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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<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{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 S prinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL I'tJril(l tr)64
<br />Notes, Remarks, Etc.
<br />l, ,s owBr oalh. lmFrly, or ny cr'rloyrB wnn w68s Lr lh.n sk omF ralion. sill tlo ll! mrk ad rh. llnel@ d ml
<br />i{!id.d or ofsd lor sl. (Sd ?044, BuiE , a.d ?of*ioN Cod.: Th. Co.r.ddt l,ic.B lrs .L'6 mr ,pply to an owr of
<br />rn pmFny whn hnrLs or iE{,bE ttrmtr lnd who &6 sEn m* him.lf or lEmlfor llwush hh or hd oq .nl,lortfl,
<br />p6viG 'h!l ch inl|,e!k@or.e mt i ad.dffoitr.d f6r sk,l[ I'offi,0F buildin3.r inpowm hsEvilhinoftr@
<br />ol@rloldion, tu O*rd BuiBd pill lar $. hrdd oftmvin8 thd h. or sh. did m hild or in!)mE ilt. pmpdy 6r ItE rrrpos of
<br />_1, E owM of rh. ,rcpdry. o .xclu.iEly o.rradire wnh lic.Bd codradoB to odnEr rh. pmj.d (sd. ?044, BuiB
<br />and Pmision Cod.: Th. Corlrrcror'! Lic.nr Llv do6 ml lpply ro .n owEr oftNlcny wlD buildr or impmk3 rh.rai.
<br />.nd wto @fl@r t r $ch pioi{k wirh a Coit6do(i) lic.Bld purulr ro r,E conrDcrd r Lk.k L!w).
<br />-l
<br />am.x.nrt ldd s6lion-. B, & t.C. for rhb EMn
<br />EABf,SBIi:IAUIENIAI|qE
<br />D[C!.A8Auj]N
<br />I h.r.by .fllm und.r F@lly ofFdury oi. orrh. lolowins dccbotion!;
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<br />havc ed will @inr.in a Ccnrfic.!. ol C.$d (6 s.lf-lnore for workda onpo$lion, r. povid.d for by S<riot 1700 of U.
<br />Lihor Codc for lh. Ftommc o t lh. e* for shici llE ndnil 6 isacd
<br />_l h.v. and will mlml'm {ork.n' c.nn.ns onin$Ence,ds r.quiEd hySalion ]?00 ofltc Lobor Codc, fo, th.,.rforun.. of
<br />p.mir i! is$.d My work.B omtl.cdlio. iosumN. crEi.r ad F,licy numb.r &el
<br />BNJ"tco t96P
<br />I ccniry lh.r in rhe pcrformrc€ ofrh. so* fo! *hich rhh r..mit h iiucd. I shallmr cdploy.ny pcmn in rny mann.r
<br />$ !s ro lr@e sobjc.l ro fic e*6 @n Eosiion lowi olcalifomir. aid ,gB ihd ra l fiould beoft shjNt lo lh.
<br />h.l6'comrENrionpmviioNofSerionl?00ofrhctiln.Cod..lCull.f.nhwirtoq,lywilhdrErmvkbm..
<br />WARNING: l'arlur. to surc workes' comp.nsation cov.m!. is u.l.wtul, and shlll Nhjd an mplors to mniml p.mhi6.nd
<br />.ivil tnrr up to orc hundr.d thousnd dolliH (S100,m0), r
<br />Sdion 1076 oalh. tibor Cod.. inls.{ !.d.non*y 3 fes
<br />n iddirion Io rh€ cosr of
<br />Iov 1 5 20t8
<br />u:Llr.B.rr.Itt
<br />IhcEbynnnmuodcrpcnillyol,)e[JUrrrhrrInmI'cenk\lundcrnnnrsionol(hrfr...,l.ohrcd.,n8trnIStcri)t7l)rr(r)oil)'v'sotr
<br />.l' rtu Llunnc\s.nd Pmlc$ionsCod.. n'rlmy|cense N n tulLli)rce arlelle.I
<br />I f
<br />,"," Nov t
<br />colsrBrcuaNrlNollc-dclilcr
<br />I h.€by amrn undo p.Dlry ofFrlury rbd fic is . onslrucridn hiding "e.ncy aor th. pdfolmrcc of lhe work for whi.h rh'r p.mir is
<br />bw.d ls.c.1097, Civ. C.)
<br />a8tlLcAll-Dlg,aaauo!
<br />Ihdrty,fll6under F.nehy of lcrjury onc oflhc a.llowinS delamli.ns:
<br />Dcmlilion P.mils'Ash.,!o, Notific.lion l:.d.ral Rcrllarilns (l nb40, Pdn6)
<br />-R.qut.d
<br />Lerr€. of Norifi clton
<br />-l
<br />c.nifyrhtrt rhe fcd.mlrepl0rions rcgdiin! asb.,rosrennul e Dorrprhcihl.t, rhirpqed
<br />Ey'..dff-t dsr I hl\. rid rhr applrcrrmn iffln.r. rh.r rh..h.vE 'hf.nndion R corsr I asrR r. co!ry'ly *'ilh all Crry and counr)
<br />ordimhc.s ind sbr. L.wr ftlr.n! r. burldiry conntuc..[ ml h.r.byiurlfir. rcllrc*.hn\es olrhis Cnya Counrtn]enrdtrF,nrhr
<br />ah)!.nEnrnn.d pmp.ny lb' rnspcr n,n !r 4xre3
<br />AppllLnnr or A! r Si,ln8ru ilpt, I 5 zfiS
<br />I
<br />()wNaR BUtt,DUR trl']l_cAtA ItoN
<br />l h.rcby rfJn , und.r !.nrht of t'.rjuy rhd l . ex.mtrltuhdrcCotrlridotsLic.nscL.wr'orrhclollo$in8reosn(sccTolll5
<br />Buiin.ss rRl Professnni Codc) ny Ciry or Coumy which rdlut.s i Ddnril ro connrud. rlrs. imrrr'., dcmolish .r to ir .ny
<br />drucru.r, pnorro irs Fruame. aho r.quu.s rtc aPplicanr fitr uh p.mrr ro filc a ssn.d {nr.mcnr rhd h. or ilr ii liccnsed prN$r
<br />ro rhe pmvhns olrh. co tncrois l,rcetrsed L.w lch.prer q. Connncncir8 \'llh sccron 70m ol DrFrn :r .f rh{ Inmrnts .nd
<br />I'm fe(()ns (xlc) o. lhir lrorshe is.i(nrrlrherefr.trrrnd lhc h.!is lor ltu nllesrd cxrtrfl nn n, vnnironolserionTotl r hy iny
<br />apJrlicrnrlitra,Emnrsuij.crslhcanpl'canrr).cLrrlncnilrtofnolmorcrhrnnv.hu']dr.ddolhtr($5lxD.
<br />laAu,
<br />lad.i. Ad&d:
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<br />UNDER GROUND
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