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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDEI DELCARATION
<br />I hcrcb, lmrm under peMlry of tE.Jur, rnd I d cr.npl from rhc ConrmloE Liccne Li* for rhc following @rn (S.t.7011.5
<br />B$in.$ arn Proac$io. CodcJ: Any Cily or C.uty *hth .cqlirci a FftI ro 6NlM( rli6. ioprow, .hrcfth or Npat {.,
<br />rtrlcru.. rrt r lo its issulncc. ds riuircs lh. appltrnl for sh ,Emil lo nb d siSncd slltcrcnl lhll h. or sl* is lic€nsn pursu,
<br />lo ltE prcvisions of tlE Conhcloas Lien$d L{w (Chapter 9. Comm.rcing wirh Seclion 7(m of Divi.ioi 3 ol rhe Busii.s rid
<br />Pofcsions Codc) or rlEt hc or stc is cr.mpt rh.rcfron and rh. b&sls for thc .lLg.d crcmprion. A,y viohtioi of Sdbn ?031.5 by any
<br />applicabl lo lfmii {h}xr! rlE .pptic! lo a .i!il pe.lhy of nor me U.n fivc hurdrcd dolles ($500).
<br />-1.
<br />as owns of lh. pmpcny, or ny cmployec wilh wagc. a rhcir sk @np..srio., wil do thc mrt ard dr sletm i, ml
<br />inrcndcd or oll.Ed aor sh (SE-7044. Brsircis sd Pmfcssions Codc: Thc Cr.thcl.is Ucctr€ L* .ro.3 mr rpply lo !n owm of
<br />rh. Flrcty who hikG or inrms *Nn. ud sho do.s sxh tu* iinNclfor h.r$lfor rhhugh hi. or hd om.mployes,
<br />lrovid.d rhor su.h imFnkBirs e mr hkndcd qored lor$lc.lf. t x@i i* tsiuinS n inqrcEMr is sld whhin oft )e,
<br />of.orplclio( llc Owrcr Blildcr *ill hat tlE hlden of prcving thrr h. or sh. dil ml b'rild m irpmw fi. popsly for 0r porpoE of
<br />vfl*.*,.,r...,,,r.n'.,mi\.rr.rcr),,,r,rr,1Etrhh n,ir.,..\nr,.rr.Hu!T\.,U h,,k*i (1,1. lhr(-t{ rJ(ini, Lrcn..l..'n J',r\ rr rmlr- n, ni .wrr or fiotcrty sho hui]ds or nnFov.s rhrrcotr.
<br />md Nho @nt6c$ for such pmFck wirh a Conrrack,ns) liccn$d purru ro rfic Contractols
<br />I r ror. ,jn tklcr Srcr
<br />,.*,-b-:-lZ
<br />I ll.rcby um.m und6 p.n lty of n€iury oe of rhc
<br />l:ft, Co(|.. LrrlNJ,cnoflurcc.rrtu rvijrk ri,r \rhir[ rlt Nnnir n i\ucd.
<br />_l haw and siu minuin {orlcn .omncnrarion insurarc. I rquicd by Serion 1700 of rh. Labor Code. tor dE F,to,il1'G oa
<br />ihe wort for whicn fih IEmi is i.ser,- My works' orp€tu rion inlumc .eic. altd polb, nlnbe. @:
<br />\ikl ccnrfvrhnt rnrhc n rr.tr uftcrrrhc work rn whrh rhis p.rmn is issucd. I shdllnol.mpk,t un, pcson inanyronE
<br />ll J\ro ksm.uhiNr ro rhc qn,tcr\ omFn{rinn Ltrs ofCrlilnmh. rnd agN rhd rfl shnuld t(onE suhFcr b,hc
<br />lLr Lo ', c.nFnsu.r Ir or n nns nl Scc! ion .171U .l lhc L{tnr C.nc. , rh.ll. ionh* h comlly wirh rh* fhvi},nn. .
<br />WARNIN(;: Frilurc b sur. work rJ .onFnsark,n .oknsc i\ lnlawrrl. md sh"ll \xbr.{r an c.rk)rr lo ftnn.,l tBtrlrics inrl
<br />i'Il..ii;#,::,:T.,I:tiTlJi:tiiT *:
<br />,,", b'12-lr A
<br />lls\ (ll0l).l)ll0r. in dirn,n t, rhc .osr of ioredamgcs as pmvidcn for lhc
<br />I hcmhy rlflflnrnddr prirhyoftf,rjury rhrr I rnr I (co,nNcncingwirhS..rirnT(X{))ol Dni\ion:i
<br />of rnc Businessond PDfesionsCodc. md nryliccns h
<br />caxflBtJcuotrrllDlNc-aalNqr
<br />Ih.rcby rfinnr lcr Fnrlr,ofpcrJorvrhtrr rhcr r a .onrrud i,,n hf,di'r! rgcRt nnrhc p.rfonrui.d ofih.*ork tur shi.hrhtr linn a
<br />i\sucrt (Scc. .ll)97. Civ. C )
<br />AtPrlc6lfD[cLrr.8 uoN
<br />I hrr6,allimondcr pcnlhyorperjuy onc of rhc follosins de.l alionsl
<br />Dcnnlirit)n l,.mirsAstr\tos Norificlln,r Ftdcial RcEUhrions frirt.1o. Pan()
<br />-Rcqut.J
<br />l.llcr ol Nrifi slioo
<br />I .drfvrhd rh. fcd.r.lEruLrons Ellrdru ssb$'o! Emvdl m m' otdtr.bh r. rhh Imje'.
<br />tfl .srify rhlr t havc,€ad rht unrlicurbo u.d srurc th.r thc otovc nrfomrion iscoret.l !3@ ro coqJly wnh lll Cirylnd C6ury
<br />rncc\ r Sric I rw\rL in8 k) huildin8con(rucriqr r t hcrch,rcEc\cnrarivcs olrhk Ciryxnd Comryt, Mtu. uF,n dc
<br />lbovc mtrtiored porcny ftr inslf,ction ,'urposs.
<br />ADpli(trnl or A,:enl siannlu 6-ra-lI
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Tub/Shower Test
<br />Rough 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
<br />Final Gas Test
<br />Meter Release
<br />FINAL b'29-18./,).{*u(t'g
<br />Notes, Remarks, Etc.
<br />Policy Nlmbcr:Jrnie(: _
<br />t^ n,lcr\ AtlJn...
<br />UNDER GROUND
<br />Rool Drain
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