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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDI]R DIl-CARA'IloN
<br />I hcrcby rlltn undcr ,)cntrlry oi rcdury rhar I cxcmnr nom rhc Conlriche l-icensc L.$ ior lhc follo*ins .cr\on 'Sec.?(,:11.5
<br />BNnrs rnd ProLsrion Co.lc): Aiy Ciry .r Counly ahich lcqutcs r Fnnir io con(dcr. llrcr. inrn,k, d.fr,lirh or rqrn an!
<br />ntu.rur. pior b ir\ i\surncc, al$ r.qunclrhc rpplicrri fu ch pcrnit t, filc r si!ftd {dcmm rhd h..r shc L\ li.ctr{d pur\ui,I
<br />t, rhc ptr,vist,rs ollhc Conrr!.tn r l,ien\rd u\,(Chrprcr 9. Comnrncins *irh Srcri()n 7(xx) or l)i!ki,,n .l orrh. Burn*s and
<br />Pmfcs\ion\ Codc) or lhsr l[.r shc k crcnu rhcr.lio atul rhI ln,\n for rhc dlk!*l crcnrBnnr. Any vioklnrn ofScclion?0.11.5 hy uy
<br />llpliclnt lqa pcnnit n'bjcck rhc lpnlicnnl roa.i!ilpenoliyol not nmrclhnn lirc hundEd dolhF (S51t))
<br />l. ss ownr 6f &e pf,rFny, or ny emrloy!.s wnh wag.s e\ lnct eh corwn$ri6n. will .lo 0F m* rnd lhc sturw is ml
<br />iil€dcd or ofrcEd for slc (Se.?044. Blsim3s ed ProfessioN Cod.: Tn ConlEcltr s Li.cn$ L,* dB tul al'ply ro s oqfi of
<br />lh. t'repdiy who hiktg or i'r?NB thasn .!d et docs tuh elt hidrclf or hcell Ooulh hi. o,lrr ow!.ophyc.s,
<br />prcvn.n lllll such iqmwmnhe ml intci& orof.Erl ro. sle.ll ho**i lhc trildinS or iqmv.mnl is sld within on. Fe
<br />ofcotrpLtbtr dE own.r Buit-16 will hlw dE buno ol pmving th{'r lr o, .h. dU mt hoin or inptDw dF proFry aor tlE purpos ol
<br />-1,
<br />!s owtur of tlE pmpcn, ad cxclusilcly conhdirs wilh lien*d conrtlcloh k, .onsulct rlr ptrj.ct (Se. 7044. B6uc$
<br />lnd Eofshn Codr: Th. ConlEtols Lic.ns kw do.s mi apply ro m ownd oftrop.nt who builds.r inpmvcs ltcrcon.
<br />lnd {ho .onncc for iuch pmr(k wirh u CoiEac$,li) liEnsd p!*u!n ro rnc Conr&br'r Liens llw),
<br />I a .rrmtr uid.!S..r B. & PC. li)r rhi\ r.ne,n
<br />Dri€: O*ner
<br />WORI(ERS' COMPENSATION
<br />IECI.AAAION
<br />I h.obt aflir undcr Dcnohyof pcrjuryonc of rhc follooin8 dsLrations:
<br />Ih.ecddsillnuinrdn!Ccnificrr..IConrnrt,Sclrlrulc,rsorkcB.o.llfnsrrir,..isfrDvidcdrrbySdio.lTUoofrhc
<br />I trtxr Codc- i.r rhc rrformrce of rhc *ork f.tr shict lhc ,l.rmi h nul\|.
<br />lhrluandeiUm!inr!i.s6ikcr'comFnsart,nin$rancc,osrcquirdhySori,nlTm.rrh.liborCod..forrncpcriormnccof
<br />rhc w.rk for which rhis n6mir ir i.turl. M y worlcn conp.n\arion in$rane .arier arld policy .umb.r m:
<br />MrdWVlf C4Sh lru
<br />NUl.l 0 oap t.tl.lrt
<br />+.2.16
<br />IrcENSID.CONIAA.qIAB
<br />IIECI,AAAIIQN
<br />I ncreby aflirm undu pc,ahy ol !.rp.y rhd I an liensn un.lcr NvtionotChoprd 9 (c.mmtinB enh scclion 7m0) oiDivisn,n 3
<br />ot lh. Busim$ {i PmfcssionF Codc. uld my liccns ir in tull forN id cfial
<br />uiemccras, 6 Lkcn* Nuf,b.,I O01{&q
<br />CANEIA]JCIIONIEIDIIGI.GE !I
<br />I hcrcby amrnruder ncnolry orncrjurr rhlr
<br />'hcrc
<br />n ! consiflrcrion lcndinE lscncr au rhc pcnbrun.r orrhc sork ritr shi.h rhG lEmir i\
<br />hsued (Scc. 3097. Civ. C.r
<br />AIILICAIiIDICLIBAIIOIi
<br />Llnby.nnn u.dcr pcndhy.lpc.jury otrc of'hc lolloqinS dc.Lrrriotrs:
<br />D.'nolirion Pdrnrir\ Art*n.s Norifi.dnrn F.dcralRcguIrn,N (Tirl..ll,. Prd6)
<br />R.quin txrr*olN.ritiori(r
<br />-l(o,rtyrh.
<br />rl-.ltdc Jlh.pulJri,+ rcc,rdirF r.t{in\rcnrnJJrc nnr,,!f flhll x' rhi. nni.
<br />{r.nur,n,,, r,^.,-utna rrnl'. r 'a'kl{rrr rhr rhcrh)vc i'rron,urtn i\.oftrrr Ir!r{tu.onrdywrh0ll(rlynfld(h!trr!
<br />ordtrrtu.s and Shrc Lr*\ rchrin! ro buildin! connrucrio!. r hc!.hy ldhorizc rcprt\cfidnd ufrhis Ciry $d Coutrry b cntcr ulntr dc
<br />+.2.t9
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Waler Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL 'l>/ue 1\ {f6
<br />Notes, Remarks, Etc.
<br />Area/Storm Drain
<br />Miscellaneous
<br />I ccniry rhar in rhc pcrlb,tuncc oirhc trork for shkh rhn n rmir k i\\ocd.l \hrll nor cmploy trny p.r\on in.ny mrnNr
<br />s rstobeonr subjrrltu rhc sollLyj conlrnsd ion lrws or Cnlinrnid. d 08rcc lhnl ilI rhouldh.oE ul,id ro rl'r
<br />work$s' co,irt'ctr$r ion povnions of S(tion 3T00 or llr L2trtr cod.. l s,Bll. n,rhwirh co'rliy *ir h rhos tmvhions
<br />WARNIN(;: lailure lo surc workcn' compcns0rion corro8e is ulnwtul. ind shlll \uhjecr an enplor. ro dninal Fn,lrts r.n
<br />civil fincs ur h onc hundrcd lhou\and dollffi (Slr)o.tuo), in rddiliur ro rhc co\l ofcomri.nsrrioo. drmsc\ rs rbvidcd r.i $c
<br />s(rn,n lt)76 olrhc lihor C.dc. inrerc( ud lnomy\ ttcs
<br />,",", +.2'l& .-,."." F4tCtzl'4
<br />Itr ., .
<br />^ttJ'rr
<br />abolc m.rt).cd proDcrr, for in ccrion puq,oes.
<br />AobU.mt or A16r SI!nrtuR:
<br />o".,,u* -*" rp.i"o, If a h t I AYt (\
<br />F
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