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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h€rcby sffsm undcr lEnalry of lcr$ry rhd I d .rctrB foa rhe ConrddoF Lhmrc L,w fo. rhe loUowing Msn (S*.'r0! 1 .5
<br />Busin ss rrd Prolcsion codc): Ary Ciry or County shhh requnca a Frnn to onnrud. alrcr. ihprc!., &mlnh o, qun M,
<br />rrro.rm, prior to ilr ksuuc.. oho Eauircs th. olrlic,nl for such Fmir Io filc a si8trcd ilar.m rDr lr or shc & liftnsn p!d!m
<br />b the povhaon.6f thr Crntr&rm\ Licc.*d kw (Chlprd 9. Conm.minS with S.clion 7000 of Division I of lhc Busin.si lnd
<br />Pma.ssions Codc) or rhnr h. or 3nc is crcm rn E6on Md rlE basis for $c llhscd .xcnption. Any violaraon of Sdlb. 70,I 5 by uy
<br />opplica for ! p.mil slbFcrs rhc llpliclnt lo ! civil lJcMlry of mr er rhd fivc hundrd dollm ($50o)
<br />_1. ai owM of rhc proFny. or my.nployes with wrgc. I rlEt $h ompcnslion, wiu do llE qnt an dE nflll@ i! nor
<br />inrcnd.d or ofrcrcd for sh (Sa.7044. Blsircs s Pmac$ions Cod.: Thc Conm.lofi Lac.M t w de. not .pply lo u owner of
<br />lnetNocny wlh hilili or irpms ttu@n. !d vho dca sEh e* nimcll or h.r$lf or lhouSn hir or h.r om cnplor*i.
<br />rovidcd lh3l sEh inpmmis N ml inl.ndcd n of.Ed aor $L. ll hwE llE bo dnu or inv@mfl is $U within om Fs
<br />of o,pLriorl tlE O.ver Buildcr wil lew tlr hifthn oflmvin8 lhx lr or slE dt ml hoild or in!rcE 6e l,olsry tu tlt p6po* 6f
<br />-l,
<br />os owmr of rh. pmFny. am crclusively contDcrin8 wilh li.cnsd conlracro^ ro construct rhc pm.,cn (Se. 7044, B$incs
<br />oiri PEftssia Cod.: The CoflEror's Lic.nsc Law do.. nor apply ro u os.d 6l prcFny who buiids or improves rh$.on.
<br />and *no onlacc fo! ocl lrojGrs with ! Co.tBcro(s) liensd po^udr io rh. Conbelors Lief,3 bw).
<br />-l
<br />rnci.mpr urdcr ser B & PC brrhi( rcasotr.
<br />Drte
<br />IOT6E&$:.COMEENIAIIQN
<br />DECi ANATION
<br />I h.rcby am,n undcr pctulty of rojury oft oflh. rollowing d.rLmri.tr
<br />-lhrvc
<br />flxl sillnnrnrhin oCcnilrnrcor(],n*nr t, Scll l{su'c nn sork.A-.onlilcns (in,as rrouilcdri,rbysalion:rTo0orrhr
<br />Lltntr c.i]c. rd rhc pLafunmEc olrhc wo* rbl *[ich ihc ti.nni' is isJucd
<br />_l havc rnd qill nuinr,in $o crs cornFnididn itrsurancc. os rcqunrd by s&rion lT0ooflh€ tjbor Codc.lor rfie rcrfo,tuncc of
<br />hnlnmn t nntd M, workcF sml,Cn\d'on rn\ur u!. .n'cr ard policy numb.r ee'
<br />.,tr^,r rl-- th,r rrr+.M:
<br />I c.nity lhai in lhc pda.rronc. ofrhc work lor which lhis rcrn:il is issucd.l shrll nol .mployaay peson in iny mtnmr
<br />so Nk,lxsmc slbid to lhc workcs comncn$ion laws of Culifoni!. and ale Ihar irl rtbuld t*com subjer lo th.
<br />eo*crf snpcnsolion pmvnions ofSarion l?00or fic kbor Codc.l \hall. fodhwirh onplt wilh lhos pmvhions..
<br />WARNINC: failure lo Kure *orkc^'cotrqtnsdion d'vcros. i\ unlawtul. and sh8ll suhjel on.mplo]tr lo sir.itul pc&hics dd
<br />civil fincs up to orc fiundrcd rh.usord dollrs (slm.m)), in Bddirion ro lh. ssr oicomp.nslion, damacs ar poidcd fot lhc
<br />s.cri{nr.l)76 rn rh.l rhtr .T
<br />DICI,ABAIION
<br />I hcfthy rlftor dcr pculry.f lfr.Jurt rh.r I.n li.cn{dxndcr tmvnbnol Chrtlcrglco'nnrNins wirhsc.thn ToLio) ol Division.l
<br />of rhc Busin.$ and Eoltsion\ Codc. tuJ h, li.cnE i\ in inll lar& d cfli.t.
<br />6 leo*Q?.rt
<br />IaNEIA!&IINIINDINGACDXjjI
<br />I h.nhy allirn u.dn,f,mltyolIr julylid rhcrc h u coDstruclion kndi.s lsctrcy fttr rh. pdli,mnc. ofrhc wort for {hi.h rhh rmril i\
<br />is{cd (Sc. :1097. Ci!. C.l
<br />AIIUIANI.DEII./IAA.I]AN
<br />I hrrtyalltmundcr pcnrlty olp.rjury om orrh. follo*ins d(hr io.r
<br />Dcmlition P.rmirrAsb.sos Nolificoriotr r'cdcral Rcauhlhtrs (Tnb 4- P!n6)
<br />-Rcquncd
<br />Ixrld ol llorificarion
<br />-l
<br />ccnify rhrr rhc fc(lc!!lrcsuhrion\ rrlrdins tr\h.nos ftnbvrl3rc nor rpplicrhlc to rhir por.r
<br />-a2/' llrn'lJrlL ll',tr! r.rLlrh'\ nfl\.,.tr.r1{,[crh. rhcrhrlc i'nnnmri.n tcor.cl.l agNbcon,t]rsirhallCirtdnd Courrr_
<br />odinrncc\ rnd Sr,ir Lrws LrinA ro b unrg .onjtud nnr. drd h$cby runn zcrcprc\cnrrtn?solrhisCirytrddCotrnryrocnrcrupotrrhc
<br />lbovc nrnriomd pDl,.rr, for insF.rn,n Duiloss
<br />ADpllBolor Ee Shn{lu ,Pl
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Undeffloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trapi Drain Line
<br />Main 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 />Rough Plumbing Uarle S\rfr
<br />Final Gas Test
<br />FINAL 7 /q-- /rz )s lol
<br />Notes, Remarks, Etc.
<br />TubiShower Test
<br />Meter Release
<br />rai.yru.,t, F d:iiJd ElN rJraJ(OL3? o?t,rr,",
<br />1l
<br />knLlfl'. \Jni.
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