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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCNf, ATION
<br />I h.rby aflhn udd l)ci.hy of pcrjury lhd I m .x€r'fl ton llE Contretou Liens tlw for thc folloqin8 Easn (S.c,70r1.5
<br />ausin.$ .d Prcf.$ioo Cdh)r Any Ciry or Counry whbh rqune. ! Fon lo c.Nlrocl. slld, lqtmk .,cmlish ot Epoir &t
<br />smdw. prior ro iri isrue.. rlso rcquircs lhc applbdl lor such Fmi to nk a jgEd ftlcm thal lE or slr b lieNd tutlurl
<br />to thc povGions of thc C,nrturort Liccned Lia (Chlrrcr 9. CoMrcing with S.dion 70@ of Division 3 of tlE Blsitu$ rnd
<br />Pmfcssions Codc) or fi tE d slE is*nlpl $cElionDd iE b.!ir to, $c rlhg.dcrcq,lion. Any liolalion ofS6rion r0ll.5 hy..,
<br />smlicrd fn s Fmi subj.rls tlE .rplicml lo . civil FElly of ml mrc thu fiv. hlothd dolbs (4500).
<br />L rs owr& or rhc p(,!cny, or nry cnrloyccs wirh w,ecs n\ rhoir nnc compc0sd t'n- qill do rtr Bod !d rlt {turm i\ mr
<br />inrcnncd orofcrcdiorqrlc(SN.7OI4,Dusincssandhora$i.ns(:odc:-licC,nnctt'\Li.cnsctjwdoc\nol,pDlyloa.ouncro,
<br />ihc pmpcny Nh, trius or iryrolcs rhcrsn. dd who dms soch sorl hnn*lfor h.rstllor rhou8h his or hcr o$n.Dployc.\,
<br />trovidcd th.! su.h i'nprcvcmm u Dor ifrcnlcd or offcr{ (d slc. li h.wcw. rh htril ins or in{rownrnr i\ s,tl wiihin , c Jrr
<br />.fconDldi(fl, lhc Owftr Builds will h.E !h. huRlcnofpmvin8 rlr h. o. shc dd mr t'urld or i,q8)vc tL pDpcny lbr rhc lUIIr,t of
<br />IOItrEIN:.COMPJNIAIION
<br />DEC!r8A:U(A
<br />I hcrcb, amrn ridcr lcNlry of pdjury om of rlE follopine .lctlahrhni
<br />lrhor(q1.. fnrhcpcrliflMncc ol rhc {ork f${hich rhc p.ihir i\ i$ocd
<br />-l hovr and vill mi!t6i. erkst .onp.Baiion insranc.. a. Equn d by Salion 3700 of lhe Llbor Codc. for ilE FrforltEft. oa
<br />lhc wort fn whth rhh lfnn i. ar .d. My sort6 o!p.Mb. insum cfficr drd lbli.y nunb.r @l
<br />Mrdtwgt rruh [v,rsgpv61,p16{0?o 1.il'lt
<br />-l
<br />c.nily thur in rhc tB.forroncc ofrhc qort for which rhh pcrmn h issucd. I rhlll.or cotLyiny Fmn in rny mnrcr
<br />s s ro txrom sutrcr ro rhe worldl onFnsrion laws ol Cdlifom,4 rrd ogm rhar if I slnuld bcotu sbid 16 rhe
<br />wo cn'omt'cnslionpDvisionsotsd'ionlT00.flhcLrlD,CdL.lshdl.fonhwilhomply*iththospmlnioft.
<br />I)IARNINCT F,ilurc tu sur qorkcr( conDcn\alion covcmsc i\ utrhwlul lnd shall \xbjer nn cnplolcr ro dirin.lp.mlics and
<br />.ivil finc\ ut ro om hundEd lhousnd olhrs ($100.fix)). ir odJilnnr lo rhc co\r ol.onD.nsdion, danugcs as Proridcd for thc
<br />SR'tr.n rr,76rlrh. tjF r'ic. rrcrcr Jn,l J nr,f,y, rtc...Z.r S
<br />I lEnny rtEr6 !nd6 pemlry or p.rjur, lhfl I an ticn cd undf Flvisioa of Chrprd 9 {oMncinS eirt s6don 1000) of Dilhioi 3
<br />of rlE BusiBs .nd PEf.ssiotu tu . ,rd my liccM i! in tutl fo@ ard cflecr.
<br />poa48t
<br />.z :L€'lcwa
<br />AIIL.ICANIDICLABAIIAN
<br />I hrrhr" rfllm unttur pcnnhy.r pcrjur ), orc oithc,ollowirg dcchrrrn r
<br />l).'rolirt,tr Pcrnrils Ashc(.\ Norifiorn,n F.dcrnlR.guhrn,ns (Tirl..l0. Pfi6)
<br />-R.quncJ
<br />lafl cr oi Noriftdir
<br />l.cdilylh.r r h. fcd.ral rc8uh I ions rcsrding asbc(os rcnoHlarc nollpplicrhlc lo rhnlmr.d
<br />-l
<br />eniay rnar I have rcd rhis amlicnrion rnd {!rc rha! th. .vc i.lbrn idr is.orccr.I agm lo omply wilh all Ciry tnd Cou.ry
<br />odinaNcs and srorc Llws rehri4 ro buildins
<br />aholc mnrioncd tmpcny lor insp.ciion purlm
<br />ivcs ofrhis Cny otrd Counryro cmcr qr,o rt!
<br />Appli.nnlorAg.nlSlgn ure:
<br />sDanr.ol
<br />a.z.t6
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-underlloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain Drain/Pool Pipino
<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 Plumbinq
<br />Final Gas Test
<br />Meter Belease
<br />FINAL K/s/tx 2bgr
<br />Notes, Remarks, Etc
<br />Lnso* c.olrh.pr.pcny.r'h.klu\ivcly.onk rin! {irh 1tuf,\cd .ont(rr\ b .on(n,cr rhc nn+cl (SN 7(}1,1, Bd'inrs
<br />rtrJ ltrl!!\ircod.: Thc Cotrtricntr \l,iccn\. L!r'rloc\ ror.p,rlyk, rtro{ncr olpn,p! y!h(,buikkorltrrtrorcsrhcrcon.
<br />trnd lho conrrckitr \trch tx)icr!{irhsConrrrct{o licc'Md funurrr h rhc O,nkmrn s I-ic.nr lrr)
<br />lrn,cx.nu uodcrSltrtrnr , A & PC lar rlrs rcrnnr.
<br />roNtilBucugxL[tluNli-&GENcr
<br />I hcrby ,afirn und.r lf,nrlrt of pcrjury rhd rhce is a co.{d.tion lcndin8 qcncy lbr lhc I,.rli)rtun!* of rhc eork fDr whi.h rhh !.flnn is
<br />i$ucd (Ss :ll)97.Civ. C )
<br />Area/Storm Drain
<br />Roof Drain
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