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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDEB GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL 7/to/ra )s tol
<br />Notes, Remarks, Etc
<br />OWNER BUII,DER D!]I,CARATIoN
<br />3u\nrs md Eolcsiflr Codc): AnyCiryor (.unry whi.h rcqunc\ a Fn.ir lo condrucr, alr.,. inprolc. dcmoli\h or hl]rn r.t.
<br />{rudu,e- ldtrk, i,\ hn,aEc. al$ rcqutcs rhclPpliofl lor \uchl)Cnnir &r fil.r \isn.d nar.tunr Ihd hcurdr n,iccn{d tu u..r
<br />tr rhr pn,viri( \ of rlr Co.tr.ntr's Li.cnscd Lrw (Chofrcr 9. ConnmncirE wilh Scclion TtXX) ol'Diri\ion :l oi rht Btr\i'ics\ rnJ
<br />P(ni$!u.s C.dc) or r,rl lE or$hc iscxenrfl lhcrcnon d rhc h.ns lirrhc rllcgeJ.irnlprion Anyvnrri{,.olScdioi7l):ll5hyrn,
<br />arpli.nnrturrNirnirsuhjc.rsthcnpfli.!nrro!cnilp.nnlry.l'nornrorcrhannvchrndrcildoll$(55(x)).
<br />l. I osn.. of rhe pbFny. or oy .mploy.cs wilh u8.s I rhcir solc 6m!.Nalion. will do llE *dt &d llE slrEi@ l! Dt
<br />inrcnrLd or ofimd for slc (S8,7O44, Bosirc* dd Prof.ssions Codc Tnc Conrebai Lior Lle docs rcl a00ly lo !. owm. ol
<br />rhc prcFny who hiild.6r in+sB rtEB.. .!n who dG sh h,t hi6.ll or h.slf or rhmu8 r nis d hn osn etr9l.yes.
<br />provned ltat ,!ch imr,l!ftnts c ml inlqxL{ .r oflcrcd rD. Elc. ll hoEw. ltE tnildi4 r in9rcEftol n $B wirhin oft Fs
<br />ofconphlion. llE O*Er Buil,6 will haw tlr hld.n ofFovinS thd lE or df, dil mr t ilt or irprerc t E ropd.y for dE po{D* or
<br />_1. s oqncr of rhc Imrc y. !n ex.hsivcly connncring wirh liensed conrmcroN n @nsre{ nE Foj.Er (se. 7044. Buim$
<br />Md &D6.sbn Codc: Thc Co.rr.toas Liccns kw do.. rcl applyio mowmr oftmlErly who builds or inproEs lhd@n,
<br />lnd who ofllmds ror seh Foirrs aith 3 Conrtrto(s) Itc,sd r!B@l rb rhc Conr&rd B Uccn* tl*).
<br />-l
<br />Mcicnpt lndcr Sccrio
<br />roaf,Ef,s:.coMPillAn0!
<br />PECI,AMIIIIN
<br />I hcrchy lffirn udcr pcelry otp.riury orc ol fic lollosing detdldonsl
<br />-l
<br />hrrc ud will Nir .in . Ccn ificarc of Con\enr r Sclf- lnurc lor worlcE Nmpenqrk,n. ,s ttuvidcd lor by Sccti.n l7m ol thc
<br />bh, codc. for rtu p..fornBnce ofrhc worl lor *hich rh. p.nnit t issu.d.
<br />_lhovca dwilldan sin workc.s c6rrpc.\ nrn insurrncc. !i r.quidd hy Sccr io. i?(x] of rhc hhor Codc, fu lhc pcrfomtc of
<br />thc sork torqhichrhh pcmir ir tslcn. My workcG compcnsation ins!6(c .adicr .nd lblicy nu,nh.r ml{\
<br />o
<br />I eaifr rh{ tu rhc prfonuftu of rhc work for rhich rhk p.rmi k issucd.l shall nol cn{,loy a.y tcr$n in any 'unmtso s lo bc.om subjccl to lh. wortcB omp€nsti,n l.*s of C.lifomia. and asN rhd il I \hould bccom \ubjet io th.
<br />woltnr .rml.hsarion ,mvisions oa Sdion 1700 of rhc t2&" Codc. I slEll. fonh*irh omnly wirh rhos !o!icionr..
<br />WARNING: Failun ro s@ Mrk rs coqx.srion .ovcagc ii unl,{tu|, 8od stull subFi m c,nplo}cr lo didinal Ftulri.l dd
<br />civil nner up ro onc hundEi thouend dollc ($100.00{)), i. addilion lo ttE cosl of mmFnslion. d!@8cs !s pr6vidcd fo, lh.
<br />S&ri{in 1076 of rnc lf,h, C.{r. inturci rnd ,rroirEy\ f.cs.
<br />-cux+f 20Jt ,**r r
<br />I h.shy rrarnrundd p.Mlry of pcrjury lhar I !m lien{t u.dd lbvisbn olChoflcr9 (conmcncins wirh sc.rion 70fi)) ofDivirion l
<br />of rhc Busies and hoL$bns Codc. ,rxl my liccnsc is i. tull ror.!.nd cfic.l.
<br />€
<br />calsrBrJl.rloNLl:xt lN!i-&cEN(r
<br />I hcr.hy lirtn nndcr pcmlryoipcrjuryrhrrdrrci\a con{rucri'n f,:ndir8 r8cn.yforrh.piir Bncc.lllr truk hr *hichrhi\ pcr ri\
<br />issucd (Sc. :1097,Crv. C )
<br />A.TETANIDIiSLANA T
<br />I txrby aftr'n und$ lcn![y ol Frjury o'E oirhc follosir8 dcclrdions
<br />O. x,lirion Pci, ia Asbcios N.rificrrioi Fcdcrrl Rcgulnrtnrs (Tirl..l0.l'>fi6)
<br />Rdquft d Irrrf of Norifi .dnn
<br />-l
<br />cerrily rhal rhc fcdcml rcsul ions rcgadi.g rslEllor ctuvil uc oor q,pltahlc lo fiir poj.d.
<br />lri ccnify thal I h0v! rcd lhis.lpliclriotr and (!leliar lhc !tF!c infoturior is cotrdr. I alr ro 6nlly *nh all Cntod County
<br />ordinsres and Stdc L3ws EhtinE ro buildinB on{dction. and hcrby,!rh.ri& dpEscnrdivcq orrhh Ciry ond Couolylo cnlcr utronlhc
<br />8bv. n.nlbmd pmlfnt ior inspc.tn,n plqr*s
<br />A0pliranl or Ag.nl Si8nalorel
<br />I
<br />POOL/SPA
<br />Gas Service
<br />l.ttt
<br />I e,on441.
<br />t]1,'1.''. AJ'l'r$
<br />Pemlle Dmr (prinl):I
<br />r',,,.,1. I l- rr
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