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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.oWNER BUII-DEII DEI-CARATloN
<br />I hcrchy 3tlirn uftlcr Fnilry 'l pcrju,y rhnr I am cxcnu fbrn rh. (bnnrtus l-iccnsc Law lor rhc following r.,wr (s..?0.115
<br />Busincs\ nn Pfl,rcsi Codc) An, Ciry or Cou , qhich .crtuncs . !..nir 1,, consrnrcr, lllcr. inrrotc. d.nxnish or ri,'rn jtry
<br />nrudurc. prin b ns is\uan... rl\o 6qunc\ rhc,rpli(lnt tu {rh rcrnril ro filc a sisncd shrcnEnr thar h. or shc is li(cn{d nu^;.un
<br />rorh.,iovh(,n\.lrhtConrrcttr\l-iccoscdttr'w(Chaprcr9,Co.rcncn,B*ilhScdion,O(UolDivisn,nIollhcBu\nr$0nd
<br />holc!\ion\ Codc).rrhat hcorshc iscxcnn rh.rcftnnand rhcha\i\ nn rhc rllclcd crcnprinn Anrviolarn,nofSarion?0ll56yany
<br />.pFl,.rd ftr a Fmir ttrbrr.r\ 'h. trnpliconr ro rcivilpcnilryoinor nntrc 'h livchutrdrcddollan(s50o).
<br />-L
<br />ss owrB of rh. Ir$rEny, or ry rmployei wilh sre.s 3. rhcn $k omF.slio.. wil d. dx *o't s,n $. slrEIm n nor
<br />inrcndcn or oniEd fo. sk (Se.7lx4, BNim$ ,rd PiofBrions Codc: Tnc ContEcrois Li.cn* tis do.s mt appl, lo !n o*rcr of
<br />th. Irltdy Dho hdildi or ir{mws lh6er a eno &Es Mh ,Drk him*ll or txrklfo, $rcu8h hh or he, owo .mtlor*s.
<br />pmvided rhd rkh ioFo\ftits d ml itrLndcd orotrcrcd for sL. ,l howEr. th. hoihinS or ntpbwnEnl is $ld silhin om Fr
<br />or cotrpLraon. $€ Owtur Blildr will htrE rlE hlnl.n 6f rs\in8 firl hc or slr dil mr t{ild or nq'mE thc l,oFrry for lhc ,Ioeor of
<br />-1.
<br />as owM ol rh. !mp.rly, !m cx.lusively cofirading eilh liensd ontturoN ro onstrucl rlE pmic.r (Se. 7044. B6inc$
<br />ard P,trEsion Codc: Thc Conrrsrolr Lkcns. hw dm3 nd !!nly ro d osno of proFny wlro builds or improEs rhmoil.$d who @ 6.r.lor seh !rei*K wirh o Co reto(s) licnrcd puB6r ro rh. Conrreroas Li€n$ (iw,.
<br />-l
<br />an.x.npl u.dd Setion- B. & P.C. for lhir it&n
<br />Dale: owmr:
<br />]4OEf,EXE.TOMTENSAIION
<br />DEqI.ABAION
<br />t h.Etry emro undcr FD.lly of Frjuy onc of thc follouing drbrdioN:
<br />I hrvr nn *illftrinr.in!CcnilicdcofCotrsc k, Sclf l' urc nr workcrr ro'n8i\rrirnr, as prcvn[d br h] Sr{rion :l7rD ol rhc
<br />lf,bor (odc, for rhc Frrbrmincc olthc $olk ior *hi.h rh. Frnrir n i\\&
<br />_l hsv. .nd will @i.rain m,t6 snpens.tion inrlraftc, ei rcqun.d by Section l7O0 of rhc kbor Codc. for rhc l]gfolmre of
<br />thc wort for *hjch lhi! pcmn i. hnEd. My sdls mqrnslrbn inrurlne @i6 en poli.y Nnh.r dc:
<br />c""r. !4rdr.!rfF CUS' Lhs.-
<br />c
<br />-l
<br />ccnifylhar h lh. lcrformrc ofthc qork {or which lhh F nit is iss.d, I shrll nol cniploy any pcMn in ony manm.
<br />s !s lo b.com subixr ro thc vortsd conqEnrarion luqs of Califo,ni., .nd asft lhir if I should bccoft subj.ct
<br />'o
<br />rhe
<br />vorlcB mmpcnslioo povhiong ol Serion 3700 of rh€ Libor Crdc.I dEll, ao tsirh omply wirh ttFs povhions..
<br />WAINING: FBiluB to surc rorkc6'.omp.nsalion .ormgc i\ unlnwtul. and $,]l subjccr nn .mplorrr ro aininal lxehi€s and
<br />cieil nnes u! lo orc hu.drcd lhouFnd dolles ($10o,fi10). in rddkion ro rhc cosl of.onp..sdion. dame.s rs trcvid.d ror rhc
<br />Sccrion 3076 of thc Llhor Cdq inlcE( lnd dromy s lt.s
<br />*",JULIS 2{ll$
<br />I hcrcby dlir undc. tc rlrrofp$jur) rhrr I ar licctrsl of Chaprcr 9 (@mncinB eith Scrrk n 7000) o( Difision l
<br />9.lwlga
<br />?4..".
<br />SOISIAICDON.LENDINCIIiEIqT
<br />, h.rcby rmnn under Fndty of pcdury llBl thcrc is a cons{ru.tion tRli.8 4cncy ror thc Frfttrmnc. of lnc wort for whict this p.mil i,
<br />hrucd (S(.:1097. Civ. C.).
<br />AIILIIANI.IIECI,ABAII!]N
<br />I hc,.ty anim u.dcr pcn.lryoiperjury onc oflhc lollo*ing dRlararn,ni:
<br />Dcmlilion Pcn rlAsh.ios Noriicrrion Fcdcral Rcsui.r ions (Tnh t0. Pan6)
<br />_Rcquircn kncr of Norirurbn
<br />I .cnify rhrr rhc ac!€ral esllarions Esarding asbcsros Ermval aE nor .p!,lkst h lo this tDirt.
<br />Gllfy rhar r h!'c rcid rhis oppriclr
<br />ordimnccs.nd Sl c tiws ElalinS lo bu
<br />rt{w mnrion.d porcny lor iBpcciio.
<br />ion .ln sl.l. thal lnc orc inrorMion is co,Et. I 08rs to
<br />ruffiur'#:fli{'1f
<br />Apdic,.l or t*enr slrnllurei 9a\.
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterce ptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<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 />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewericap
<br />Back Flow Device
<br />Rough Plumbing 4"/eu/(,sA6{
<br />Final Gas Test
<br />Meter Belease
<br />FINAL b/2-?tY >\97
<br />RemarksNotes , Etc.
<br />COMMENTS
<br />Gas Service
<br />l.\. \n
<br />or rhc Bnsi.crs aJll Pmrcsrk,n\Codc. ud nyliccns is in tullforccutcficcr
<br />*'dtI[-
<br />F
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