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PLUMBING.INSPECTOR RECORD
<br />()tl NtiR trt II-Dt,tR DLL(,\R,\1I()N
<br />I lrrcby lrfrrn und.r F6rlr, or Fijury rhar I @ cxcn{,r Iiom rhc ConlncroF Ltcosc Llw for rlE follosinS rca$n (Sc
<br />Businc$ aid Prof.ssion Codr): An, Ciry or Counry which uquiEs r Fmit ro @nsro.r. rli6. imprev.. dc@lirh or cpat uy
<br />sltu.{urc. Fio( lo ils iss.N. rle rcquhs rhc ,ppltlir tor 3uci Fmi ro fih ! si8rcd rrar.mnr rhd h. or sh. i. lircn*d purs.rr
<br />ro lhc lNvhions ot rhc ConrEcrm\ Liccrsd t w (CnapE 9, Co,lmfti.g sirh S*lion 7000 of Divilion I of ihe Busircs and
<br />Pma.siols Codc) or rhit he orihc h cx€nfl thcEfrommd rlE basi! forrt oll.gcn cx.trrption. Any viohtion of Sdthn 7031.J by cny
<br />apFlic! for ! Fmil sbj.rls th. .ppli.anr r. 6 .ivil p..!lr, of mt mr tho livc hoftlcd doues {55m),
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<br />I ownf of rhc l,n)tErly, or m, .qllor.cs with wagca sc rn ir $k onqrMrbn. will .lo llE m* .nd d. .r r@ n mr
<br />inrcndcn or otrcr.d for sh (Se.7(x4, Busircs rnd Prercr*ions Codc: Thc Conxr.tols Lac.n* Lr* do.s rcl +ply ro e o*nr oa
<br />thcp,DF,ry ehot ikl\ or inFor6 $de'l. ad rlDdG uh vo,t hinslfor hc.*lfor rhmu8h Ib or h.r o*n ctrplorrcs. .
<br />provid.n lhd tuh impoEmnls e nol i, ci'd.d M otrdld ln sh. l[ hoEB. ll* b{ildire or in+oEmit ir eld wihj. o* }rd
<br />ofconplclio4 0r Ownc. Buil,er eill h.w tlE ho(ln oapovir8 thd lE or sh. dit mr hild .r inprcw dE p,DFly fo, tlE FsF,F ot
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<br />No{rcrofttE pmtdy, !ncx.lusirclyconhicrane wnh lkcnsd conftcros to .onsnct tlr pmFl (56. ?Oa4. Burimis
<br />ar{ &brB\i,i Cdc: Thc ConrBcror's Liccnsc L,w do.s nol .!ply to 6 ownc. or prop.rly who btrilds or improvd lhcr..n,
<br />ud sho $nrft.rs lor ilch pbirrs *irh a Conhcro(, licensn ,'unurnt ro Inc Conlmcrols Lie.sc tiw).
<br />_l m crenfl undcr Serk'n- A. & P,C. lor rlis c6on
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<br />loBf,E8{llqlrlENsauoN
<br />PECIJSAITOB
<br />I hcrcby amm undn pen<y of pdjury oE of lhc following delatutions
<br />_l hr\c rals'illnuiflrir d(tdili.dc oiCoNcnr rr S{lr ltr\ur tu sorkr^ conl^- \drirtr1. $ polnhJ tur hy Srr i(h :17rX) ol rhc
<br />hhor Cdc. tarrh.p.Ironhiccofrhc s1trk lar trhichihc lcnnit is is{rcd
<br />_l hdt ond *ill mainlah worlcBr comFnslion in$@mc. a .cquircd by 56tion l70O or rl* l$or C6dc. lor $c F.(()ilr@c of
<br />lcmn n issud. My eorkcrs @mp.nsri6n insudrc .eiff .id tblty nunb.r de
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<br />ccnily thal in ltc pcrformre of lhc worl for ehi.h $is pcrEjt is irsn rl, l sh6u.or cmploy M,,ENn in,ny @.Nr
<br />F $ to b.€r subirr ro rh. e.tdi @rqE.srio, hws of Calitomi!, rid .BE rhlr if I stx uU beom subirr ro rlE
<br />wort n oq,cnei.povi3i.n.olscrhnlT0OofrlELaborCodc.lslDll.fonlNilh@mplysilhltnspovisions..
<br />WARNINC: FriluB ro scurc workcts'.ompcnsdion.orcErc n uobsf!1. Md shrll subicr d coployc, 16 cinlnnl p.uhhs od
<br />.ieil fitrcs up lo orc hundrcd lhousand doll&s (510o.(xD), in dddi'ion ro rh..or .f.oq)cns6rio.. dao,g.r 0s tbvid.d ror rhc
<br />St.rion 1076 of rh. Ir-r C.xie inrcrcn
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<br />DI'OANAUON
<br />.l rhc Busi'k\\rrl l,rolr\s.rN (ixl..lkt nry ll.cn\c i\ h nrllnr.u d.lli.r.
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<br />qAN EI]CIIONIINDINIj-dIJ'NII
<br />irru.d lscc .llD7. Civ C I
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<br />I lmby afllm u idrr f,cnrlry.apcrjury onc orrhc t,llosnrs dccl0r,iotrs:
<br />Dc'noliri,,n P.nrirs A\bcsro\ Noriljclli l:cdcrnl Rc3xlrriors (Tirlc.l0. Ptdr6l
<br />Rro0ird lrrrrr of Nori,i.Iitr,
<br />I.cni!rh,r rh. rcdc$l rcgoldii. \ ruselins lslrstns rc rovrl.,c nor{,plic$lclo thh!n+rr.
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<br />ccnify lh{ I h.v. r.ad lhis .ppltalion .nd srrt thlr th. shore inlofiElion is @Bl. I lEB lo .tmply wnh atl Cny ud C.nnry
<br />onli'rrn..( itrd Shrc ltrs\rhr b htr ild iU .on{tucri{,n. s'rl lEchy aurhnh r.!rc"r rarifc\ olnri\ Ciry Md Cotrnryh.nrcr lIx)n rhc
<br />ovc nrnlioncd pmFny ro.
<br />,\pplici l or.\xml Sixnilu
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GHOUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underf loor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ptng
<br />Gas Pipinq
<br />Roof Drain
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ivlain Drain/Pool Piping
<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 />/1
<br />FINAL t0 -t6-tu .krLld
<br />Notes Remarks Etc.1:7
<br />-
<br />Drl€ '//// I
<br />Tub/Shower Test
<br />Fill Line/Back Flow
<br />Meter Release
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