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PLUMBING-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER ITIILDER DELC NATION
<br />I h.rcby offirn !nd.r pcMlly of Fdury fiul I m qcnlpl &u $c Conlacloh Lie.e tlw for lte follo*itg rcasn (S€701t.5
<br />Busin$s ltn &olcssi.n Codc)r A", Cily o, Connly enih EquiEs a r{mil ro mntMl, .hci in{)rev., &tulilh .r EIE dv
<br />itrudllc. priir lo ns nsumc. al$ Eqdes lh. sPPltel for such lEmit !o ljlc I siSn d slar.m rhal tE .r shc it liccnsd 'prma
<br />ro ltE l,hlisions of $c Co.trl(lols Li.cned Llw (Chptr 9 Comd..cin8 siih Scction 7000 of Division I of thc Bnsine$ md
<br />Pofesions Code) or lhol lt or shc h cx.t{,r lh.rciiom snd rlE h@ir lot ilE llk8cd ex.nfli.'tr Ary viohlhn ofsdrjon 7031.5 bv a.,
<br />,pplicer for ! pcmir slbjers rhc apllicanl lo ! citil P.mlly of Nt @E lh.n fivc hundmn do[rs ($500).
<br />-t.
<br />f,c ownn oflh. FoFny. ot my .DPlott* v fi qlBcs as lhet $le omp.tretion *ill do tlE wnt &d lhc s$r1@ n mr
<br />inted.d or ofi.6d ao; ;h (Se.?o44. BNift$ ed Ptllcssion. Cod.: TIE Co trrort Licin* L!* &c! .d +plv lo o ow, of
<br />rh. prcFdy who builds or in{,6ts Uxmn. .,1d who dms trh k* hiru.f or hmlf or lhDugh hii or hd own cmplo]eer.
<br />pmvidcd Ihar such it ,lovtftnls e nol inkid.d o, ofTold ror slc. lf. hoevcr, rlI hnildin8 or iqmwmd h $ld wi$in orc Fd
<br />;lor?L1ion. tL O*mr BoiB.. vil hlE rlr bldcn of povine lnd rE or slE dit rcl hnB or inprcE tlE proFrv ro lrE I,lrtDE of
<br />-1.
<br />as oercr oI rhe Is,poly. an cxclusile ly conirelinS uirh li.cned conl8ctoo ro co.stDcl lnc Imjccr (sN. 7044 Blsircs
<br />dd PDrca\i'n Cod.: Thc Conlracror's Liccnr L.* dcs nol lmly ro u ornf of pnpcrl y sho builds or imlmts rn ..o..
<br />d who onr@k 16r skh pmrrts wnh a C-nrdclo(s) lkcnrd puMnl lo rhe Conttclols Li.cnk tiwl.
<br />-l
<br />ah ercmp mrtc. Selio
<br />lrrrc _ Otnrr
<br />wotrx"xs corupoxSlrrrw
<br />DECITIX{IXA
<br />I hcrcby am.6 uod.. F.ely of lsjGy oN o{ rn. rollowin8 ddbtalions:
<br />-t
<br />havcandwillm'inr0i.sCcrlificalcolcorrntro s.l neurc for sorlds comptnsllion.ar lmvided ro! bvSNlion lT00 olrhc
<br />L$or A'dc. foi rhc pcdommcc oflhc uo lor whth rhc lcmn is tsud.
<br />-l
<br />hnv. snd will roinlain wdrkcB' comp.nsation insuratuc. a( rcquind by Selioi 1700 of lhc Llbor c,dc, fc lh. p.lformft 'r
<br />his ,crmir k ksD.d My vorkc6' conrFnsdion insnramc .aFi.r ud nolicy .u
<br />L k n/ -19LL(Bot
<br />-l
<br />ccnily rhar in rlrc pcrfolmmc oa th. *ork for whth this i,crmn ir issucd. I nE nor cnDloy {ny Fson in aov lmmr
<br />$ as b hcNm subitr ro tlE wol*6s comnchsalion hwr of CdlifomiE. o agN lhar ilIrhould t(oe slbr{l rolhc
<br />wo*s €onrDcnsarion DrcvisioG ofSelt'n 3?@ of rhc hho, tuc.l dull.lonhvnh mnply wnh rlrc tttuvisions.
<br />WARNINC: Flilue lo scw workcs' mnqrcnsalnin .t\ttug. is unhwtul. and sh0ll subirl .n cq,lorti to aimiml pcmLicr.nd
<br />ro oic hundr.d Ihousand dolld\ ($l(x).(xx)). in 0ddilior h rh..o( oi.onDcnslrion. dam4cs as [ovidod f.r rh.
<br />Sdion 1076 of rhc llb., Cod.. i crcn ddromy s acci
<br />du ,fpnlonr:7 ?-
<br />n ofChoprcr9 (cohmncing *irh SLrrirn 7(rco)
<br />torncr"r,*<t)zl
<br />I h.Ehy amrn under lf,ulty ol Frju.y thlt lhse h u on{
<br />issu.n (s.c. 3097. Ci!. C ).
<br />irscrct f6r thc nc onrMe oarhcsotk
<br />Lrndd r Nrm.
<br />k.dcar Addrsi:
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<br />APIUIANLDECIAMIIIJN
<br />I l$$y alIntr undcr leialry or pcrjurt om oltbc folk,sins ddLtrrrions
<br />Dcmlirion P..mirl^sbcalos Norin.arion F.d.ral Rcauhtions (Tirl..r0, P.n6)
<br />Rcquircd t llcrofNorificrrk tr
<br />iry lhar rh. fcdcrtrl rcsuLrln,ns dg,rding ash.sros rcrmlal are nor amliclblc lo lhn [.r..r
<br />I hlvc rudrhis!r icllion 0nd ll3lc Ih,l llE tr ncotur I agd k,con[ly*ilh ullCiryrnd County
<br />ur faws rlatin8 io bDildin8 .on(ruct r€prcsnraritcr otrhk Cilyand Cou.lyro Mrcr upon IIE
<br />abovc Nnr i,ncd nmp.ny lot inspc.lio
<br />ADDlica.l or Asonl Sistrot
<br />P.mile nomc 1onnl):4 t l1
<br />UNDER GROUND
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Buildinq Sewer t '/rt/r* I iry?or-D /62 -
<br />Area/Storm Drain I I
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL a 7/A/tt t .,//r/W /trZ-
<br />Notes, Remarks, Etc./
<br />-t
<br />DATE
<br />Waste & Vent
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />I h.Eby rffifln undcr pcmtly of r.rjury rhd I sm lienan
<br />of th. Busiftss alld Prefcsn'nc Codc, nrd ry liccns is in tuU trcc 8nd cnccl
<br />r_r*^"cr,*, . ( - 5 G r_,.",,,"",^*,, . gCqgXJ_l)
<br />',,",.1_H*
<br />*", - ?- 6-i t
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