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PLUMBING.INSPECTOR RECORD
<br />DATE tD/stG.COMMENTS oIVNER BTJII,DI]R DDLCARATION
<br />I hcrchy ifiinn unJcr I'enahy ol pcrjury ltu( I m crcnDr 6om lhc O)nrnclos t,icensc l-,w lnr rhc lbllowing rc"{in (t:c?Oll5
<br />Bu\i cs\ nrtl Pn,{.\\n,n Codc) Any Ciry or c.,uniy uhi.h Bl!t(\ n lcnnir t, ..nirud, axcr. inwovc. icnoli\i or nl|t ntry
<br />(rucrue. l]ro ro ns nsuaNc, !l$ rcqutcs rhc 8t'pli.nnr ror nkh Jrnnt h firc. siSncd {nrcmnl rhir lf,or shc n liccns.n pusuatr'
<br />ro rhc fl.visnnh oftlr Conh.ror's l-i.cns.d Lf,w (Chlprcr L Connrcn.in! wirh Sc.ti()n ]O{n.f Divisi,)n.l of rhc aurincrs 0ndr
<br />Pmlcsn'nsCodc)orthrlhcor\hcncxcnlllhcrcfnmandlh.b!ri.lorrhcrllqcdcxcnrpraon.Anyvn,htionolSs.-ti,o?03l5nyany
<br />ltpliQ ntr ! prrnrir suhjtrh lhc utnli.anr l{' ocirilncnolrroinnr Nrurh$ filc hu drcd d.llar\ ls5ln)
<br />-1.
<br />N .wrcr of rhc FlFny, o, my cnplot@s wilh s4$ &r rh.ir ek onp.nelion. will .lo 0E wort .ri rt! srrEr@ is nor
<br />ialc(H or oftrcd fr eL (Se.7044, BusiNss ann Prcfasions Cod.: Thc ContEcltr's Lic.M Llv do6 ml cp!!, lo !n o$B of
<br />ih. p6Fry sho blali! or ar{'68 thaetr ald *ho dB sh ed( himclf or lr.Blfor rhough hi. or hcr own cmployet
<br />Dnlid€d lhlr $h imprcErnlre ml inLndcd oro,fccd lo. sL.lf. h.*6. r toilduS or apltrmnt i{ sld s,lnii onc Fr
<br />oforplclion. lhc O*d Bui|.ls will hlw tlE b'mhn .f pmvhS lhx hc or {E dil mr buiu or inpmrc dE I)DFly ro. th. Ftrp.e of
<br />_1, ns o*ns or rhc pmpeny. mciclusivelyconr.acrirp*irh liccnsd co rcroF ro connod rhc nojccl (Se.7044. Burinc*
<br />n Pnlfssblr Cod.r Thc Cont0cror's Li.cnsc hw do8 noi lprly ro u.!ncr 6fprop.ny who builds or inprovcs $crcon..nd wh, .onl8.ts for such l,oi{rs wirh ! Conr.ado(!) liccnscd puF!.trt to rhc Coiradoas LiccnF Law).
<br />I r r.xrnipr undcr S.cr B &l,( |,trrhnronnr
<br />UI}8f,EBS].COMTENSAIIAN
<br />DECI.ABAIIQ!
<br />I ncEhy amrm undcr Fcf,dly oa pcrjury ore of $c rouowin8 d(lnaiionr:
<br />-l
<br />h3v. rd wiu minrain . C.nifr . of Con*nl lo Sclf-l.sE fo, sorlds orp.n:.lion. s lmvi&d for by Selion 3700 of lh.
<br />ttho, Cod., to, dE pe.firlltN ol rh. s* tor vhkh fi. p6nl n i.s!cd,
<br />-l
<br />havc 0nd *ill minr{in workctr ..n'F.ns{rion iisu,licc, N .cqxircd by SNtion 17(x) of lhc Ubor Codc. for $c pcrfomme of
<br />fic wort for whkh rnis Fmil is nsu.d. My *o.k6c on{rndaon i.surtrcc crdir {rd p.licy.umb.r uci
<br />M\dw4s+ r^E tNs
<br />AN \l\^rr n\ Z .1n t t<
<br />-lceniiyrh
<br />in th. p.,fortufte ofrhc wort for which rhh pen.ir h hsucd- I shrll.or cnploya., F6on in any nmn.r
<br />$ as lo tNom subj.ct to lh. workcd $nF.n$rion lnws .r Calitumi,, md .Erc thal if I should h.com subjd to ttE*oltcr s rFn$tion tmvkions ol Scction 3?00 of thc tjb.r Cndc, I sh.ll. fonh*ilh.oryly *iln tho$ pmvnions .
<br />WARNINC: Foilur.lo $cuc sort tr co,qxnsalion ovcagc is utrbwtul. and shall subr{d m cnDloyrr lo aiminal I'cmllhs and
<br />civil lincs up lo onc hundred rhorBnd dollas (Sloo,mo). in addhion Io rhc cost ol comp.n$lion. daro8cs as prolidcd for lhc
<br />DICIAEAIIQN
<br />I hcrhyltllrm und.r Nnahyol pcrjury th,l I am Ii..6*{ undrr p$i\nr. olGnprcr 9(conrnEncirg wirh Ssli,tr 7OU)) ofDiy(i{'n l
<br />ol rhc Busircls and Pmfc$ions Codc- ud my liccnsc h h lull rbB a.dct{ccr
<br />B laoqeSq
<br />€ rh^
<br />CJ}NIIAUqII!)NIENDINC.AOEM:I
<br />I hcrcb! aflirD undcr p.ntrllyofpdury th0t lhdc k s conerudion Lnding,scNy for rhc pcrfonMncc ollhc Norl tu whichrhis Fmril is
<br />iscu.d 1sN. :r097. civ, c ).
<br />ATILIIANI.IIEqdAAIION
<br />I lrrhy afllm u nd& r.ndlr, olr.rjuryonc ofrhc blbwnr! ddlr.riors:
<br />Dcnolnbn Pcdirs Arhc{os NDiificarion Fcdcnl RcBulrriinr (Tiilc 40, Pan6r
<br />Rdquircd tr(.r ol Norifolion
<br />_l ccnify thar lhc fcdcEl rcBuhrions ESading asbcsros rcmvol !rc nol aprlicrblc ro rhh pNj$r.
<br />-l
<br />ccnify rhlr I havc rcd rht lpplicntion ard srotc rhor rhc iho'c i 'onMrion n coftcr I asrs b codply virh rll Cny,nd Cou.ry
<br />ordinarccs lnd SIcrc bws ruhrilt8 t, blildins onsrtucrion. ud hcrcbyournoriz. rcrcsenrrivcs r,rrhis Ciryand Cou.iyn, cnrs u|bn rh.
<br />aborc nEnlion d Fnpcny lor irspelion pu4msr
<br />Appltsnr or AeEt SlgnoIu.€: D.lc:
<br />1)oaP,1 ,frr6a(
<br />dul n6 20
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Buildi ng Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pi ping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbinq %i(,r,t/s 9rg,
<br />Final Gas Test
<br />Meter Release
<br />FINAL 6/k/lv %s6
<br />Notes, Remarks , Elc.
<br />APPROVALS
<br />Gas-Underfloor
<br />POOL/SPA
<br />Back Flow Device
<br />!,ncr! Ad,&Br'
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