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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.()tvNI,:R BUII-I)t;R DUl,CARrl',tl(rN
<br />I hcrcby a,hrN un t$ Fboliy of leljury ltlr I d drcrq,l iiom lhc Conlr!.los Lt ctre tiw for lhc fotl*ing c.$, (Se.7011.5
<br />Busin.s ard Prof$rmn Codc) An, Ciry or Crumy which Equ6 r Fnn to onnrud, slls, irprch. &nqlilh or Epon dy
<br />slrudlrc. lrir ro ns h!u,m, ,lso equircs lh. lppticsnl for sch Frmil lo f € o 3ie*J ntum tnd lE or stE t1ic.nsd Putssl
<br />ro lhc FDvisioB ol tr Cod@lols Licnsd L!* (Chr!l.r 9. Conmfting silh Selion l@0 of Dieision I of lhc BBincas itd
<br />Poicsions Codc) or thal h. or shc n cr.no rhcrchon dnd rlE basi| lor rt !lL8.d .xcmpl io n. Any viohlion of Scciion ,03 L, by lny
<br />,ppli.ant lor s p€mir subj*rs rlr rgplkel io . civil pcElly of ool @E Ihs fi!. huid,.d dollat! (s5m),
<br />-1.
<br />B owrcr of rh. pm|tny. or my cnployE3 wnh s.gB d rtFn slc.omFisllion. *ill do tlE wk rn lh stutE b ml
<br />i eftlcd doflecd ftr sk (5€.7044. BlsiNss ed Profc$ions Codq TtE Conl'*rols Lien* L.w&cs.ol aPPly o eowFof
<br />rhc pmp.ny wno builds or inp6B rlrEn, arl wlb d@s sch wrt hinself or hNlf or lhhlgh his o h* osn cnployccs.
<br />!.6vii.d ihnr 3u.h itrprcwmnk N mr inro.hd mof.rcd lor sb. If. rEecE tlE hdildirg n irplrNG is $ld within ot r@
<br />ofcolrpbiion. dE o|"n* Builhr wi[ haw rlP hods of prcvi.8 dd lE or shc dij ml hnh d inPmE tnc pmlgly 6r ll* pqns of
<br />-1.
<br />ar owr of rhc FdFny. m crlusivcly conrrering wnh lkcnsd Nntrdcnr io onsnud tlE r,oirl (s4. ?044. Bu\hcs
<br />and h!ftsin Cod.: Thc Co.tdior's Lic.b* tt* do6 nor.tplr lo !no*rc. ofpopcny eho builds or inprows lhcmn.
<br />lnd who coflrack lor such l,oFcrs sirh a Coitrern{, liccn*d I)u6uu( lo rh. Conlraclols Lictr$ trw)
<br />I o rxcmd undcr SNrio
<br />,^. .lt,l's B. & P.C. tuthis r.,$..
<br />DTCIZIAAITON
<br />I lrrchrrlftDutrdcr rctrtrllyolpdjuryoncoirlt l,,ll,'wn,g drchr ritrr:
<br />-l
<br />h6r ud wiu miniain rC.dirc.lcofconscnl lo Scr.lnsuE for eo 6 onFndion. as Frvid.d for 6ySetion 1700 olttE
<br />L,lDr C.dc. for thc pdfotljle ol thc mrt for which lh. Fnil is issucd.
<br />-l nrv. .nd sill minllin *orkes' coottnsrion iniurmc. r! rqlircd by SRI ior 3T00 of lhc t bor Co.t , Lr fi. I,cIforromc of
<br />rh. work for whtt lnis pcdir ii iield. My w6,k6 @q,cnroti.n i.sram. ffi.r en lDlty .unrbc, e:
<br />P.licy Numb.ii-Expircs:
<br />-l
<br />ccniiyrhor inrhc lcrtortuncc.rrhc *ork lor which lhi{ !.rmn is hsucd.l shall nol cfrploy any pcnon i.!n, m ner
<br />h as k, bc.6m subi{r io rh. sork c'comlcns.lbn lsws of Califodia. ud ,ec
<br />'htr
<br />if I should tE{om sut tl ro rlx
<br />worlcn mnlp.ns0rionlmvtions of Sdion]7mof lhc htnr Codc.I shrll,lonhwilh coryly *ilh lhoc lbvnio.s
<br />WARNINC: t:rilurc xr *.trc wdltcB .oDrpctrs0tion covcr0gc is unlawtul. nd rhall ruhjc.r drr crnploycr lo girtiid l.tu'lri.s Md
<br />civil fincs up lo orc hudtd rhousmd dollr\ (Slu).(xro), ir rddilbn n' lhc.o{ of.omp.ns,rion. d0nE8c! o\ Prolid.d ror rhc
<br />ltzslt,
<br />DEII,ISAI]I,}N
<br />I h.rcby rflirnrrndcr p.Mny of pcriury rhlt I om li.ctr{d undcr pmvirion orChaprcr 9 (.onnmn.in8 sirh Sccrion ?mo) ofDilisio.l
<br />ol rhc Au\incsand Profcsn n\ Codc. xl mylic.nq is in tull forcc 0!i cllccl
<br />c(lNsrRucTl(lN I F-\nlM: a(:FNcY
<br />I heEby llfrm undcr IB..hyorlcrjurylhot lhcrc is o cMltdclh.lcndog ogcncy for lh. t rforNncc otlhc eo.l( lor whkh lhis psmil is
<br />irs.d (SR. 1097. Ci!. C ).
<br />A.TtLICAILDECLAIAru'N
<br />I lrnt'yalimlndcr ncnrhy olFrjory oru or rhc rolro*ing d.clMiions
<br />Dcn.lnnJn Pcrnrirs-Ashcsros Norificaliotr Fcdcrol RcSUl i.ns (Tirl.30, Pnd6)
<br />Rcquircn L.rtc! ol No{ifrari0n
<br />-l
<br />ccnify rtd rnc f.d.!rl Esuhlions EE&nins &S.slos rcmlsl sr€ ml amlh$lc r. rhis ,mitr
<br />I ccdily thrr I tqvc rcad lhis apnltlrion ui narc rhar rhc nh,ve infon:di.tr i cotrccl. I aare h mfrpl, wnh allCiryond Counry
<br />ordin.mcs and sllrc L{ws rchring ro bxilding.on{d.r h.rcby sulhorn! rc!rcc diree of lhis Cny md Counly lo c q uF. lti
<br />rN,vc nf,rioncd [opcny hr inslcclion !!qr*\
<br />^," '/at
<br />/t 6ADDllcnnl or Alenl Silnnl
<br />P"-lr* *netpnnrt: f,.{-E-
<br />UNDER GROUND
<br />Waste & Vent l ltsltp \)@
<br />Water-Under lloor I
<br />Gas-Underlloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />Back Flow Device
<br />Rough Plumbinq 9lt lt?{da)
<br />Final Gas Test
<br />Meter Release
<br />FINAL PlLfiSTl '-rn*.4 vx)
<br />Notes, Remarks, Etc.UI
<br />$^^E+ vz^^k txrrrl r-r L.. /-tlkt<.A" k Etk IlL'tIly t'7 uJ/
<br />6
<br />COMMENTS
<br />lJnrLar AddE$:
<br />-
<br />TOP OUT
<br />Water Service
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