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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER I]UILDINT D'LCAI'A'I'TON
<br />t hcrchy rfinfl undc! Enally ol Erjlr, rhar I rm cxcnDr imD rh. (i nrb^ l-i.cn\c lntr r,tr rh. r(nk,wnrg mq,n (s(i 70:rl 5
<br />Burir.ss rftl Pofc$ion Codc): Any Cny or Cohry whrch .cqtrircs r t rini( ro connrucl, allcr, nn0ro'c. dcmlirh or rcpan atry
<br />\lnrcrrtrc. [i]r ro ir\ issurmc. rko rcquncsrhc rflrlicMi for such Frnri o 6lc 0 sisned (lrcmnr rhll hco! \hc n liccnrd pu$uanr
<br />t, rhc Fmvi\i.n\ of rh. Gr h.ktr \ l-ntnrcd Ltrs (Chafrd 9, Conrncncing airh Sc.ri.n lftX) of Divniotr 3 oflnc BurnBs\ rnd
<br />Pmfcssidrscodc) orrhd hcorsnc hcrcnDrrhcrclrunrnd rhc Msis lrn rhcallc8cdcxcrpri,,n Anyviouri,)nofs&ri,n?0lllhvrny
<br />rpplicrnrt)ra pcmir {'hj.crs ih. +rlicrnr r. xdvilpcnrlr, ol flor nxncrhxn fivc hundr.d d.lhs ( $5fi))
<br />-1,
<br />as o*mr olllE pmpcny, or my ctrlployNs *iln v!8.s ss rhen $b smpcnsrriofi Mll do rlE *6t dn [E s.rl@ i, ml
<br />inr.nd.n or oflcr€d for elc (S(,7{X4, Blsin6s d.d Prof..sioN Cod.: Th. C6ni.!.rofr Licctre bw des ml srply lo omr of
<br />Ihc r,DFdy who hildr or imprDB drmn, $d who do6 si w.t hiniclf or tErPlf or fiFUgh his or hs own chrlorte..
<br />providcnllrll sch iqmwmnl8eml inlc rd oroff.r.n 6r ek It hoqtE. tlE hlildii8 or ir{,oEtuil i\ sld *irhin o( ,*a
<br />of complcrior llE O*rcr Build.r *i,l lurc lhc h!d.n of prcving thd h. or sh. dil d ttrild tr inproE dE potEty aor tlE pury* of
<br />-1.
<br />arowE of rhc pmrcny. m cxchriwly @nmdang wnh li.ensn .onradm l. onnrud dE pmjcl (Ss. 7014, 8u(i6i
<br />and Pntr\sbn Codc: Thc Conrrlcrols Licen$ LsR dos nor 0pply ro owflcr oflropen,*ho blildr or ihlhr. rhs6..
<br />and who 6nr!.rs fo. su.h nDj(k wrh a Conmdo(i) lt.nsd I,IBM| ro rhe C.m$dols Lkcn* tjw).
<br />-l
<br />Mcxcmpl !od* Sdion- B. & P.c.16r rtis @sn.
<br />Drr. _ o*n.r _
<br />II}Bf,IBa.I]OMIINIAIION
<br />DICI.ABAIION
<br />I hmby rr,,n md.r pcMlry ol pgjury onc of lbc followin! dckmdons:
<br />-l
<br />h,v.0d*ill mintain r Ccditkar. ofcon* ro scltuns. L. wolkds omFnssrion, !s povid.d for by Sccrio.l70O ofir
<br />L$or Codc. foi th. IdforljM. ol thc so* fo, which rlE p6mi i. i.sucd,
<br />-l hav. dnd will minuin wort$ comp.nsation insln c,as rcqun.n by Scctinn 3?00 offic lnlrr Codc. fo. rhc Frf.trmrcc or
<br />n M
<br />h
<br />-l
<br />.fiify rhar i. rh. pcrformft. .f lh. work for which rhh lemi h isslcd, I sh.ll .ot .nploy lny Frsn in liy m.tui
<br />s sro6com slbjet b tu *urns onpcn$tion b*s or Cdiforni& a !€Erhlr if I sh6nld hc6ft sbjet lo th.
<br />{ortm.onqEnsrionr,ovisiomofS€.lion1700ofrhcL3tuCdq!dell.fonhwirhompl,enhlthstmvisioN..
<br />IVARNINl:: I:rilurc ro rcur. wo,k.r\ cotrlPcn\rri,m (ir.ngc i\ unhsful. r d \hrll \uhllcr (r cnl,,oycr r, (rirnifil p!nnllt\ Jt,l
<br />cnil inc\ up Io otrc hur&cd rhou\ntrd dollJr (!10).(xx)r. in tfttirn,n k, rhr co{ uf .o rt,c rdrnnr, drnr8.( r\ Dr)!i(lc,l ntihc
<br />Scrrnr.11176 olrhc I rhor C, r. i'nc'r{ a nrtm.y \ lr.\
<br />LrcIMEDJ!}NIBACIAB
<br />DICIAtrA.Ila!
<br />I hcEh, dffirm und.r li.n,hy of p.rjurt rhar I un licci{d md.r pmvkion olCh(lrq 9 (.onrmncitrs Nilt Scciion 70(x)) orDiri\n,n l
<br />of lhc Busincsrnd Pmfc$ionsCodc, lnd mr liccns is intull lorcc ann clftcr.
<br />D",Ie-
<br />CONSTNUCTION Lf,'NNING A(:FNCI
<br />I hdby !,Irf, lndd l*nahy of Frjury th.t dErc is a @.sMrbn hnding agccy for llE p.rfofue of th. iort for whkh lhh |Emn ie
<br />isslcd (Se. 309?, Civ. C.)-
<br />/TIIUCAIiLDLCLAAAUO
<br />I hcrhy dlim, rndcr pcnrlry of lrcrjfi, oft ofrhc folb$i'rs dcchBrbns
<br />Dconilirion l'crn,iN A\h.nos Norifimr$n Fcdcrrl Rc$hrions (l irlc.lll. Ild6)
<br />R.qdrdJ l-.n.r of N.rifturi,nr
<br />-,
<br />ccni!th{l r hc fcdcrll rcs! lar ions EBBdins lshcslos rcnnvrl o,c nolarpltablc rorhi. pmj..{
<br />_l.cni[ rtur I hn\.,cud rhnrfnli.. ' r mJ {rh rhnrrsc inromrion is corccr I !8re l. comrly Rnh lll Cn, lrd Colnry
<br />.rdi"rmc\ rnd srrrc hw\rularirBt, hu'ldi"3 h.reby.!tonz. mlEscnt0tivcs oflhk Cily lnd Colnryro
<br />uhovc nrnrioncd pmpcny lor in{pcdbn g
<br />UNDER GBOUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Bough 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 />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing ?4ollc *<-(
<br />Final Gas Test
<br />Meter Release
<br />FINAL 7/L3/t,(,SDtiS
<br />Notes, Remarks, Etc"
<br />**&
<br />Waste & Vent
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