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PLUMBING.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS ()1!NI':T AUILDI'R DT:I-CARA'I'ION
<br />I h.rchy aflirnr undcr n.Mlry nlncrlury rhd I r cx.n,Ir fft,o rhc (-ontrrcloB' l,ic.ns. Lra ror rh. hllostrr-r r..sr(Se70115
<br />Ilusin.sc ind l'roi*sion (-dle) Any C y or Counry $hich requires n pen,ir lo c.tr(tucr- rlr& imrm!.. d.mol'sh oi rcprr n')
<br />dtucrurc. nno! ro irs hqancc, als rcquncs rl.a sppli.rnr fo! suchIlcmir ro fil.a risn.d s,c,n rh h.orshc G liccn$d nur$anr
<br />t, rlr nrevRrnr ofrhc conrroclors l-ic.nscd Law ((hrpr$ 9. co nneflrn! wirh Secrio 70Ol) olDilnrrn I ofrtu Bu3incss iid
<br />Pmn$i{'ns (,rlc)orrlr'n n(orsh. Fcxcmnr rh.rclro ond rhe hasis lbr rhe allcscd .rc'nribn Anyvk'litonofscdlon?0ll5hy.ry
<br />amlrrnr 6. i lcrm'r rublech
<br />'hc 4,tlicanrroiciv'llenalrydrmr xtr hrn fivc hundreddollirs(s500)
<br />l, .s ownd o ft he rml].ny, or my .nrployecs qrh wiscs .s lficir sll. onl1.n$lon. nnl d\r rh. kdi .nd tlr slrulu. js d
<br />mr. J.d orofter.d for slc{sfr7M4, auetusr rnd Pmfcsrp* cd.: 'rhe ContEdois Lccnse taw (h.s ml .nrly to an .(rcr of
<br />rhe pmFe(y qh. buil& or rnDn'v.s th{6.. afrl sho don nrch k,rt hnnscll.r htrelfo.lhn,u8h hi.r tur oM.6tk,r!.s,
<br />povded rhol nEh impmvdrcnh uc mr inreiddl or ofieEd lor $L. I I trwcilr. lhr huillms or irryntrnr is sk! wr[in .n. ,eir
<br />olonDlclior lhr()Nncr tsurldd srll h.vc dD hn!.n orr.sns rhx' rE or sic dd d huild.r nqmrc tn. pmpdy for lh€ rdqn*ot
<br />_1, rs 6Bd ofrh. popcny. e .r.lurively.oru6d in8 wnh lia.rd onrEctoN to onsiruc[lE pmF.r (Sc. 7044. BlsiEar
<br />and Potisbn Cod. 'l h. Co l.tcrol3 Lic.Nc Law do.s mt aDply io d ovncr of poD€ny who hu'ld. or impmv.i tn r6n.
<br />and who 6 *r$ tor$.hflrierseirh. Conlfrcto(o lien*d,,uMir lo rh. Conlracloa! Lic.ne t w)
<br />-l
<br />m .r.nrr uid.r S6rion- B & P,C. lor lhlr Bron.
<br />-
<br />omc-I OIKEiS'COMPENSATTON
<br />D&CIdSATqN
<br />I hEby .lIm udd p.ulry ofDojuty oE oftlE blbwhg d.claarhnr:
<br />-lhiveand{rllnri'lrrna
<br />CM r ncd. olcohrcnt kJ SLlfln\urL fir sorkcB-conrpensrion, !s pmvidcd f.! hySccri{iDl?{)0.fr1r
<br />I xrr cde. for rhe pcrlomun.e oflh. *ork r.r*hi.h rhe n mrir h Fsued
<br />-!
<br />h.v. rd wiu minl.in w*sr' comp..srlion imhftq nr r.qu&n by Sation 3700 o f lhc L.bor Cod., for lh. dhmnc. 6f
<br />p.rmn is hs.d. Myvo,kdi smr.rslion ins.anc. cori.r EDd poricy.umb€r m:
<br />^-s€rtl)c>t37o+o \.\.\1
<br />-l
<br />c.nif, thll in rh. pcrfo@@ of rhc work tu whch rhh p.rnn i. i..ued.l shnllml mploy any p.mn in 6ny nanEr
<br />m osro 66rc rubl.cr to rh.wo*d mmp.nmrion lawofc.Lfomia lnd osR thlr ifl snouE h..oft b.idr ro 0E
<br />m*n' comp.r$lio. ,,ovisirB ofscclion l7O0 o{fi. bbor Cod., I slsll, fonh*ilh comrly wilh lhos tDaiiiod .
<br />WARNINC: Flilurc to surc *odim oDpctrstlion mv@sc ii unlawtul. and sh.ll tutjd an mtlottr lo crimiMl Fmllir and
<br />civil fin.s up ro orc nu.dr.d rholsnd douats (5100,m0). in sddirion ro th. cofl ofcomFn*ro., d.m8.r 0, ndvidcd for lh.
<br />Sdion 1076 oflh. L.bor a)d., inlcrcst and atlom.y s fes.
<br />,",.110V I 5 20lg ^,,,,""",,
<br />I h.Eby .IIm uodn FBliy ofFrjury lhrl I 16 lie.rd unrt . ,'rcvi3io. ofchaptd 9 (oidmiig ,nh Sdion 7000) of Divi.io. 3
<br />of fic Buli.s a.d Pof*ions c.d.. ad my lhcne i! in tull foe dd c,Icr.
<br />{}\oo<a1 Ac
<br />I 5 20t0
<br />g)NIAUCIjoNI.}:NDI!G-ACIDC.T
<br />I ncrchy allirmnnder p€nahyoip.rjuryrtsr rhere R! clrndrcti,,n kndiflrr asc^--) nn ih. noforrlhnc. olrh. work frrr which lhn |Ennil h
<br />iqsucd (S.c 10s7, Civ C )
<br />AIILICANLDIiCIAAAITq!
<br />lhad'yailmundcr pcnalty of pcrjury one ofth. folkrwiry dd!nlioni:
<br />Demo lirion P.rmirl^sb.{os Norilicarion l'.dcnl ReEUlarions (Tirle 40, Fan6)
<br />-R.quncd
<br />L.rtcr olNorifieli0n
<br />t c!i'fyrld rhc fcderi|rcsnlxro sftgdl'n8 ish.stx rc,noral arc hor trlnLMbl.h rlnsrmrec'
<br />.-l(dtrrhirllu\cR.JdrhFimlr on flxl nrcrlN rhe.tnve inhnNM i(comcr I xsrr ro snrnl, wiri f,ll cir, rii couhrys{drntrnc€. ind \arc Lan! rchr'n! ro hu'ldrn! ct 'nnd'nn,0n1h€reiyourh.riTf,r.p.erDrr!'r.s(,lrhnCnyannCounrytucnrdulonrlEabv. m.mion d DmD.ny lor iBnc.lion purD.*s
<br /> ppli.onl or Agrnl Signnlur.
<br />ilov I 5 20ts
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />ater Piping
<br />Gas Piping
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipino
<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 Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL Ll3/l'b ,b #{
<br />Notes, Remarks, Etc
<br />APPROVALS
<br />Waste & Vent
<br />Roof Drain
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