhdc ii t oi{eti6n kndinS !8crcy lor the Pcrfo,rj1lm otttE mrk fot which thh Fmn is
<br />issscd (s(, 1097. civ. c.),
<br />A.ETIICANI.DIILABAfIAN
<br />I llnhy tlttN undcr pcnslr, of Frjo,, om or rhr rolk,*i.C ddhratnnls:
<br />o.molirion P.irnils.Asbcstos Noriiicnrio! Fcdcral Rcgulart rs{Tnlc J0. Pfi6)
<br />Rcquncd htrcr oi Norilicurion
<br />-l.cni{yrhillhc
<br />ltdcflI ngularit)n\ m! dir8,\t n.srcnmvilnc nol otrpliclblc ro rhis lm)cd.
<br />Z&icniry rlrr I h,vc rcd rhiJ ll)pliclriotr ! srarcrhll turh'vr i'rintr,urion s concci I!Earoconpryeih,rrrnyaido,unty
<br />ordi'ricc\ aM sr,rc hws rlllins lo huildins conshclior. ud hc,chylurh,rizc rcflcscnrolives oflhh Cir, d coutrrl ro c.1.. ulon tlE
<br />rh.!c mtrrnxrJ tn,pcny fd in\lncr
<br />Apnli.anl or Agcnr SiBtuln
<br />Zwr frlh I L.,
<br />UNDEB GROUND
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Irilain Drain/Pool Pipino
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing 1/{//"{ED6\
<br />Final Gas Test
<br />Meter Release
<br />7/fi ll{iUts.{
<br />Notes, Remarks, Etc
<br />Waste & Vent
<br />Fill Line/Back Flow
<br />Back Flow Device
<br />FINAL
<br />lrrn'
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