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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS orvNItR B[JI_Dl:ll t]tlt.CARAl tON
<br />I hcrchy alltm undcr lcnrlry of pcrjury rhd I o cxcnrl riom rhr (i,nt"cktrs Li...\d Lf,w for rhc n hwin8 caq,n ($c 70ll 5
<br />Br\incss md Piori\\i,,n C,xlc) AnyCiryor Cornry $hich tuqunrs r triinir nr.on{nd. ill6. nntrovc. &nFli\h or rulln'{ y
<br />llru.rur.. pri(t lo irs NsuJtc, rho.crtuircsrhc rmli.rtr n)r su.h $mrirh lilc s \iancd \hrc *nr rhtr hcor \hc i li.ctsd Frrru.rr
<br />h rhc pn'!i\i{* ol rlf, Co rxdor'( I-i..nscd lrw (Chrrr.r 9. Coixnori S q{h Sc.rion 7{ 0olDni\ion.t.irncBu\incs\rnd
<br />Pnns\n sCodc)orrhrrhcor(hciscxcnDrth.r.li(,nrrndrh.ttrsisntrrh.all8cd.xcnDlion.Anyli{ftrionofS..ron70115byrny
<br />Lll'I)licrtrr lorr pcnnir \ubjrcr\ rhc applicxnr ro rcivilpcuh, ol n.i nnmrhrn llvc hundrcd dollds (s5(x)).
<br />-1.
<br />!s owf,cr of lh. pmp.ny. or my .mployes {iln *!scs !s lhcn sb .ompcn$li,n, will do tl! wnl 8rd llr rn,clm h ml
<br />in!.iddt or ofl.rcd i, sL ( Se.7o4f. Busi.css dnd Prol.sions codc Th. c.nracrols Liansc L3w docs nor q,ply 16 an owM ol
<br />llr phllcny who blildsor imrmrs $ca) old whr dcMh elt himsclf 6r hcrsllor ihmu8h his or hd own cnplo)ecs.
<br />lmvidcd rhar such impsmnts I ml inlci(M oroffcEn tur sL. lt howcv6.llE t{ildiry.r itrlnftNd n $B eirhin o* rtr
<br />ol otrllllcrion. tlr Oq*r Buittd wiu hlE thc hrdd or F,vi.g rhd h. or sh. dil mi hild or inpmw thc I'mFny fo. llt p!rl!$ of
<br />_1. !s 6srcr of rlr Fopcnr. ,n cKl$ivcly @nulcrirg earh li..nsd .odreror ro mnsrucr ttE Imj&r (s6. 7014. Burir$
<br />aftl EDf6sion Cod.: Tnc Contrrrol s Liccnsc Llv docs mr orply ro an owncr of trclcny sho builds or inp.ows lncrcon,
<br />dnd sho co.rturs for such tmjdr. wirh a comBdo(9 ltcned p!6er ro $c conrfurols Licn$ ljw).
<br />-l
<br />d cxchfr udcr S.di6n- A, & P.C lor thi! E sn
<br />Drt.: oM..
<br />la8f,EItS:CoMBSAIl(A
<br />DECI,ASAIION
<br />I h.rcby affrn undq rcNlry ol nalry oi. of lhc lolloviig d.chnlions:
<br />-l
<br />hlr ald,illmifl.i. aCcnifrarc otcoB ro Sdf-t6e tn s,kcR onp.N!rb., B p'lYij.d for b, SEtion l?00 6t tlE
<br />Labo Codc for ll* I,d6orlr1oG of rhc so* for phth rhc pcmi b i.iu.d.
<br />-I
<br />h.vs ond pill o,inl,in workcB comp€nsathn insumncc. as rcquiEn hy S.crbn l70o .r rtr tlhor Codc. for tta ,,crfoillw€ of
<br />the rork tor which rhis pcmir is isnd My *ortcF ioo inrurec.mi& did polhy num6.r m:
<br />per{.rmnc. 6f rh. uork ft,ich rhk n Jmn k issu.d. I shlll nol cmploy any rcrsn in uy @m,
<br />s, rs
<br />'o
<br />trsE subr..i io r worksc conrEnslhn hws of Califomid. and osB rh.l if I sh,uld t6m subitr rolrE
<br />mrksc mmp.nsorion provisbns of Scclion 3?00 of lhc Llt r Codc. t stdl. fonhwirh .omply wnh 'k'* pbvishtrs..
<br />WARNING Failurc ro s!r. workc^ conFnurtun .ort6gt ir unhBtul. md sh.ll su6Fl an cmtl,rr lo qinind Fmlries ed
<br />rivil fincs ur lo onc fiundrcd lhouslnd dollss (slm.(xx)), in uddilir. r. rh. coi .fcomFn$lion. da'uscs !s Imlidcd for lhc
<br />lhc Labor C!d., anrcr.sr ud,trrrcyt fer
<br />l6 C I O-rr ?raat4
<br />DEIIdBAIION
<br />I hcrcbyofirmundcr pcnally or lcrjury th.t I am licensd undcr pmvisio. .a ch.prc, 9 tconmxin8 wnn scdon 7000) ofDivision l
<br />oa ltc Businc$ 0nd Prolcsioos Cod.. {rd mylic.nsc is inlull forec ort cffccr.
<br />t1
<br />,)a,s S/zC /t 8 c".r
<br />qoN$tlJsrlolLExl,INcitiEN(r
<br />I hcrchy.ftn u.dcr rctrilryol!.ru!yrnal rhcrc is ! con(dcri,)o Lnni',! ascncy rd rh, Flnnurcc oirlrc *ork lirr whih rhis I.nnir i\
<br />isrucd (s( 1097.cl! c ).
<br />ATILICANIDECIIAAU!}N
<br />I hdrby umm undcr Fnalty ol Fe+.y om of rlE folloain8 del,ra' tuns
<br />D.nbft ion Pc.rnik.Asb. os Nolific.lion ltdcrol Rquloli.ns (l ill. 40, P.n6)
<br />-Rcqutcd
<br />Lcllcr of Norifi colhn
<br />6ovc nEnrnnEd F)r.ny for i.st'atiotr
<br />A0trliclnl nr A(.nt Si* rltrml
<br />t/
<br />Pfinrlrc Dn. (Ddrr):__.
<br />^", 5/n//l
<br />UNDEB GROUND
<br />Waste & Vent ),,4 ,..SAO
<br />Water-Under floor )v'r'e@
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Linei Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Waler Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq f,-tz-tg -D"{ab t ,E
<br />Final Gas Test I i-/? -n.t /clA<I
<br />Meter Release
<br />FINAL ?-7-tb)).!-lo'-rn
<br />Notes, Remarks, Etc
<br />TOP OUT
<br />Tub/Shower Test
<br />Ozcto.^
<br />kd.r\ Ad&E*
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<br />lcunrfyrh ! rhc rLdcalrcBtrlarions rc8idinE nst({os rcnn,yrl ffc nor aplii.rhlc t,rhi\ pmjccr.
<br />_l ccniiyrhd I hrvc,cJd rht lnrlicariofl arj {rrr rhd rhcnh)!. inrunsri(,r i\codc.r I aprerocouply*ilhallCiryrnd (tu y
<br />o irrne!r Srdclntrsrclarrryi)hllldin!.on{tu.rio(arllu.hrrd,r,,zcrcprcscnr0rlvc\olrhnCiryandCounryrocnrcr!g,nllr
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