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PLUMBING-INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER t}EI,CARATION
<br />I ltchy rrlirm undcr E,Mlry {)l F-rjrry rhrr I n r qc lll ln,or lhc G nru.r,E Liccnsc Lrw for rhc iollowin8 rca$n ( Sc. 70l l s
<br />Busircsr trrd Pnrfcssid Codc): Atry Cil, or County which rcqunc\ n lcr.nir lo sn{tocr. ulrcr- in,trolc. dctu'li\h itr rt'n Jn,
<br />nrucrurc, pnorlo irs i$uuncc. rl$ r.qunc\ llMpplrlnr ta, suchpcrnir k) filc a \igncd i r. f, r rhd h.or \hc i\ li.cnscd t'ursu.nr
<br />u rlr flovi\ions olrh. Cotrkr(rols Lidnscn bw (Chrptd 9. ComnrNnr-! *irh S.{rbn 7(XX) of Divi\h.I ol rhc l}urircs rnd
<br />Poic\snnr\ Cod.) or lhar,r.tshc irctcnrpr lhcrcfrom d rhc h!si\ turhcrllt!.d.xd rt'i,,r AnyrioldionotSarionT0.ll5byan,
<br />spplicanri(nrnrrnir\ubjr.^rh.dptlicrirn,r.iviltctrlryornor xncrh.n hvc hunnrcd iLlllrs(S5(t))
<br />L !s owtrcr ol rh. Imltny. or my cmphyccs wirh wrsc\ !s lhcn n,t codt n\,r i.n. will do rh. qdk d dr {(1m is ml
<br />inrc|ldd or oturcd tn qk lstr 70l,t. Burinc$ a.d Prof.\\i,ni Codc ]'hc Cu0krcrri Licnsc trs' des mr trpply b aD ow.$ of
<br />rfu pRIEny *lD burlds or inrmrcs rtEBn\ ond wn diE( {Eh tr ort himq lf nr h.r{lI or rhntugh hii or hfi own cnflovccs.
<br />I[)lidcd rhrr su.h impmvc E n *r nur inrcklLt .r oflinrl Lr slc. ll hoqcvcr. th. huilling or imfDr$rnr is $!l $idinoi.,r-
<br />ofconlhrbn.rhcOqnc!Buildcrwillhlvcrhcburdcnofpmvin-!lhalhcor\h.d ftn build ot nn rw ihc IFFyiy lnr ltE I'uqxrs oi
<br />-1.
<br />as o*rcr oarlE Fopcdy, m.i.hlrivcly conr.lcrh! *nh Lcn$d co.nadm ro conelrucr rlE porc.r (S(. ?044. Burim$
<br />ad PD6snn Codc: Thc Conrmtols Liccnsc L5w dcs mr apt,ly lo !n owtu, or poFny wh. builds or impmvcs lhron,
<br />a.d sh. .o ock fo. sh pojccrs Biri ! coitftt (s) tkcos.n luBunr rolh. co mcrols Liens L!q).
<br />-I.mcxcnrfl
<br />und6 sccr
<br />u1laf,E&i:.q0l4tBlara!
<br />D&CIrtMIlol!
<br />I hNbyrflirnundc. pc@nyolpdjuryon olthe aolowin8 dcclmlions:
<br />-l
<br />huvc &d sill nsinrain ! Ccrlifrsc.t C6n€ni 16 Sclt lnrlE ror polkds omp.Noriotr.$ pmvilcd for $y Secrion:1700 ofthc
<br />tabor Codc, for llr p.rfommc of lhc wort fm qhich lh. lsnil is isucd
<br />-l
<br />hivc .nd will m.inl0in workctr comDcnsrl ion insu,0rec. $ rcquicd by S(l tJn ]7lD of
<br />'hc
<br />rjhor Codc, for thc pcrfomncc of
<br />lhe wott for whi€h thk pcm l is tsu.n. My wo m ompcnsurion iNUBrcc.dienrld poli.y.umbcr m:
<br />c,"i.. 3e' k Fvtt"c)
<br />qztt 16k/ l
<br />_l ccnify rhar in rhc poaormtuc of rh. {ork ror whth rhii,,.nnil is hsu.d.l shllnol cmllo! utry rc^o. io aoy @&r
<br />m s lo t snE subirl lo rhc RodGl comtcnsalion h*s of Califoni!. aon !s@ th!! ir I sh.trld h.com subid lo lhc
<br />wo c( ompcnsor ion rmlhi.fls of SElion :lT00 of rhc ljtnr Code,l ihall. fonhwnh onply wilhll[s Fmlisions..
<br />WAINING] FoiluE to worc *orkcd oq!€n$ri.n covcnEc i* xnlnwtul, and shall subirl an cmploFr lo simi.al ,.rulrir ild
<br />civil fincs up ro orc tundrcd thouslnd dolld tSl00-0U,). in lddirioo !o rh. co{ ofconpctrsorion. dlm8es ar proridcn lor ihe
<br />Secrion l0 16 ol rh€ kbor Codc. inrcrcn 0!d drro@y
<br />1tz5/lb
<br />DEgLA.B{IIOI!
<br />I ncrch, llltrumjcr pcnrlrynrIltrjury rhr l,r li.cn{d und.r l,orkion ol'Chaptcr 9 (comnrncins qnh Sc.ri.6 7lxx)).iDivisbn 3
<br />ol rhc Bu(irr$ and P,ofc$ionsCode. lnd nryliccn* h in fulltorcc ud ctrd
<br />to I 7q.7 b
<br />7 tz5/th
<br />ATfIICIINI-DEII/AA.IION
<br />I h.R'b, lllnn undcr i'.nolty ofFrjuryonc oflhc following dcclaturions
<br />Dcmlirion P&nnrAsbqros Nolification r{dcnl Rcsuhtions ll hlc 40. Pan6)
<br />Rcquird tl(cr of Ndiislion
<br />-l
<br />ccnilylh l llrc lcdcralresulalion\ rcsadins ash.{os rcfrovdnre nor ipt'lk,bic ro rhis prejcd.
<br />AAtt.n iry rhd I h,\r r.ad rhis ,pl'lmti.n oxt sarc lha! rhc 0hove inr'orturnnr ir colmr I !sr.! ro c.n{|, wirh nll Cily an.t Counry
<br />ordi nc$ $d siarc ljws E[(ins ro buildins cotr(rucrioo. nd tcEhyaur,kri2. rcFc*.rarivcs olrhis Ciyrnd Counrtlo cnrqulnn rhc
<br />rh)vr rnri,n!.d pn'rcnt l i'l
<br />Appli€nt o. AE€n( Sign{lu 7/26l /b
<br />I
<br />UNDEH GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/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 />Back Flow Device
<br />Rough Plumbinq Ve /rt ,D frl,
<br />Final Gas Test
<br />Meter Release
<br />FINAL XfiEnv 9\ 66
<br />Notes, Remarks, Etc.
<br />6l26/th
<br />coNllBucllalllE DlNc-{aElcl
<br />I hc6hy olnnr u.dcr FnalryoIl}ciury thrt lhsc h ac"trnrucliotr hndins lg.trr lor $c p,rLrmmc olthc wotk for shich rnn pcmn h
<br />hsudd ls.t 1097, Ci!. C.)
<br />Lrndcl\ Ndm
<br />-
<br />tdd.rt Addrs
<br />-
<br />Tub/Shower Test
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