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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER DUII-DIJII DET,CARATION
<br />I hcr.hy rlltnr undcr rn.lry ol Nrjuy lh.l I n cxcnn fiom rhc OinlGcloF l-ic.n\c llw l,n rhc rolb*nrt rcR,n (SR..70r,5
<br />Bu\incs rid ltori$i,,n Codc): A , Ciry or G,onr! which rdtuirr\ s lf,nnir fu ..innrr, ,hcr. iq)mtc. d.nmli\h .r rcrut ,'ny
<br />{ru.rurc. rd r, n\ issu,trcc. iko rcautcs rhc ,pflicrtrr ror such F.nnr u rilc ! sismd $renxnr rh8r L or \hc is licon*d Puruanr
<br />h rh. f,ovi\nr\ ofrh. Contrckr\ Li.cn*d tiw (Chllrd s, Co nc6.i.8 wirh Sc.lion 7(Xx) of Divhn,n 3 ofrhc Bulin.rs rnd
<br />I,nlsstunsCoJc)orrhdrh.orshcisex.nurhcrcfrom!drhcbusisntrrhcrllcscdcicmprn,n A rvidlrionorsc.rion?0ll.Jbyrny
<br />npllicrnt nnapcrnit suhjccts rhr !,'pli.!nriorcivilpcnrxyoinolmrcrh fir hunJrcddolln^ (551x))
<br />l, N ovn& of lhc prcp.ny. or mt .rployes wilh wag.s 6 rh.n $b omFnslhtr. *i[ .k tlE *orl ud ltE sflanN is rcr
<br />itrlcndcd or oficrcd for sle (5€.7044. Slsimss and ftlf€sions Cdq Thc Conrero. r Liccnsc ke do* .ot apply to u ovncr of
<br />rh. PrnFny wtr bsilds tr inpros tEmr ard who dos Mh E h hi'Mf or hc'elf or Ooueh his or h.r own.qtloy*i
<br />pmvidcd rhnr 3u.h iopoEmnk m mr i .flLd n olfcEd lor s.h. Il hows. lhc ttilding or inlhtftnt is sld sirhjn .nc ,qt
<br />of o,pttbn. tlf O*mr BuiBcr *ill tew thc budcn of !mvh8 rhd t! or nf dil ml hild d! iniew trc lep.ny fu df, Firpo6c of
<br />-1,
<br />as owncr offi. !q,edr. m crdlsiv€ly conrocrin8 *irh liened conr&roN ro cor$lcl th. pojNl (Ss. ,044. Blsinss
<br />and Art$iooCodc: Thc Co @bls Lic.n$c Llw dds nor lpply ro mo{n.r ofpr.Fny wno buildsor ihpmlci iherco..
<br />.nd wno .onrfl.ts for such flojdrs with ! Conrhcro(s) liNned puN@t ro rh. Conrodor's Lh.f,s kw).
<br />-l
<br />lmcren u dcr Ssr B & P C, ibr rhi rca$n.
<br />raaf,E8[rautENsArlon
<br />DECL/$AIIoN
<br />I heRhy affirm undcr p.mhy of Frury orc ot llE fouowirB d(laElions:
<br />-l
<br />hate &d eilt dinlrb . C.nifrd. of CoB.l ro SdfJ@E lor wrt6 conp.nEtion. a Fo{dcd for by Scflio. l70O of rlE
<br />kbor Cod.. for thc p.rfotMe of rlE srL fo whhh iE pdmlt is i.!wd.
<br />Ihavcanduill'minr.wolksccompnsrrioninsuh^_c..sEquncdhySccrhnl7moftheLlborCqic,forrh.ldfotnunNol
<br />rh. work for wnich lhn Fmn is issEd. My wo ss n insuraEc.aricr ald plicy nxnbd m
<br />-l
<br />ccrriay thar in rhc |lcrfortuie of th. sork tor ichrhi\Ilcnnir i\iisuod.l rhall norcnDloy0nypcronin!nymannct
<br />$ *ro&.om bF.l io ihc mrk (.on{Ens,t n laws orcllifomia lnd!8Nlt r if I slblld bccom rubi(r ro rtt
<br />uorkcrl corpc ssrion pmtisionc of sdion ]7uJ of rhc tjt r Codc. I shlll, fonhwilh coryly wilh rh.s ln,vi*io.s..
<br />WARNINGT r,ilurc ro wur erlcrs ohpcn$tioo d,vcm8c n unheful, dnd shill subjccl an cn1ploy.t to ai,ninll peu[ics and
<br />civil fines up ro om tundEd lholsnd dollB (tl0l)-000). in rddirion ro $c.osl of.orFnsrio.. dlmgcs.s povidcd for llt
<br />SNtion 30'16 of lhc ttrhor Celc. inlcrcst and anorrcy s fccs.
<br />5/z-o,'4 ic \
<br />LICEXSruIONINACI!}B
<br />DECIJXAIION
<br />I hmby arrrm undcr Fralry of pcriury rhd I m Uftnsn und.r Imvision of Ch.prc 9 (oomNhg wnh S.dion ?0m) of Dirisirn l
<br />oi lh. BusiBs .nd Prcf.ssbns Codc. s,n ny licns tu in tull foEc srn cfial.
<br />7otit ?e
<br />-, </zl/16 D.pn ?rfcrJ ''-.1-
<br />laXllBL(]IloNIIilDllCrlQDNlI
<br />Ihcrchylmrmundcrtcnllryolpcrjurrrh,nBci\rqn,itucrt,trlctriisrBcftylorrhcnctfo,rrunccolrhcNorlirx*hichrhi\p.dni\
<br />issurd (Scc. 1(D7. Civ C r.
<br />Aftuljt[Dfilt tBtrua!
<br />I lttuny nnn r u d.r tcfulr! ol tf,,ttrry onc of rlr lalkiwin! dc. hrd i(n
<br />Dcnrnlri.n l'.!nir\ A\hcdo\ Norifiuri.n F.d.rrl Rc!Lhri{)n\ 1lnI J0. Prn6)
<br />R.qun(l lriur of Norilicrri(nr
<br />lbovc mnrioncd pmr.ny for in\tn-rion purFEs
<br />Applisl or Aacrt SiamluE:6/ts/L
<br />UNDER GROUND
<br />Waste & Vent ,8,il-9t
<br />Water-Under f loor 'o'\\ "J.-(go
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 6'tt-tc J)alola 60
<br />Final Gas Test t -tL-19.l)z (.*nt)
<br />FINAL ?-5-tO ,firtdt ,c,to
<br />Notes, Bemarks, Etc.
<br />rD/srG.
<br />Lrdci'r AddrH*
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<br />I ccnilyrl rhc fcdcrd rc8uhtions Esardir8 aslEstorrcfttrduc nor rpplicrbL h rhk pbj.cr
<br />_l ccnifyrhlr t hlvc,c!d rhn rrplicdrio.,.d darc rhd rh. alnk inrundtd (.onftr.I a8rc ro.onDly sith lll Cnr,m, Coonr,
<br />odiMnccr ond Surc L!*\ rcl,rins ro huil{line conitucrbn. s$l icr.hy uurt$iizc i.frcuhrncs olrhis Cily lnd Cotnly ro c f ulon rhc
<br />L./.
<br />Tub/Shower Test
<br />Gas Service
<br />Meter Release
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