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PLUMBING-INSPECTOR RECORD
<br />DATE tD/srG.COMMENTS oWNER BI.'II,OET DTX,CARA X)N
<br />I hcrcby illlrm undcr ncmhy ol Nrju! rhd I un crc mFl r(,m rh. G,nt.clo$ Liccnsc Liw lor lhc lnllorin8 rcaq,n i S$ ?ol l 5
<br />no\in.\\ nd ttofcs\ii,n C{xlc): Ah, Ciry or Counr, *hth rcqutc\ r p.rnir n, .oniru.r, alrc', i'rpdvc. dcnh)i(h.. rcprn . ry
<br />inr.turc. friortu ils issmtrcc..ho rcquncs rttr {r ica nrsu.h pcnni ro fik. si8trcd nilcnrd rhlr hcor shc is li.cn\cd poruanl
<br />t, lhc pmvi\i{nN of rhc Conrra.tr's Licd.{d ljw (Chlprcr ,. Co.nc.cio! $irh S..ri,,n lfiD ol Divi\iotr I olrhc Businc$ rnd
<br />PhlcrsionlCo.)urrhdh.Mshci{cr.nlplrh.rcfronan'lrh.tri{frtrrhcrllcgfrlcr.nui{)n.Anyvn,htnrnolSc.lhnT0ll.5byony
<br />lpplicanr n)r a ,.rnrir suhjc.h thc iprliclnr l(' 0civilFnnxyornor nbr'hs fivc hundrcddolhn lst{ro).
<br />-1.
<br />&r oeM olrlr !rctEfly, o. m, cmploy..s Dnn wleei.s rlEar $k onp..$io.. wi{ do rlr so.t,n ltl slrtr@ is ml
<br />inrodcd or of.nd fo. sL (Se.70,44, B$imss mn Pmf$.ions Codc: Th. C..tracrolr Lims L{w d{.s mr +pl, to u o*er of
<br />rhc rmtEny qho h)ild.s or inI,D6 ftnn. di *h dc Mh mrt hims.lf or hcr*lf or rhmudr hlr o, ltr os..mplotr.s.
<br />prcvidcd rhrt su.h impmemnb @ ml i c.di or oficEd lf eL. tt hosw, F buiBi,8 m inprosrc b sld witfiin one ,ut
<br />ofcorptcrio,L lnc O$rr Auilh. wil tuw tlE hrLn olpovinS tn lE or ilE dil rcr hiu or i,{mE dE l,Dpsly fd lh. puq*of
<br />l. $osn.rofthc Eorcny. o'n cx.lusiv.lycontucring wiih liftnscd contacloN lo.on(rucl lh. pojed (Ss. 7044. B6in$s
<br />Mii h.aBsiotrCode: Thc Conrdcrols Liccns t w .locs nor aptly ro m o*n r of fioFnr eho tuildr or inprovcs rh.rcon.
<br />{nJ *ho sn(@k fo. iu.h ptujcd. sirha clnia.ro(sl licc.ed pu*umr ro rh. atnrracrols Ltcns L3!).
<br />-l
<br />M crem0t lnd€r Sdion- B. & P.C. for thi! re@n
<br />O*n.r:
<br />llBtrEBli:ClrMfE$A8r!
<br />DECI,AIAIION
<br />! h.r.by olfirm xndcr Fnally oa p€riury om of fic folhwinB dal alions:
<br />-l
<br />hovc r willm0inr.i,raCcnificolcofConscnr r. Sclf.ln{trclnr $or*er'comprn\ition. !\ pmvidcd fitr hys(rbnll70o.f(hu
<br />Lrh, Corlc. h thd p.nnnnrmcofihc worl Ior whichthcr.flnlr h i\sucd.
<br />-l
<br />havc and will miniain wort R comlcnsslion insr.Rc. 8 rcquircd b, Sd ion 1700 of ll* Ljbor Codc, for fic pcrroll]l,re of
<br />th. *or* for *hich this pcmi n &ucd. My workdC conrpcn$tior ins.mc fficr md policy nunbct aE:
<br />_l c.nifr rhdr in rh. lxrfurmrc ofrhc worl for whkh rhir p.rmii L k\uM.l shallnor cnllloy lny pcrsn in any morncr
<br />s s to h(om subid lo rhc so*qs omlEnuliotr l.vs oa Cilifomio. lnd lBr thlr if I should hc.om subr.tt ro rlr
<br />work n $mFnsarion protirions ofS.ction lr00olth. btor Codc,l shau.l'onhwilh.omlly ailnlhos ptr,visions,
<br />WARNINC: F.ituE h ysE {trk61 @hpcnqtiofl co(E8c is lnhstuL lnd ihall subirr s cnploF, ro dimi,n p6.hi. t.d
<br />.ivil fincs !p ro om hlndrcd rhousnd dolld ($100.000). in addirion ro rhc o.l of omfirsiion. d{dgls rr pmvA.n tu $c
<br />Serion 1076.frhe LllE Cod€, iitcrcn ud omyrles.
<br />UCENTEILCANI&IIAf,
<br />IIEI;LA&IION
<br />I hcrchy rllnrundcr Ntrlltyofpcrjury lhli I ar liccn*d undcr lori\i.n ol ChU.r, (connticins sirh sccri,6 7m0) oiDivi(i,)n ]
<br />ot rhc B!\inc\s rnd h.ac$i,,is C.d.. Md n', li(nsc i\ in liill furt dd ctrNi
<br />Lk.*Cl,sr: l-i.[.s Numb.r:
<br />(OlsLBllll]llli.1,l;J)llurllifliql
<br />n\u.d (S( 1097. Civ C i
<br />d.tfuc NLDEEL]IB/IILIN
<br />I lrr.$y irmu .rlcnnlr,ol p.rjuryoncof rh. tulbqnr8d..lffirn)n!
<br />Dcnr,lni.tr Prnn s A\h.{o\ Norificnriotr lrcdcrrl Rcguhrn s (Ttlc,1ll.l,ini)
<br />_Rdqunrd lrncr of Nnriliurirr
<br />I .dify lll0l llE rcdcol rcguh! ions rcBsding lslEslos rcnDvol arc nol arplicablc lo lfiis Imrcl
<br />__l.dil'.vrhrrlh!v.rcdrhi\altli.rri,n,rd(rrcrhxirhoxhrv.i'riann i,rn.orccr InBlLtr..otrlnly*irhrllCiryindCounry
<br />oflliixtccsrtdSrjrrcI!s!rllrin!t]btildin!coNtcrn,n,u hcrchy rhornc rq)ts.trrrvcrolrlrirCityrtd Courryl,i ctrcr uFrrh.
<br />ih,vc rnridrd t)rcF..n! tu insrn-rir)n purBxcs
<br />Appliunl o. ABent SktuluE:D.le
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Flough Water Heater
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool HeateriGas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing
<br />Final Gas Test
<br />FINAL /-3-/A /)c{r+,@)
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />l.trJ{'. 4',J'r$
<br />POOL/SPA
<br />Back Flow Device
<br />Meter Release
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