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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDEH GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Gas-Underf loor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq ?/b/6 ,t\f,c
<br />Final Gas Test
<br />Meter Release I '4,0q1"1\ ,(,U{qA6)FINAL filq\$ .t 6-
<br />INotes, Remarks, Etc.
<br />otvNulr Eult,DER DEt,cARA noli
<br />I h.Ehy lmm unr penalry of pdjury ttd I sn.rcry1 fiod llE Co.lrdoR Lius L!* for lhe folloeing Een (Se.7djls
<br />Blri.es !,i B'of.sion Cod.): A,y Ciry o, Counly vhich rcquiEs a I'6mn lo otriroct, .llci imprct, demlnh or Epan &y
<br />srucns. p.ior Io ns is$dc.. alro rcquircs rhc lrplicsnl for su.h IErmn lo [k a ii8rcd alcEnl lhll lt ot ilrc ic lisied P!runl
<br />ro rh. ,rovlrion. of dE Conl@lor's Liensd Lr* Ichaold 9, Conmming *ilh S.clion 7000 of Division ! of dt A$i..s ud
<br />Pof.sio.s Codc) or lhrl lE o the ! .r.n9l rhcrcf@m and lt€ hash for rla llk8cd cr.q,tion. Ary viohrion of selion ?03 I J by !n!
<br />,ppli.dt Lr s p.mit subjKls lte spplkafl io a citil !.ntrlly ol lol mrc lh& Iivc hudbd do0rs ($500).
<br />l.r\.si$.lrhcpn'Fn!.orrrycmpkDlc\*irhNagc\r\ihcirs)lcconrFrNirotr.*illJorlks.rkr rh. nMiur n r
<br />drklcd orolircd lhr \alc (Sc..7ol.l. Bu\ircsr dnd lhnar\i \ (( c lhrfnnrrdor's l-i.cnsc l-rs doc\ nor JPPly b d0 o$tct ol
<br />rhc pmtf,ny s k' blilJ\ or inlnrn$ rhcrl\n. twt wlr n,r\ \u.h \ o hnnsclforhcr{ll.rrhroulhht r h$ o*tr cnrllo)$\.
<br />In,v cd rh{ n'.h i prrcnxnsaru or cfrlL\l DruficrL\t tr ub Il. lanvcvcr. ih. hniuiis or nntn,vcntnr n dd tirhln ' (J1r
<br />-L
<br />N owkr ol ihc pmpchy. !'n siclusiv.l, coolra.li,S wnh lenccd conhdoN lo .onnruct rhc Poic.l (56. ?044. Busim$
<br />atd PrDfNion Codc: Thc Co Dclol3 Liccnsc Lrq dm Nt aprly lo tn ownn of prorcny *ho blild! ot anprov.s thcr@n.
<br />ard wno conrack for st Foj.d. wirh, Corlsclo,(s) larn*d pusul lo th. Codmtol, Li.cN L3*)
<br />Lincxc.rfl undc! S.cl B & P.C.lbrrhi\ rcr$n
<br />SO8trE8I:COMSINIAIION
<br />DECI.AXAIION
<br />I h.Eby.rfirnund.rrEnahyof pcriuryoncof thc follosirS&.hr ions:
<br />t hrv. { will minrlin a Ccnificrrc of Cons.nr ro sclf.lnsrrc fot *orksa coon nrdrion. * lmvilcd for h, S..rion l?(x) of llE
<br />bb.. C.dc. for thc pcrforM.c ol rh. wrl( foi which lh. pnnil is isu.i
<br />-l
<br />havc and will monn.in work.n compcnselion insurarcc. &s rcqnircd by Sdion 3700 of rhc ljbar cbdc.lor thc l,craorl1mc of
<br />Tiil
<br />tri ompcnsrnrn inrxrmc .!ntr ad Poli.y nunbd .:
<br />r.t
<br />-le
<br />ifyrhar i. rtE pcrforluna oflhc *o* fo.qhkhth Frmir i! ksu.d.l rhall ml cniploy any P.mn ina.insm
<br />s $ lo bcsm snbier lo llE m*6 @ntl4.!dion l,$ of Crliforni., ud !8xe $ar if I sho!6 hocod sbjccr lo rlE
<br />woikcr'oogcrsalion!rclisionsofSEionST00ofth.tihotCodc.lshlll.fonhsirho,rll,lywilhlbsl,ovisiotr{
<br />14ARNINC Failu,c ro wnrc *orkcr' .omrcnsalion otdgc ir rrlnwtul. snd sholl slhitl dn.mploycr lo aimidl ltelri.! ud
<br />.ivil [,cs up ro o@ hundEd lhousand dollN ($lOO.OOl)). in a.ilirion lo th. cos or compcmarion, damB.s as lo{dcd for thc
<br />Salion 1076 orrlE Lbr C!dc. inrcEsl lnd arroftr'i fe4
<br />.1.oo
<br />I hcrcb, ufifln undcr lcnrkrorpcrjury lh( l6n' licctrsd u n ofCh,Drcr 9 (comftncinE wirh s..lion r0OO) ofDivilio' l
<br />of th. Busifts and Pmfcsrions Codc, t my li.c.r k in tull fore dd cfl(l.
<br />S yOofical .
<br />un , 1.L.loo &a'lr./c^-
<br />(IoNSTRUCTI()N t trNDlN(l I(;FNCY
<br />I hcrhy nlfinn und( FnrltyofNrlurylhrl lhcrc is a con{o.rt,n l. d,n8 agcnry lir lhc pcrfortui.c ofthc wort irx which rhi\ pcrnnt is
<br />issucd (Scc -1097,Cir C )
<br />ATELICANI.DECLABAII{IN
<br />I ffiydlmundd Dcnshyof p.rjury onc ol'hc followiry &rlmlirnsi
<br />Dcmliion Pnmils'AstEsros Norifi.arion Fcd.hl R.gularions (Tnh 40, Pun6)
<br />-Rcquncd
<br />Letrcr of Notfkdbn
<br />-l
<br />c.diry rhlr lhc lcdcral rcBulationr egddinB *h.sos t mval ac flol ryplicrhlc m $is pmiel
<br />9-l ccnily rhlr I livc rcad rhis applic,lion !d slarc rhrr rh. llnvc i.toimtion ir corer. I acxE lo otrtply wid all Cnv and Cou.tv
<br />ordinnrccs and Srarc Liwi rbrinS !o huildin8construclion. !.d here rhi\ Ciry ond Counry x' cnrc !F,n rh.
<br />nhovc .f,nlidrd pm,lcny for ins!.crioi
<br />9fi8
<br />Water Service
<br />tJ"'t.' \ AdJ'c..:
<br />-
<br />Applldlr or ag.nl shmluE:
<br />Prmlte ,l.m (prlnr):_5--->*21 t*l
<br />'7.2.t<
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