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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS owNIR Bt lLDtiR Dl:l,c^R^r]()N
<br />I kr.hyimnnu q peMlry of perjury rhd I D etLmpr ton rh. conl.actoc Licetrs. Lta lor rlr fi,llowrry rcaa,n ls( ?0 r l 5
<br />Aunn.ss ffd PRrfe*on Cdlc): A.t Ciry or Count! {hrh r.qun* . Dcirnd b onnruc( alr6. nnprrq d.nd6h or r9.r My
<br />qrtucrure, prtrrr. s $su!n.., .l$ rcqun.s rhr r0tl'cnd tur cn pcnnil ro lil. n nsncd ndemenr rhrr he or rh. ii liccnsd ,trN. r
<br />t, rh. rovFions ol rfu Qnrr,croas Li€cnsed Laq {( hxnr.r '), c.nnn.Nn! wrh S.crion 7000 ol Div6ion 1 ofrht Businc* rnd
<br />Pnrnssonscode)orl[nr h.orrnc hexcmpl lherclrorond rn.hans n,lnc rll.sed ei€mrri.n Any vnnarh oi sdhn 70] I 5 hy tr.y
<br />ap!licanr r{r3 pern,ir subJecrs rh€ r!rli.anr ro,c'rilnrnalrtolnor nFrc1hr. ivc Iundr.ndolhn(S500)
<br />-t,
<br />ai owr of rh. rrcn ny. or oy .dnlolq snh s.s6 s rh.t $1. onlEMlion. will & dE tult !,i tlE .rltlN b el
<br />idcid.d or of.Ed f6r $lc (Sd 7044. BuiB .nd Pmf*lioB Cod.: l lE Conrldoi! Lt.M ka &d ml lrply lo a.wE or
<br />rlE rmFrry -tD buikli M ir!'mG tlr6a dd vho d6 scn h* hior.lf or h@lf or threush bt or hcr om cu'phy.4r,
<br />pmviH rhd Mn iq,lm N mr inlod.d orolEi.d 6r sL. lq ho$,e, d. htiiins or dFbv.rrsr ir -ld wilhin om yw
<br />ofonpLtbG 0E OwE BuiLkr will hrE ttE burd.o oflmvi,g dd tE or 3lE dil ml ltriu or in+rnE $. p,opdy h. tlt purpo* of
<br />_t, ss owEr of rh. pbldy, dn .rclusiv.ly conlBrins wirt lica*d colndctod to snirocr rh. pDjd (Sd 7044, Eusin s
<br />anl PmEsion Cod.: 't hc Cont..ctols Lic.ns La{ do6 ml lptly r. m .eha ofpmr.ny who buildi .r ibprott th.r6o.
<br />and who od6ds for sct prcjds wnh ! Codtuo(!) li..Ed pllenr ro rh. Contlclols Li..r* tjw).
<br />I ffi.x.mpt und.r Sdrion ,B &P.C. forlnrr.a$n
<br />EQ8tr[88.CQ!4fE!SAll(A
<br />IECIASAIIA!
<br />I h.Eby Emrm und( pcnakyotf njuryo.. olrh. lolLwing ddl,r,tions:
<br />_l h.rc ard w,ll minlsin s Ccnificst. ofc.rsor to S.lf-lNr. for e.kds conDcn$lio[ d povid.d ior by Selion ]700 oflh.
<br />L,hor Cod., for rh. pdIoIlM. of lh. mlk f.r which lh. p.m n ir$.d
<br />I hrE lnd will mint.in sorr.rt conllnerion iN!6nc.. a{ cquird lry sdi.f, l?0o ofth. Lahor Codc, tor lh. tofome of
<br />thc work for ,hich thi! ,€mit rr istu d My worlds @ml.derion iN
<br />r.
<br />sri*.,n r.ricy Nhhs e:w3 t /1
<br />_l eniry th.' ii $. r. omm. of the wo* for vhich fiis pdmn is issu.d. I ih.ll nor cotloy tny !@n n tny m kr
<br />s re to lEom sbjel lo lh. m*d @tr{Estiotr las of C.lif.n'a. .d s8E rn if I struld beom ebFr lollt
<br />wrk6'@mp.trelionnmviiiotreofs€.lion1700ofrh.ljtDrC.d..l3h{ll.fnnhsilhoq,ly*ilhth.*pmvisioN.
<br />wARNlNc: FlituE ro s@ w6.k6' onw.sri.n otroe. is unhwtul, ond sh.ll flhjftt tn chplortr r. dim'ndl ltcEhis and
<br />cilil fin.s ut 16 one hundRi ih.uend dollarc (SI conpetrsrion. da@!.. as pmvid.d for th.
<br />ID
<br />DECI.AIAIION
<br />I h.c6y rlfm u.d.. r!@lty of Frjury th,l I m lietr*d undd pmyi,bn of Chafln I (@@in8 wnn Sclion 7000) olDivi$ion 3
<br />ol rhe BusiBr ard Pofc.ioN c6.L. d oy li.o* i3 i. tull loG a,n cftut.
<br />K3e3oV
<br />caluf,uqror!.Ll;BD.llcicl;lq
<br />I h.Ehyamrm und.r FnalryofFrjory rh3r rh... ii a fr,n<ru.rion k.dins iscrcy fin thc FrforrrrlN.f rh. *!rt 6r $i.h this Fnil ie
<br />hsu.d (sec 1097,Civ C )
<br />AIILICANLDICIA8AUAts
<br />I hdEt'y afm und.r pentrlry.fp.,j!ryon. ofrh.ldlowii3 d(ldlonr
<br />D.holiio. Pcrmits-Arh.sos Norifi carion,:.dcnl R.Eul0ti.ni ('1 n1. 40. Prn6)
<br />R.quiEd L.rl.r of Nolfi.tuon
<br />-l
<br />c.niryrhal th. t ddlrcgubriom Egirdi.E s6.noi r.nov.l m mi .IDli.5hl. to lhis tDj.c!
<br />-l
<br />ceniry$ot I havc rcad rhh lmlication&d srarc rhtrt rhc abor iolom0r6n iscond.I asR to onply wilh all Cny 6nd Counly
<br />odi.rnccs and Stolc L.*'r ElDtinE ildinscon{ crron onl herchyrurh.ri,! rerr.s.nr0riv.s ofrhh CityMd Countyro.md rron'lr
<br />ot ve mnton d,mp.ny for i
<br />Appli.ntri or s?nt signrt,r.(-r"r. /l LO {
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{rap/Drain Line
<br />lr,4ain Drain/Pool Piping
<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 D/D//6 EATQ Trhml/
<br />Final Gas Test
<br />Meter Release
<br />FINAL r\rp\r\ur.(m\
<br />Notes, Remarks, Elc
<br />POOUSPA
<br />I (r
<br />Lrndq's Addrcsq
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