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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE OWNER BUILDER DELCARAIION <br />I hcrcby amm undq pcnahy of Frhry rhrr I d cxchpt from rhc Conrraclo6 Ltctre Lle aor rhe followinS @$n (Sd.?oll,t <br />Busin.$ aod Pof6iion Codc): Any Ciry or Couniy Bhich mqlaos r F nn ro .onsldcl. it6, inpdq d.'bliih or Erri u, <br />srdctur., lrior lo ns issu!ft.. llso rcqunes $. alPlk.nr for tucfi pcmir ro 6L a sisftd smcmfl ftar lE or shc ir l6rBd pus@t r <br />lo lhc pmvhions ol0x Comsrols Licns.d t w ((}.pt. 9. Coo@ftine wnh Sdio. ?m0 of Divhkrn 3 of llE B8incsr and <br />Pn,fcssions Codc)orlhar lr orshc is cnfl th.rcftoEand rhc lEtis Lr tn akscn.xcnnrton. Any viokrio.ofseihn 7031., by,ny <br />aPl,liconl for d p.roir subjdr rh. ipplicmt rorcivilp.Da,lyotnot mrcrhn 6v. hudEn dolffs ($500). <br />_1. d. oMcr of rhc lop€nr. or ny enDloyGi *irh was6 ar rlEt $L comp.Mrion. qiu do 0E w6t ad rl! irryIw t 6r <br />i.ldd or of.rd 16 elc (5(.?044. Busimss o.l ProLs.ioB Cod.: TrE C.nlr-ld s Lirns L!* &'.s nol .pply lo d owEr of <br />lhc For*ny *ho hiBr or invo6 tlEelr !d wL &B sh s himlf or hcelto. $rcugh hir or hc, ow..mpLyc.s. <br />lrovid.i rh!' $ch intptukrcnls ft mr hl.id.d d ofr@d nlr eb.lf. hdssi rtE t iEin8 or oprcv!@nr is sh *nhh orc r@ <br />ofoi!,Lion. dE Owr Blilt.r will hlE |l!. hrit n ofProliis tlEr lE or .l'. dil ml hlld o. idprcE lhc pFpdly lo tlE purFe ol <br />-1. <br />as o$ncr of rhe rmrcny. d ciclorivcly c.nrturins airh licci*d cont !cro6 ro d,n{dcl rlt pbj(l (Sm ,014. B6imss <br />ond hdBsio Codc: ThcCo.ra.roas Liccns tju d@s nor 0tplyro !no'nq olpnp.nlwno builds.rimpolcs rh.rcon. <br />rnd who .ofia.lr lor s!.h lojccls wi'h . C.nhddr(s) lacen*d puN@r b <br />'hc <br />Conkrcrols Lic.ne tiw). <br />! n rrx. lpr u dcr Scd[ <br />lr,tr ()s rr <br />IVoRKFRv C{T[IPFNSATIoN <br />!l:ct ASAmlN <br />I turchy rlliin undcr pcMllyor'pgjuryonc of'hc folkrwirg dcclmlnnrs: <br />-l <br />hiv. {d *ill nri.hin . Ccn ifi$rc of Consnl ro Scll lnsurc tur wo.kcn c.n rn\arion, r! tmlidcd rdr by Sc-rion l?uj ol'rhc <br />Labor cnlc. ror rh. txrthnDn.c oi lh. qork for which lhc t)cnnn is issucd <br />_l hak und will mainlaitr worlc^ cohpensarion inslratuc, as rqoned by Secrion 1700 ol rh. tabor Codc, for ln Ffomncc of <br />lhc aort aor qhicn dis !.rmil is issd. My in{uktrcl crricr rrtl F,li.y nx'nh.r tv.' <br />tiJ?yr <br />uN@ tc40?o r. il .t4 <br />-l <br />*nify ln in rhc pcrfor@G of Oe wo* Io, *hi.h rhn F ni ir bsucd. I shru nor c"ploy ey pcMn itr lny Mrcr <br />$ as lo trflm sublrl k, ttr wortsc snpcnslion lrws .f Ctrlifor.i!, and a8r lhrl it I shoutd ttcom subjccr to rrE <br />wol*cu conqFnstion pmvisio.s of S.ction 3?00 of lhc Llhor Codo. I nEll fonhqilh onply sirh rLs povisions.. <br />WARNINC: Foilurc lo ssrc wkcr' mn{rcnsarion ovcn8c is ontr*tuI. a.d shall $birl a(.mplortr lo aiminrl pcE[ts and <br />civil 6n.s u! to onc hundr.t thouqnd dollols (Sl00,ql0i. in eddilion dam8cs d l,mvidcd for tn. <br />SNrion :10?6 ofrh. Lnbr C.dc inlcrcsl !trd oltomy s les. <br />DECLAB^IION <br />I hcrcby ufllrm undd rcnalryorpcrjur! (hal I arn Lcctr$d undcr tmvision ofCh{lna 9(connmncifls wilh SNrion 7Om) oiDilision l <br />.l rhc BusnNss and Ptrrcssn,ns Cod.. md nrr liccix. is inrtlllffci dlTc.r. <br />Lic.trsc Clms: b 10044o",",--fiail6 c"**,""Y4twa <br />qNIIAIIITONIEND|IC.&GENCT <br />I hcNbyrfllr trMcr p..drt olrcrjuryrh.ll rhsc is ! onstrucrion hnding lscncy lor rh. pcrr.nun.c orrhc $ork lo. whichrhh lErnrit t <br />ksrcd tscc .1097, Civ. C.) <br />A.TIIICANLDXCLABAIIUN <br />Ilmbylan rundcrpc ilryoifcrjuryoncolrhcrollo*rtrAd.rl i!i.n\ <br />hnnnirion Pcrnrir\ sh.nos Norifi.dn Fcdcrrl Rcgnhrn \ flirlc.10.l) $) <br />Rcqunc Lcrrcr.lNurl,i..r0r <br />-l <br />ccflilr rfiar thc fcdcrul rc8ular ioos ftBriling ash.(.r Enmvdlr. m' .pdtablc lo lhis pmj€1. <br />.!4;I (y thd I harc ,.id ihb appltarion and (ltc rhar th. ahovc inao,mrion is corNr. I Isre ro comDry uirh au ciry and coutrr, <br />ordimrca dld Sr.!c t ws rl,ring ro tuildinS.o.*rudiotr and hcrcbylur ol rhis Ciry md G,lnry b cit$ uB lhc <br />abnve tr.rionen nmpcn, for irsF.rion puqb*q <br />P"-'.**."(p.i"t), Dlflh <br />a-z4g <br />UNDER GROUND <br />Waste & Vent <br />Water-Under Iloor <br />Gas-Underlloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarilier <br />TOP OUT <br />Waste & Vent <br />Water Pipino <br />Gas Piping <br />Roof Drain <br />Tubi Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <br />Fill Line/Back Flow <br />Pool Healer/Gas Line <br />Miscellaneous <br />Waler Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meler Release <br />FINAL 6/snA Eiltr? <br />Notes, Remarks, Etc <br />ID/SIG.COMMENTS <br />,.,", ?'Z'lE <br />L. c' \ Ad'l'r. <br />Appli.0t or A8.nl Skmloe:- <br />Gas Service