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PLUMBING-INSPECTOR RECORD
<br />OqcFBu ildd D*llnrion
<br />Iheebyatrrn! ..p. hy of pajury rhlt I m d.ftpr lom rh. Corm(.oR' Lienlc t w lor th. followin8 raen (iE 7ol I 5 AEiodr
<br />. d Prof*ion Cod.): Any City or Colnry which r.quir6 . D.,dn lo @Brtuc( allr. inpIov.. d.molieh or !.p.i! !n, 3rodu.. pdor lo irti*rn a, rllo r.qut6 lh. ipplitut aoi .uct psmir lo nlc . ri8..d !r @fl d[r h. or sh. it li*M.d p!6@t ro rhc provalioG of rh.
<br />Corhaofr L.eNcd trw (Cllpla 9. ComodlS eii Sc{tior ?000 of Divi.ion , of rh. Blrin€r Dd ProfsioE Corl.) or rht h. ot
<br />sh. iq.n rhd.6om tnd th. b$i! fo. thc !ll.8.d emprior A,y viohrio. of Setion 7Ol l. t by uy +plistrl for . pmn subjccl! th..pplia rorcivil pcult, ol rct noB thu fiv. hundr.d doU.R (1500)
<br />_1, s om.. of th. popcirr, o, oy .mdoy6 wid ug6 .r Utct iolc .o6pc6!tion, will do th. mrk ud th. luodue ir nol iir6d.d
<br />or o,Is.d lor elc { Se 7044, alrn6r ed P,ote.ioro Cod.r Th. conhtu t LieM las do6 @r .pply b u oMs of rh. prop..q
<br />*ho buil.Lr or improv6 $66,! .d wh. do6 rwt wo* hiN.lf or hcroll or rtuoud ,'ir or ha oM .mploy.a! provid.n rhr ilch
<br />ioFolcncnl! .r. .ot inlcnd.d or offs.d tor nk 14 howda, rhc building or inprcv.n. i lold wihin orc yar of.omplcio4 rh.
<br />OM.lBlildd will hrv. th! burdcn of proving rh.t h. or rh. mt blild or irp.ov. for UE pu,polc olsL).
<br />_,1. u oma oltlE proDlrty,.s qclwiv.ly @trhdh8 wilh liccBod @ r.ctori !o @Blo.r th. prcjcr ( Se 1oaa. Bsin6! lid
<br />PDesior Cod. Tn Co r..roa! Lk M lr- doa aor .ppl, ro 6 osa of prcpsty who buid! d inprov6 rh.6. . rn t etoo r.cll fol .u.l' proj*E *nh . Co r!do(, lic4.d pu6u to rh. Conurdol! LiaM bw )
<br />I rh.i.hpt u.da S.crion _ ,A &PC forlhir rdon
<br />WORI<'IS COMPf, NSATION DECLAX TION
<br />I ha.by rmm lndn pcdry of pqjury onc of tlE followinS d@hdioN:
<br />I hav.and willmlmia,n a C..lrfiat of Comem b s.lf-l NUre i.r *or[.( .on,pensrkrn, rs p,ovidcd aor by s{tion]70(, oarh.
<br />Iihor Code,lor thc pc,forman.c orth. w.ik ior *hrh thc p.rmn is nsucd
<br />I ltv. ttrd r'll mtintlin wo,t.R @np.6rrion iisu,!nc.. G r.qun.d by S.c1ion r'700ofrh.t bor Cod.,lor$e p.rform, eofth.
<br />wort ao,whkh.hipdmn i5 i$u.d My wort.n @m!€nFrion iGuan@ aiii...nd policr.umbd are \cruid, Er'<.Z p,a.l
<br />P"n"yN,.b. TCoOOO lt03l I I Expn.! lJ ,l/ozlLot2-
<br />(Tht t clao, i..d nor b. @mpl.r.d if $. psmir it fo, Orc hundied dolhB lll00l or lcE)
<br />_l ccnify tnlr in !h. pdformft. ol.h. wo* lor shi.i rhi! p.mn n eu.d, I rhlll nor.nploy.ny Ftun in..y mloo.6 s to
<br />be!h. 6ubjet to llE mrk.6 ' @np.Mtion h$ ol C.liforni!. lnd Br.. tht! if I rnolB b.@m. lubj.d to rhc woikot
<br />@mpe.srioi provnio.! ofsddon1700 ofth. Llbor Codq I !h!ll, lonhwirh @mply eirh iio!. prdhions
<br />-lwri-^
<br />L,,z<,s l.a L ll1
<br />WAANTNG F.ilur. !o Fur. mrlcc coip.Mtion @v E is unhwful .(l .hlu Nbje! !. cmploy.r ro Bimiul p. hi6 lnd civil
<br />fin6 up to om hund,.d th.usnd dollid (l100,000).in iddnion b tn. 6rt ot @mp.Mtioa drmgs s provid.d for rh. Sdrion 3076 of
<br />rh. trbor Cod.. intsat lnd !{orn.yt f.6
<br />LTCINSED CONTRACIORS DEICL{IIATION
<br />I h6.by iftrih unds p. hy olpqju,y thl I m li@i!.d oda provnion ol Ch.pls 9 (@ftb.ncing wnn Scction Tooo) 6fDivirion 3 or
<br />lh. BEiIE .flI Prof6sioB Cod., ud ny liccB. t in tull fore .nd .ffal
<br />L,crcrtt, P C-lc.s->-t**"r" * 1S?1 L
<br />Lrtqf rz-
<br />cglsIB.UeroLtElDllGl.GlXCY
<br />I hcrcby lttrrm unds p.ully oar.rjuryth the..isi con*u.tion l.ndr8ra.rcy ror rh.p.formnE olrh. work io. whichfiG p.rfrir is
<br />nsucd(Se roe?, civ c )
<br /> DPLICANT'S DECT-ATTATION
<br />D.mlition Psmi!.Atb6ror Notiliotion F.dsll R.sullrioro (Tnl. 4q Plrt 6)
<br />R.jut.d Lats of Notifi @rion
<br />I @nily rh.r rh. Ld.olrsullrions r.g.idinB $b6to5 r.Bovrl rr. norarDliobl. !o rhi rrojer
<br />APPROVALS DATE tD/stG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-U nderfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipeing
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Misc
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 2.\\r \\\Itor/
<br />Final Gas Test l'l t
<br />12\->FINAL '//P// I
<br />Notes, Remarks, Etc./ '/ ''-.
<br />M \WP51\P6.Brl-lnspoclion Forms\Plumbino lnspoctor Ro@rd doc 03 31 06
<br />Meter Release
<br />_ I cdlif, th.r I hrvc rad thi! lppliqion rnd st . thlt rn .bv. inlormrio! n or.a I r8re b @Bply wnh nl Cny .nd counly
<br />ordi nG rnd St r. LrE r.htinS 10 buildinS @6ru.don. lnd hd.by .urhori.r ,@r.6uriv4 ol this Cny rnd Co6ty 1o ore lpon ft.
<br />rbov. h..tion.d proFny lor in.p..rion porroc
<br />^pp,ien,or!sd,!is &--StzaZ .
<br />-^
<br />4q/n- _
<br />pc.hin6'm(p.inr l.S::t t ^/alb_
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