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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE tD/srG.COMMENTS OWNE'I BU!LDtrR DDLCARATION
<br />I lmhy rrlrn rnddr,cnah, ot f,crjury rh l am cxcmlr fr.m rhc Conrracron l-iccnsc tiw tur rhc [,lro*in! rcavrn lscc.70.]1.5
<br />Busincsr uxl Pmrlssnr Cdu) Atry Ciry or Counry whic[ rcqurcs i Fnnir ro co.sfl.r. .lrcr, nnpturc, ncDrnish or apn ..,
<br />srrudur. Frktr ro i'\ irsuaicc,6l$ dq,ncs$c rpplicrtrr lnr such pcrnrirh nlc ! sigrcd n cmnr rhnrh.or\hc i\ liccn\cd rursrd
<br />ro lhe lmvhions ol tlE Conracroi\ l-ianscd ln* (Chrrrcr 9. Comn{ncin8 sith Scdio. 7fix) of Dnision ] .t rhc l]usinc$ trnd
<br />Pmle\stnN Cone)orrhd ncor shc is crcnrrl rhcrcliom Md thc ha(n lnr thcullc8cncxcm ion AnyviddionoiScclionT0ll.5hylny
<br />+rlicrnr nr d pcrnrir \ubjcckrnc lmliclnr lo r.ivilpcntrhyolnol nnrcrhan rirc hundrcd dolln,r (S5(h).
<br />_1, as owM of rhc D'sFny. or n, enploy€s wilh wtr8.s .i rhcn $b .ompef,erion. will do 0E sdt !d llx nndu h mt
<br />inl.nd.d or oficrcd lor sh {Sc.70421. Eu.ifss ed Prcfc$ions Codq TIE Conrtu loas Licns L{w iloc! nor aptly |o an 0*6 of
<br />lh€ FotEly wlb tlillls or iqm*s tlEmr ud whD dce sch mlt hiN.lf or h.Rclfor fimueh his or h.r osn cnphycs.
<br />pmvi&d rhd ien i!'prDvlml{s a mt iotodcd nofcEd lor sL.It novcw. dE ttrildinE or inpr$rmnl h $ld vhhin orc rsr
<br />ol orphtiotr dE arwE Blildcr *ill her tu burko of provine rhd lE or slB dil mr build d inr'te Ltc potEi, td tr pupos of
<br />-I.
<br />ns owmr of rh. ,!BF.ry. m €xclusatcly.o.racli4 sirh liccn*d .onrractod ro on{od rlE J'oj.tr (Sd. 7044, B!3ircs
<br />md hoLshn Codc: Thc ConlEclols Lic.nR tlw dB mr q,ply ro rn ovnd or orop.ny sho build3 o. impbvcs ln rco..ond who 6ntn rs tor iu.h poicdi wnh a Coomdon, lien*! pu6ud ro thc Conrdhis Li.nE L.w),
<br />-l
<br />u e &ntt udcr Serio!- B, & P.C, for rhi! rMn,
<br />l)rrr
<br />]IOSTESLCAMIEXSAIION
<br />IECI,If,AIIAN
<br />I hcrcby oflirm undcr Fnalry oi !.riury om oa rhc following d(l@rk'nr:
<br />-J h.E.rd will mint inrC.nifslcof Co.F ro Sclt'tnsc for ertft @m!.ns{ion. &. previicd for by Selion 17q) of th.
<br />Lrbor Codc. for tL p.rfoM of fi. erl( fm *hhh dE pcmit is hscd.
<br />Ihnvcrtrdwillmrinrlinworr.ra.o.rp..\rri(,.nr\urrncc-us,cqutcdhySNri{,n:l7q)olrhclih.rCodc.forrhcpc.tortunccoa
<br />[E vnt for shbh lhi, p.mil is iis.d-.r'mpcnsltn,n n$ulrrcc c!fli( and ,xnicy nlnb€r m:
<br />-t
<br />ccnify dat in lnc Frfoirmre ofrhc wort for which ihis p.rmil ir islucd, I shallnor.n:plo! rny pcr$. in a.y nMn$
<br />s. a ro bccotu slbiccr to rhc po*m ompcnsdn,n hvs ofcdifomia. and aBr rh, if I slould b$om subFr ro r,r
<br />w.rtsi.ompcnsationtrolisionsofSoclionlT0OoflnehhorCodc,lsh.ll.tonhwilhcotrplysiln$o$tDvisions.
<br />WARNINC: Failurc ro wur. work s' mmpcnerion covcngc is unl0wtul. e.d ddl subrc.r atr .npl.rcr ro rininal ,cmllis mn
<br />€ilil fincs {I, lo om nundEn lhousrnd dollds (Sloo.0o0). in lddirion lo ltE cosl olcoqrns0lion. drm8cs !r provitcd for lhc
<br />Sc.r ion 1076 of rhr Llbor C.dc. int Esl and arrofty\ aes
<br />IIIqdAAIIIJN
<br />I hcNby rftlnb o.dcr pcndry or Frjurr rhui I m lia.sd u.dcr polision ol Ch3fls s (conmmios wirh Sccrion 7 n) .r Oirisnnr .l
<br />ot lh. Busircs ond Pron$ionsCode, url myli..nsc is ii rull rora u cfrcct.
<br />37u ts3
<br />IAIEIAICUONIENITINI;.AGENST
<br />I tctoby affirmlndcr pcmllyolr.@rylhol lhm h a.oNtdclhn hnding rgcncy fo. thc,crfortuncc ofltc e tu which lhh,rmil h
<br />issucd (s(. J09?, civ. c.).
<br />dIILIIANLDIiCL BrlII0N
<br />l lm6yillim utuicr Ntr.lryoltrrjry rnc ol rlc rol[,*i | dc.lrari.n\
<br />l)cnn Ii(,n I,.rrnirs \h.nus Nor n.!i(in Fcd(rLturgn!rri{nx Il ittu J0. P n6)
<br />Rcqun lanrrofNotrnlri{trr
<br />-l
<br />c.nit, ll[l tlE fcdcBl rcglbtkins EgerdinS lsbc$os r.mvrl ec nor optlicabk lo lhis pmiEt.
<br />_l ccnify rhlr I lElc rcad rhis ippliqrion3 l shrc rhar rhc rvc informtion isco,Br.I a8re lo@nlly*ithrll Ciryaod Coonry
<br />ordh!ftB 4d Srar. ti*s Ebrin8 ro buiMioe consmcrion. Dd nmby auho.i. Elrc*rrdrilri of rhjs Cny and Coumy ro cnro updn 0E
<br />oh,vc mnrt'n(l lrropcny ttr inspccrion
<br />UNDER GROUND
<br />Waste & Vent h-l?-tY ).J MA
<br />WaterUnder f loor
<br />Gas-Underfloor
<br />Buildin g Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent b"tz-tv
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-t raplDrain 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/Cap
<br />Back Flow Device
<br />/t ./A
<br />Rough Plumbinq 1''t'tg
<br />Final Gas Test
<br />Meter Release
<br />FINAL z-\]t'l\
<br />Notes, Remarks, Etc.V
<br />-----A t
<br />Area/Storm Drain
<br />YJILIL
<br />*,v-.ull
<br />'l-/^kt1
<br />-,.,')-)*-?
<br />I
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