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PLUMBING-INSPECTOR RECORD
<br />APPROVALS rD/srG.COMMENTS o$NER Bt ltDUt Dt:t,C,\RA',U('N
<br />t) rhc nnir(i{r\ ol rhc Cotrrrr.tn \ I icrn*d l.Jw 1('hrprrr 9. (innucnrtr! r,irh S.crion 70oO oi I)iri\n,n I ol rhc Br\i'rr$ J,rJ
<br />f|]llcrtrrntriJ{rnnr\uhjc.srl.( r,'fli.nfrtur.i!ilpctrrlr!of or kr.rhd fik hutrtlrrddullr\ (S51X)r.
<br />l.r\o$n.roirhcpn)pcny.or,,crl,,yc.\$irhwi-ac!r\rh.ir{lcdnnpcn\!ri,,n.$illJolic\ortr rhc{drestu,
<br />inrcMcd or oficrud lif qlc(SLr 7{}l-1, Bu\irc$ rnd Pnilc\\i,,n\ C{xl.: Tlr Coirr.ktr \ l-tunsc Lsdoc\fr, imlyroatrosDdof
<br />rhc lln)F-ny trlx, idild\ or iqroN\ rhcNr and who de\ s'.h u.rk hnnscllor h.r\cli.r rhmu8h ih or hcr owncmployccs.
<br />r3. N osN of lh€ l,spcny. !m crlusivcly conlrading wnh lc.*n conlraclm lo .on(ru.r lhc p'oiEl (SN. ,O44. 8usrc$
<br />3,n Aoftssirn Cod.r Thc Com@'ofs Li.cmc Liw der nor artly io d 6qm, oa pr6ncn, who hilds 6r inpruv.s rh.r.on.
<br />znd who ontmcls for slch IFrccts sith ! Contzcro(9 lt..ed puBua ro rhc ConrEcrols Licene L!w)
<br />I mcrcnDr u'(cr SNt-,"*/u ioi -4.&
<br />DECLABAIION
<br />I h.,cby {flirn und6 F.ahy or pcrjury oft of rhc tolloeiff delsnriods:
<br />-lhavcMdwillmi
<br />ninuCeniric .olConsctrlloScllrnsurct{,rsorkcN conrpcnsarion. as rmvidcd fo.l,y Sccrion l7lr0 orrh.
<br />hh.r Codc.l rlt rcrLrnnMcc olthc *o lor whi.h lhc ncn r is is\Dcd.
<br />I hrvc rid willnrinr'io sdrkcri conpcisrrirn io\!6ncc. ns rcqlircd b, Sccrioo.l? )otrhc hbor Cod.. foi rhc p.rf()lruRc of
<br />rhc $ork fn uhi.h rhh p.mir i( icsk{. My *ort.B .uqrnqrnn, i.\!tunl..rEic, !fi1 Fli., nxn$.r e.
<br />btcnilylhal in lhc p€rforMmc oarhc work ior vti.h lhh lEnnil h issud, I shlll nol cmploy lny r.rsn in any mnmr
<br />$ trs ro t sm subirt $ rhe eoA6s con{Ensaiion lnwr of Calitorna!, lnd .er $!r if I stEuld bcem subjsl lo lh.
<br />sortc.r'conlxmrionpoviihBofSdion1700olrhcL$orCodc.Idalltonhsifi@nplywithllb*Imvisior!..
<br />WARNINC: fril!rc ro surc workcn'compcn\alioo ovcruac bjccr .. cdplortr ro aion.d Fruxas &d
<br />civil fincs uI ro onc tundrcd lhousand d.ll.rs (SIoo-UX)). in 6ddil r. rhc cosr of comNnsarion- dr,rogc\ a\ pn,vidcd lnr rhc
<br />rhc libor Cdc. inrcrc( d
<br />4
<br />I lrcEby !flim uidar Firly of Friu.y 0[I I @ lh.nEd uftlq pllvilion ofch.prE I (@i@6i.s wnh Scibn ?0(J0) or Divilion 3
<br />of lh. ABifts dd PtufBioB Cod...rd my li.cN k in tull foE &d.llftr,
<br />caxsralsloNrllDtNci!(llcr
<br />I hcrchy afinn oi cr Fnalr, or rdjxry rhrr th.rc n n conrrtucr ion knding asctuy ror rhc Frro.tu.. or rhc wdrk tu which rhi\ tE nil is
<br />h\ucl(S(-^ 3rr9r, Civ C)
<br />APPI I('ANT D[(]I IRATIoN
<br />Itmh,dnnnru drrp..a[yof trrjuyoNolrh.rdk)srn8J.rhrrrn \
<br />t).nxrliri{r ltcirnik A$c{os Nori,lcrrnri Ftdcrrl Rrg!hriotr\ flirl..l0. P3n6r
<br />Rcqun.d Irrr.r of Norifi .di,rr
<br />-l
<br />ccnif, rhlr rlE fcdcrrl rcsll.r ions rcBddi.-q lshcsros cnnvrl N nor .I,pliclbk ro rhii ,rtuirt.
<br />fi.oriry rr', t r'"," *,a ,r* eppltsrion .id sltr $d rh. dhJvc intonrDri{rtr is cor.cr I oer{ ro comFly wirh all Ciry and Cou.ry
<br />;rdinr.t\rdrlSrrtt'$s(lrrin!krhu,ldirB aJrl hrby r h.n2.rpr.\cirrlircsof
<br />abvc nEnlioncd pmrcny lor inspcrl
<br />Appli(anl or ,laenl Si*nolu strr Beooa-.-.,
<br />::au:
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<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 />Rough Plumbing
<br />Final Gas Tesl
<br />Meter Release
<br />FINAL l.l1-t0..Dcs*b @v)
<br />Notes , Bemarks, Etc.
<br />DATE
<br />I cr,L,l \ A,lJ'r$
<br />Back Flow Device
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