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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent //4 ?1hfl4 /tl)
<br />Water-Under floor fr'trd)1,,l/ -..''
<br />Gas-Underfloor
<br />Building Sewer lta &ttl,tts
<br />Area/Storm Drain
<br />lnterce ptor/ Clarifier
<br />TOP OUT
<br />JLI -t1
<br />Water Piping w I .',| 'fr 7
<br />Gas Piping T l,
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />Ptrap/Drain Line
<br />Main 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 (Valu/ta,/fr)
<br />Final Gas Test u 'r.,
<br />Meter Release
<br />FINAL f-j"r XJ,
<br />Notes, Remarks, Etc
<br />OIINER BI]TLDEN DELC NATrcN
<br />I hcEby !,IrD un&r ,.ulry of ,.ruy $at I m dcmrt fmm fic CottocroR Li.cnr Lls fo. rh. followin8 .!&. (s(.?011.5
<br />Bu.inds .,n Pol.sioo Cod.): Ary Ciry o. Courry trlrch EquiB r p.mn b 6^rrucl, .1t6, inpmE, d.mlnh or i*t &y
<br />srdct@, rri.r to ils irsd.,.bor.quimth.spplidforMhFmirrofl.!sisrEd0r.6rrlElh.orslti.ilic..sdluNll
<br />to lh. povirioN of tlE ContEcld s Lic.f,ed Law (ChaDrd 9. Comm.minS wni Scclion 7000 of Divhion ! of lh. aui..$ md
<br />Pmf.Riions Cod.) o. th.r h. or ih. i! .r.q,r rh.EIiDm and rh. hosir for rhc dll.8d d.mtlion. Any eioldion ofScclion T0ll.5 by any
<br />rpplieln tu o !.mn sbjcr rlE rpplior ro a civil ,.ohy of mt ma rh.. liv. huidr.d .tolla! (1500).
<br />-1,
<br />s ownd of llE pmo.nx or ny.frployH with w!g.s s rh.t sk comF slion. pilltla lh mi( Md tlE fionrc ie ml
<br />iirad.<l or olTd.<l hr slc (Se.?044. Slii*s sd Pmf.*sioB Cnd.: 1 h. Contoclols Limr. L,w do$ mr aqply to s ovnd of
<br />lh. ,,Dp.rty wlb hln& or inFoB ltE6l\ .!d wts &E Mh mlt litu.lf or lEMl,or llwrrt hir or lE om .rpl6ycc.,
<br />pmrid.d rh och riom$Ed.&El addtdcdffoftild litr$l.l[ hoqffi, dEt ildtr'B or inp,!\!mri i3$ld*ithnoft ]€r
<br />olotrpkiin\ rtE OwEr Buitkr wil IEE tlE ttud.n orpoi.g rhlr lE or !h. di, mr blild or inEotr th. Fottdly h. tt! fllF- of
<br />-1,
<br />$ owM of th€ FDndy, ad.t hiiv.ly@ ddins wnh liccr€d co.rdcroFro6^d cr rlE,'mj..r (sr 7044, Bu.rl6
<br />rnd Pmfr*bn Cod.: 1 h. Conlrrclol ! Lic.n.. L.w &H mr atply ro s owmr ofrmn ny wlF huilds or imrrcki rhdo,r.
<br />rnd *ho 6, 6c1s for Nch ptoi.cri wnh a Conreto(r) lic.nr.d puM ro lh. Conrr..lols Lic.ne Law).
<br />-l
<br />d .x.hfl undd Sftrion- B. & P.C. for lhir @$tr
<br />Drr.: Omet:
<br />WONKERS' COMPENSATION
<br />DESIJAAIIO!
<br />I ha.$y stlim undcr D.Ehy otD.rjlry oE ofrh. foltowinp ddhrario*:
<br />I hrle ifllwillm.rntoi..Ccnific0lcolConFent r. Scll.rnsure lor $ork6 conpens.rnn\ !r rr.yidrd Lrhts.crionlT00 ol'rh.
<br />L.h.r Codc, lor rh.,rcrfonnirc. of lh. wol( for which rh. n mnr h hsusl
<br />_lhar.rnd *illmainrain wo&e6' coon.nrarioi iaflr.nce, nr r.qt'Erl hys(rionl otth€ til,nr Cod., for lh. n fommeof
<br />e r
<br />_l edifrthll in ih. Frtu@m. oarh. wod( for which lhk r,@ir is is.n, l sholl nol .nploy any r.mn in rny manmr
<br />m ae ro bc.oG rubFl ro lh. w*d' otrp.nsrion laE ofcalifomiq snd asE rhd if I iholld lE om mbirl h rn
<br />*o*m' mmp.nFlion pmvhio* ofsar ion l?m ofrh. Lobor Cod.. I $ull, fonhenh @aply with rt$e ,,ovkioN .
<br />IVARNINC l;ailur.lo €ur. workcs comn.n$rion is unl.q tul. nnd sh.ll ohJal rn opk,rlr r. oihiMl p.Mhi.s and
<br />sivil fin.s up lo om hundr.d lhousnd dollan (tl io,! da@!.. as lmvid.d aor lhc
<br />S('ion J076ot'h. t hr Cod.,lnrd.s
<br />o,*, - Ul)a"/ltr ('
<br />IhcRhyrflt ond.rp.nrlryol perjurrrhrr I rn,lrcn\drftk. nn^ si{mol ( h$tcr9l
<br />ol rh.lJNnes r.(lftrn.sk,ns(ixl.,lDd orv l'..nsc r\ u i,llinc.ifrl.llo.)6U;
<br />(l)lirallu0lLllDll(ljr!1M-I
<br />I hcrchy rmnn und.r p.m rtoi!.rjuryrhsr rh.rc r r con{tu.rtr)n l.'!nn8 rlc .y Lr rh. Fcrlir
<br />Nctrcd (Sc. :toq7. Civ ( )
<br />uork 6. r'hrh lh's ,'{rn F
<br />_l .cflit rhd rh. H.dl rcguLriom Egarding &rb.n6 rmsl a. mr qlpli.abL to rhis lmjer.
<br />I cdiry$d l harc..ad lhi! applh,ion ad slat.lh, thc at v. infoml ion s coret. I nsta lo omdy snh lll Cny aod Cou y
<br />onlimnc.s and sr . Laws El.ti.E to
<br />aln)v. hcmon 'l nmn.ny n
<br />appll.rnr or genr Slgn.lurc
<br />h.rcl,y authorizc ,.presenl.riv6 o ll::Uiil;
<br />railI
<br />Waste & Vent
<br />92<lu',
<br />ffrucaNtDricLdBAlto!
<br />I lEEby afllmr uodcr penolty ofpelury on. otlh. tollowins dal.rations:
<br />D.molilon P.nnn*Ash.do. Nolificalion l.neral R.suhtion, ( I nlc 40. P0n6)
<br />-R.q!ted
<br />l!tt.r olNorrfi arion
<br />QL.
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