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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pi ping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{raplDrain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanita ry Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL tl-2-l-t? -,VE
<br />Notes Remarks, Etc
<br />OWNI]R BTIII,DIR DEI-CARA I'ION
<br />I hcrchy nfirm uftlcr ncMlryolncrjuryrh.r I n crempr fn'm rM Conr'aclo6' l,i.ense l-a* Ior rh. nnk,{rry rca{,n (s*7(rrr 5
<br />Eunncs .nd rrolcssio CodcI Any Cily d. County $hrh requtres r pennil lo consrucl, nlrs, rmp!trt. d.dolish or E .( any
<br />n^'crure, p',or h irs Frurnc.,.horequrcsrh.lnplicanrf{reuchp.rnnib,i!.xn3ned{d.nFnr rh lr.r sft N licc.sd nu$urd
<br />lo rhr pmvhiotrs or llE ConrEcro.t Licei*d Law ((-hapler r). Comnrnci.s *irh s.crion ?000 ol Divison I 6rlh. auqinds ,nd
<br />PhLsr!,ns Codc) or rhrr hcorshd i\ erchnr rlffcrr.or dtul rhc harF lin rhd ,ll+dd .rcmrr.n Any voldDnolsc(tion?o:ll5 h,yiny
<br />.rrplcrdaorapcnnnsuhj.dsrhcaprlmNb0civrlpcnihyolnor,nor.rhmfiv.hundrcddolliB($JlJo)
<br />-1,
<br />a olm oftlr pdD.ny, or my.nplorB wnh ms6 ai rlEir sl. onq*nstioi, wil & $. m* r,'d lh drud@ i! ml
<br />idod.d or orcr.d tu oL (sa.r044, Euti,E ed P,ofcssi,B Cod.i TIE co' r.crd 3 LitM Lre &d tur +!ly to mowr ol
<br />$. ptuD.rty eho hildr or ntI'6B th.tu4 ad *ho &B Mh *rt hinelfor lrB.lfor thmuSh hn or ll.r o{n.mploF .
<br />p6vid.d lhat sch inplErEl! c er otdcd oroftEd tu eL. lf hona6, d! ttrildiig or irpbwGrt i! FE witnin oR ,6
<br />of@npldr\ dc o'xM Bu ,.r sill I'aE tli trt!.r of povi,E lhd tE or Cr di, mt hdld or ihDo!. rhc pmpdy for ttE pl,Fr.f
<br />_1. I osa ollh. pht'dy. @.xclusiv.lyo .acting wnh lic.(ed oflBroN ro co[(rud rh. rmj..r lsd. 7044. BlsiEsi
<br />and lmt$ix Cod.: l h. Contrdclor's Lic.Ne Lsw d€s not apply ro on o*ns of pmrcfty *lF buildr or impm{.i lh..co[
<br />,nd sh. onlnfi for sch fm,fls *irh a Co @to(i,lic rd,umanr rd rh. conlruclol! Lhmk t w)
<br />-l
<br />m cxcnfl ud.. Sctk,
<br />]{oarIBs-cautBsAra!
<br />PECIAAAI,IO!
<br />I h.r.by .rlm uod.. p.mlry of pFjury oB oflh. folloeiis d*la6iionr:
<br />-l
<br />hav. ard ,ill minl.in & c.nificd. of codsr ro s.lf-lNrc lor erlei orp.urioq a prcvid.d fo. l,y s.ction 1700 of lh.
<br />Lhor Cod., lor lh. p.rfolrr]!tr orlh. ftrt( fM $iich lh. Fmil ir is.d.
<br />_l hrE rnd will min(ain work.6 onp.nsilion i@6rc., d rcquircd ny sfttion l70o ol rh. L,ho. Cod., 6. th. p€rfoMc of
<br />ii f$.d. My workd! snpdirtdn r{6m. oni.r ond B,licy numbn R:
<br />l_b"
<br />3 to- t- t1
<br />I c.dify lhd in rh. odfomrc€ ollh. wort aor which fiis p.ron i3 iss.d, I shall not cnploy .ny ,.Mn in any MEr$ ei to b.com sbj6t lo rhr hftd @mpensrion hsr of Cslifomia. a.d alre rhar if I slruld bccoft shjet ro rlE
<br />sortdl @mpcNarion prcvi3io s .f S.clion 3?00 ofrhc Lahor Code ! ilEll. lonhBnh {mrly wnh !h.e levishnr
<br />WARNINC: l:riturc ro scu. Bo.k.*' otrqEnslion mvc6-sc h unhstul. lnd shall subirt an.r'ploFr ro 6ini.rl ,.Mlli6 8nd
<br />civil fin* u, ro otu hutrdrcd rhou$nd dollm (S100.000), in addnion !o rhc 6it of conwtreli.ll. d,ru8.s.r pmvid.d for lh.
<br />Se.li{nr 1l)?a ollh.lahort.lnle. mIer.{ an{lanomev i l.es
<br />LL:2$)6
<br />DEqJAAIION
<br />I h.Eby rrltror und.r p.mhy ol Frjury that I an liar*d undd pmvisionolch.rrs 9(ommmcins {rth sdbn 1}r0).lD'vsion l
<br />ol rh. B$in.$,nd PtuL$ions cod.. ! tmylic.tr* ( in tulllorednd.rdr
<br />C.t ,)5f
<br />,r",-/-]-2(l- r
<br />IONSIBIJCIION.ITII}IIG.ACENCI
<br />I hcE6yafftrmund6 p.mltyofp.rJu.ylhat rhdc is a mnstruclion LDdins !s.Ny for th€ lsfomtu oflh.work n shfhlhrFnntr r
<br />issucd(Sd.109?, Civ. C )
<br />A-ttIl!LNLl2}:CLAtALl()!
<br />I lm$vr,li' 0 rl.rnemlr) o,nerluyofcoirlt,nllnrin!d..lrr.rins
<br />Dcnn)l'rtr,, Pcrm s ,lshri.s Nooficrrnn licdl8l R+uhius(111. {0.lxn6l
<br />R.!uftd I.ller.f N.r']icrrt,n
<br />_l cdify lh.r $. f.d@l .cgul.rioN E8ardlng rlb.srd rmBl ac mr .pllt.bL ro thi. ptuiri.
<br />-,c.niry$
<br />l F6v. rc.d rnh orplic,r inn ard dil. th.t rh. obE infomrion h c.rct. l asre to coqly anh lll Ciry and C.! y
<br />nrdina.cd rnd Stllc Lsq ELrins ro buildins c.trnrucrio'l, !d nurlxriz. rll)r.s.nknlE ofrhr Cirymd ('6udry b.nr6 uBrn rh.
<br />ahovc ftnlio..d Dmr'.ny fot
<br />ApDll.inl or,\s.nl Slsnilur.:I L.-(
<br />L"-B
<br />7Em
<br />Water-Under floor
<br />POOUSPA
<br />Pool Heater/Gas Line
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