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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<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 />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />[\,4ain Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />RWL.trp,"lFINAL4LAt4 fa)
<br />Notes, Remarks, Etc UI \
<br />o o
<br />OWNERBT
<br />'LDER
<br />DI),CARA l.ION
<br />I herehy annm under penilly of ncrJury rhrl I mr eicnrpl lmm rh€ (onnad.u'Liccnse L * lot lh.,nl[Juin8 rci$n (S(?0]ll5
<br />Btrsncss n tu'G\su Cd.) Aiy C v or c.!nr! whrh ..qur.\ I !.rnn t' .onntucr, .lter, inDro\c. dcmlnh o, rqtr anv
<br />*ru.turc, nri,n b ni 'siurme..ho.cqun4 rh.,!plr^d rnr{ch lem ro nlc r nsrcd shrcmnr rnar lEor shc n I'ctnsal pumtnr
<br />lolhcDmvhioniofrh.ConrrldoasLic.hsedIr*{Chapr.rg,(}nm.ncliswhs.crion7000olDivhonIoilheBusEsand
<br />tmre$nos Code)orrhar hcorrhe 'reremtrrtu.efbn Bl rh.nans ntr rhcall.rcd.x.nrptn)n Any ,l n,nofsecron?0ll5hyinv
<br />aptlicrm tur.led iuht.hrh. infltr.nr h a.rvrlren.ht.lnor mrrrhrn firc hu.nr.ddoU0F(5500)
<br />-1,
<br />ar owner o lth. rmFny, or nry cmp!.rt.s wnh was* I rh.t *rc onl'etrsrion. w l do lh. wo* and lt nitl@ h mr
<br />idend.d 6r dllr.d foi sl. (s6 70,11, Bu.im. dnd Pmi.arioN C6d.: l h. Conrrdoii Lic.M L.w doB ml lpply lo an ourer oa
<br />rlE pmFny wln tuil.Li or iqd6 dE6l\ rnd sho d.d nrn ed. hin..lto. h.elfor
<br />'hruuah
<br />hir or ha o*n .oplottd.
<br />Drcvid.d th.r $cn rmFmwlnimmt hlqd.d oroftftd lnrBle l[ 1F{@, rht toildi,u or in{,mwMr isFldwirhino* r*
<br />of6opl.liol\ ih. Own.r tuild.r *ill IEE lh. budn oapovins llDI h. or *lE did hl luild or in{iov. th. pDpdy lor rn purF*of
<br />_1, Ei owE of rhc I'mFny, m .xclu.ivcly conrr.crif,s *ilh tic.B.d mnrturoB ro 6i!^d llE prejd (Se. 'rM4, Buins
<br />Etd Potsion Cod.: 'l'h. Conticlol! Lic.os Lru doca nor.prly 16 uow..r otproEnywho builds or i potsrn.rs.,
<br />and who 6nr6ct' aor sch pmj.cts with a Contmdo(9 lic.trrd prm.d lo rh. Contnctol! Lic.c hw).
<br />_lMr.x.nfl und.r S.crnrn .lt &PC lo. rnis Ea{rn
<br />.!a8trEBS:CO!If.!:!SATIA!
<br />DICIASAIIOA
<br />I h.cby amrd und.r p.illiy otpr.j!ry om oflh. following d..l66tioN:
<br />Irho.( c. lnrrh.Jicr]itroxf,c. o,0r $frk lnr(hLrl, rlrn.nn N '\!,r(t
<br />_l h,vc .nd will ori.tiin work.B onD.nsalion irsmmc. as EquiEd by Sd ion 1700 oflh. Lthot Cod., ror lh. !.rfomdre of
<br />llE mrk lor wnich lhn pdmil i! hs.d. My wortd omp.ns.lion insutuN @ni.r a.d ,olicy nuob.r @:
<br />l'.lrt Nu rlicr I \th\
<br />-l
<br />c.nify rhar in rh. l.rf.ifuEc ofrh. work f.r shkhin,. p.md is issu.d,I sh6ll ml.Dploya.yFNn in.ny ftanN.
<br />s m to b.em wbidt b rn s*6 comp.nslion hsi of Cllifonia, &d alr rhat ill stsuld baom sbiet to tL
<br />mrkeC sq,.ns.tion pmvhiotrr .f sd ion l?00 .f th. L€hor Cod., I iDll, |.nnwnh smply wilh rhos pmvision(..
<br />WARN,NC: [.ilur. ro wac srk.n' mmp.ret 6v69. i! unLwtu!, 6nd shall Nbirl s .qrlotd to GioiMl FMhiR,nd
<br />civil fio.r !p to o.. hndEd rl$usnd dollffi (rh. ssl ofcomrlcncdiont damig.. as rmvidd for lh.
<br />Srrion 11076 of rh. l-'hor Codc inr..d
<br />I heftby oflirn under p.mhy o lr.rjury thot I lnr licen:d vkion of ChqId 9kooo@ing walh serion 1000) olDivhion l
<br />of lh. Blsinss and Pefssioa c.d., rd ny licN i n tuU fom ott clrd
<br />I h.Eby.mm und.r n Mllyoftsjlry$al
<br />isfl.d (Se. 3097, Civ C.).
<br />Lr ! @ad crion lcnding .g.my for rtE Ffo,rum. of llE *!* f.r whkh rh'r ldmn ir
<br />attuc xfDl:ctaBAuo!
<br />I hdrl,y amm under p.nnlty of Frjury om ol rh. lollowhS d{lral ions
<br />D.nn nn P.rmih Asht k's Norificdlon licd.ml R.euLl ionr ( r ilt 40. P.d6)
<br />-Rcquircd
<br />Lctl.rolNotilicarion
<br />I .dr ly rhor dr ftdcr5l rcgulalioB Esardrns ashdtos r.mval ar. ml orDlicabl€ la this poj..r
<br />a.d Coury lo .nl6 utsn tlE
<br />Roof Drain
<br />Miscellaneous
<br />I etrdcr \ 4,i,1.6.
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