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PLUMBING-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNllR BUN,DER DEI,CARATION
<br />I hcrcb, rliirn u dolI rlrt {)l r.rjur, rhar Imcxcnrrr ftun rhc a,nrm.ro^ Li..nsc Las io, rhc lbllowins rcahn rscc irrll5
<br />Busirc$ 0nd Pnncs(iotr Codc) Any C y or Cdnty trhich rcqutrc\ I lurnn tu .urntu.r, rlrcr, imprnk, dcdolAh or rcnJr ;n!-
<br />(tucrurc. prior ro ils hq,rk . aho rcqun.rrh. rrpli.tr.r rirr {ch pcrnrir ro iilc i siSn.rl {dcmnr rhd h.oi $. is ti.
<br />h rhc Fovision\ ol lhc Canr!.ttr-s Li..nrcd Lrw lchlntcr 9. CoNnrncin8 *nh Sc.n.n ?0(J0 ot Dililbn .l olrhc Btr\incss ond
<br />Prollsiotrr C.dc) or rhrr hcor \hc i\cxcmpl rhcR.ftonturd rhcbr\n rnr rhc stkscd cxcn,prion AtryviotlrionotSccrionTi):]l5bynnt
<br />trnplicrtrl ior tr pcnnn suqc.hrrE rttli.,iir,scivilltnalryolnornbrcrh fivc hundrcd dottr\ (95u,)
<br />-1.
<br />B owNr ot rlE l,oJtny, or my .hpkryes wnh wogcs as thch $k conFNalion. sill do dE *dt ukl rlE srDciE i mr
<br />i.lcftkd d otrcEd for slc (Sr.7(x4. Busiftsr s P,sf.srt B Cqiei The Cotrlr{.r6r's Lixn* Llw dfts ,ot $dy to e owmr of
<br />lhcrmpcny eho hitLs or in?brcs itootr a.d *ho ttE Mh ft* nims.lf or h@lf or rhrcugh his o hs own cmployccs.phvt.n rhlr .u.h irlpr.EdnB c,or hrcnd.d orotu ru sl.. lt hoEE llE hilditB or inpmEmd n $kt wirh'n mc Jarofon{,lcrbc dE Own6 Buildd ,iU hlE rlE t{d6 of Fovi.g rlEr lr or shc dil mt tlild or inprcw dE poFny lor rlE purpor of
<br />l, {s owftr oltlrc pmpdy, .m.iclusivcly.onrelinE wirh liccncd contrlcio^ro ron{Ecl rh. projd (Se. 71x4, susms
<br />and Aoftssi.nCod.r Thc Conuer.ls l-iccnsc Lru dNs ml apnly 16 owndotphpcny wto tlilds or imnrovcs ltcEon.
<br />and *ho conrto rs for s.t !rcjccls with r Co.tmcro(t li.rn*d p!r@ lorhcConlBctols Lic.ns tjw)
<br />-l
<br />u cxcmpt undd Setioi . B. & P.C, fo, rhl een
<br />uaaf,Exs:coMfrusarlo!
<br />DNCLARATION
<br />I hdcby rffi.m undc, Fnslt, of p€rjur, orc or $. aolo*irg dchndonsl
<br />-l
<br />hlw d will mint.in r Ccnifrar. of ConsnrloSclr 160r fortu ar compcnsrion,6 pmvidcd for bys..li.n 3?m ofrtEt bor Codq aor rhc ,crforflUc. of lh. volk ad whi.h rhc p.mi k issud.
<br />_l tuvc md vill mrinrri. so&cc .oq).Narion insuraft.. !s requtcd by SNlion :1700 of rhc L.boi Codc, for thc pdromtuc of
<br />I i\ Gssl M y *orien conrr..\ir ion iniuDnc. .!ri.r lrd Friry lumbc, rrc:
<br />/./n.
<br />l.cnafylhll in lh. p.rformmc of lnc work for which thh p.mn is is$cd.l snull.ot cmrloyanrl.son in sny mnncrs s lo b.co'm subi(r ro tt* wnrk6'@npcnsliotr hrs ol Caliaornid. .rd dgrcc llxn if I sholld b{i6ft rut.irr to th.
<br />wo*crs comr.nsarion proliiion$ of Secrbn l?00 of thc titrr Codc, I shdl, fonhwith Nnply sirh rhoe Dmvtions
<br />WARNINGT Fdilurc r. slre vorkcs'co.r,'cns.lion L{Krugc ir unh}tuI. and 1hall slbjd an cmphrtr to dminulpcmhics Md
<br />.ivil fincs ut io oic hndrdd rhonslnd dollsrs ($t00,00O). in ddin,n b rhc cos ot nDscs $ EovA.d lor rnc
<br />.:tufl "I
<br />I hcrchy ailirn und.! Fmlrrol,'.rjury rhd I ri licn{d undcr Forhnrn olChaprcr, (onnrcminr *irh Sccri.i 7{D0Iof Divi$n.l
<br />ol' rhc Busiilcs.n'l Pn,r..sn,ir corlc. dd n,y li.cnsc is in fullloru{ldcllc.r.
<br />tan6?.
<br />CoNSTRUCT(IN I I.:NDIN(] A(iI'NCY
<br />I hrtohy rfliu undcr p.nullyol Nrjury tlut rluc i! r coi{turrion lcndir's a8.ncy ir rlr pc!,nrnuncc oirhc work l'or qhich ihis Fnnir N
<br />n\u.i (Scc :1007. Civ C.r
<br />ATTLIIANLDECLIN^IIQN
<br />I lIEh,lujmundcr |{ni[yof tf,auryonc orrh. lnllosnrgdc.lnari,nrs
<br />Dtm)riii()n l,cflni(s A\bc{o\ Norificarn,n Fc.tcril Rcsulariotrs (Tnlc11), P.n6)
<br />-RLluircd
<br />lxfi cr of Mnillrdrion
<br />_l cua it, rhBt rhc fcdcmt rcBlhtions rgoding Btr{or remul urc nor opplicoblc to rhis lhid.
<br />n",,ifylhjr I la'vr rc rhisrpl,licarir)oaRl{rrcrhd rhc rt!,vo ihbflMtirrr i\rorc.r I asre h cdmpl, wirt allCiryrnd Counry
<br />iver oflhh Cit, lnd Colntyro cnrc qEn rh.ordina.ccs a.d SGrc Lak Dlalins lo buildins c{a
<br />rtx,lc Drort,ncd pnrn ny,irr irsFcdion
<br />..t<'
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipi ng
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Irilain Drain/Pool Pi in
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanita ry Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing €lzo /t,A41/rl 7
<br />Final Gas Test
<br />Meter Release
<br />FINAL T/u/s 9DG9
<br />Notes Remarks Etc.
<br />DATE
<br />Gas-Underfloor
<br />Gas Pioinq
<br />rl,?t'18{ud!,0rcisres
<br />o""jl-$H
<br />lxtrdc.. AJJI.r
<br />JUbUUUN]L,\Dplir nl {r A*etrlSiAnlturel
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