|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTSID/SIG,
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<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 SewerfCap )12-ll-ls YUt1t,
<br />Back Flow Devi#u
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL l4F11
<br />Notes, Remarks, Etc v
<br />O\\ NI'II 8U I I,DER DI]t,CARAI'ION
<br />I hcrehy.mrm under pen.hy ot p..Jury rhar I am qcmtr lnrm rhc ContrcloB l,'.enrc L.u' tu lh€ n'll'*'ns rd^rn {S.t7oll 5
<br />Brsine* ind PR,L$on Cod.l Any Ciry o. Couory s'hich r.{tutres r p.rD,ir nr &rn{tucr. alr.r, inrpmrc, dcmlish or Elatr lnl
<br />nrucxtr . nnorlo irs Rsrtrc€. al$ rdfrtrcs rhe rpplEinr ftn s&h p.mn h fil.asi-!trst ndenrnr rh h€orshc n lic.n{al ,rtrsu^.r
<br />b rhe nn)visionr oldr Conlradois l-lc.nsed Law (ahrfler g, (innm.ncins r h sccuon 7000 oi Divisrcn I olrhc Bu\nPs ^nlPn,f.s$oni Cod.)orrh.l h.orshe tcx.nrpr rlEr.fnr drn hisF nx rhe ill.*cd .\.nruon Anylnhrion.rser.nT(r:!l 5hr.nY
<br />rprlrconr lor o,'c.!nrr suhJ(k rhc artl'ci h ac'v'lrcMlryolnor rmkrhrh five hlndr.ndollors(S500)
<br />l. rr orvns .lrhc prcI'cnr. or ry . rtroyNs { iih {nscs N rhcrr $1. cotrEmarion. \nl d. lhc *ork and rh. N tuue s ml
<br />'nr. kl orof.r.d nr $1.(Se 704.4, Dusressrnd lmlern.ns(od. l lE cirnt,crorr Lrens. L.{'do6Nn irdyx)in.*d.roi
<br />rhcpmlcny tr tn hurds or mptrnE rhsbtr aJxl $hi dNs sch q! hnn{lf rhesell.rrhnushhnorh€rorr.mnlo!..q,
<br />pn*dcd rhd su.l! inlFoEnEnrs arc rr mr.frl&l o lTeB! nn sil! I ( hN(r, rh. hu'k!'ry or i'htn,vcnf,nr ie sil u irh'n.n. ,kr
<br />ofs rnlcro( rhc Ownd Burlder urll ltrv. rh. hutrl$ of nmvns lhd h. or shc did nr huikl .r impn^t rh. Dmncny lor rh. NrIx,* of
<br />I, m owr of rh. pmpcrly, M €xclusaEly conrerins wnh l6sd onhcroR ro coNrrud lne pmJ..l (Scc 71N4, Burircri
<br />rnd PbEili.o Cod.i 1h. Conlr.clol! Lic.ns L.w doB nol .nrly lo .n ov..r o f F.p.ny who blilds.r impmEs dr.roi.
<br />snd wno onhcrs for such poJek wirh 3 CoirDcro(, Ii..tr*d pu,Md b lh. Conlr&1dt Lietr* L.wl
<br />I m.r.DDt ulds S(lrcr ,B &PC hrlhEEosn
<br />WOfu(ENS'COMPENSATION
<br />lEq.a8auqN
<br />I h4b, .fiirm unds p.Ehy of pdiury oE ofrhc followins d(l@tio6:
<br />-l
<br />h,vc nl$'ll 'tuihbin.ccdilc c.fconsenrlo self'lncure lir. $o'k 6a .onr,).nsar ion, is nNid.d forhyS(rion r7mof rh.
<br />Llhr codc, i{, rh. p(fttrmmc. ofth. wolk n whi.n rhc r..nnr a issu.d
<br />_l h!v. ..d will m.inrain wort.. oDp.trsrion idtudtuq .t cqun.d by Selion l?00 of lh. Llhor Cod.. fo. th. p*foltr1m. of
<br />rh. wort for s,fiicn rft ,.mn is is.d My rcrl6 @mn @rion itrrmm. fft. .td F,licy nunbd 6.
<br />-l
<br />c.ni,) rlRl in th. perfo!,Nm. oflh. worl( tor which lh! p.mn h hfl.d.l dEllmt cnploy lny nctun in aoy mtnkr
<br />s ar ro b<!e tubj.rt lo rh. mltm 6Dp.mli.n l,wi of Crlifomi., nnd asE thll if I sJbrld h6m ubj.rl to th.
<br />eri6' coon.dr on nNvnio$ of S..tion 1700 oflh. Ijt rCod..I stsu, fonhsith omlly wnh rt6* povirio$..
<br />WAlNlltG: l..ilurc ro sw hrkd'@np.tulrion er.ng. i! unlawtul. 6rd slElt $bl..l !i dPlolq lo diniBlFrlil.id
<br />.ivil nm! up lo oE hundr.d thownd &,llaE ($IOO,OOO), ii addnio. ro thc.or of md{E@tioq .lr@3!. ti pmvidcd for th.
<br />s@tion10?6otrh.t bor Cod., i.l@d.nd aftonty! f.6.
<br />llcl:!$lr-c0NtMcr0a
<br />DICI,ABTIIAN
<br />I kreby.ltirmundd nenollyofpeljury lhd I tn lienqd xnd( Isvisnn of( h$t.r 0 (..mm.ncinr {nh s..rion 7000)olDivision:l
<br />.f rh. BNiher rnd P$fssions Cod., ind 'nr lic.n€ h in tullforce ard€n cr
<br />CONS'I'RUC]ION LI'N DING A(iI]NCV
<br />I h...hy afiiri nnd.r I.Mlry of nnju.y thit thd. ic a snslrud ion l.ndins aglrcy lit rhc fdfonntR. ofth€ q'otk tu wh'.h rhir P.nnr s
<br />hsud (S( 3097.Civ. C.).
<br />AllLlcAull[clAsarlox
<br />I hdlb nflimundcrD.mhyofp.rjrry onc olrh. nnk'w'.9 de.lnr.rions
<br />D.nxnnion P.r6irr'Ash.slos Notificalion Ldeml R.sulllnrnr ('l l.40, I'td6)
<br />-R.quked
<br />Lctr.r of N.linclnon
<br />-l
<br />ccnify $or rhe tirl.ml ,G8uldions rcEordins ssh.Ftos r.nmval nre nol amlicahle ro thi t'mj{r.
<br />-l
<br />cdiry rhar I l[v. Esd rnis dppliqtion ad nlr lhar th. alrE inlomrhn is coEc.l. I lse lo on ly wnh !I Cny !d Counly
<br />ordiEnce and Sht. t5* Elaurs ro blihing coE<n.rioa dd h.r.6y rull[riu rcpEs.rl.livd ol thtu ciry r.d C6uty to 6Lr upor th.
<br />abov. mntion.d pmrcny for i.rFerion purt *(
<br /> ppl,.. or Atar Sl8naiur.:
<br />]IEff'I
<br />TOP OUT
<br />PolicyNlmbq:-E ptcsl
<br />L.nl.' s Addrecc
<br />-
<br />P.r,{n. n!n. (pdEa):_
|