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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNET AUIDER DELCARATION
<br />I hcr.by a0im und.r D..ohy ot prriury rh.r I h cx.mpl fmm thc Coir6clo6 Lic6r Low &r rh. f.lLwing ra$i (Se ,iol I J
<br />BNin.$ ai! Prefc*rion C6rL): Ary Cny or Counry whi.h EquiB a Fmii lo oncruct. .h6. imtmw. domlirh o. cfair any
<br />srEchrc p.ior b ns i!Mm., aho r.qliE rfi. 6r,pli., for $ch FDir ro fik s srrn d sr$cMr rhar tE o. dr b ltco..d Dum.r'l
<br />ro rh. ,mvirioN ol$. Conrrlclors Lic€n!.d t w (Chrpr.r 9, C.m.ein8 wilh S.crior 7000 oa Divi$ion 3 of lhc B!iin.$ ..d
<br />Pot sioN Codc) or thd h. o, CE i! .x.t!pt lh.E&.n rld th.68r! to. th..lLg.d .x.frplio AnyviolllionofS.sirn701I5by!!y
<br />.pplic.d ror a p.mn subjel3 llE applic.nl to ! civil p.mlly ofml mrc lh.n fiv. hlndr.d dollaB (S50o)
<br />-1.
<br />s owr of dE pop.ny. or ny .nplortd wit ore6 s lh.n $k on{Enr.rion, will do th. sut &d llr lrnrt@ a el
<br />inr.ndld orotr r.d Ior $1. (Se7044, ausiks Md Pmf.lsioN Co<k:'lh. Co r.cloCs l-ien* Lao do.s mr .pply lo !. ow.d.f
<br />rh. pispcn, wh6 hild! d i@rcc dE6c ltd wlE .lG *h ft,t hi@lf or l'.elf or itmwn htu or h.r ou.rplorE&
<br />povidcd lh.t sch iq'mrrEr e @ ftr i nxLd o.o,E!d 6r ek l[ holtr. d* t ildi.g.r iriibEnmr c $ld {hh,n om }o.
<br />ofQtrpkrio'! rlE O$rur Builda will hav. th. lrrd.tr ofprcving thar lE or shc dil ml brild or intooc 6c pmFry a.r th. purloF ol
<br />I, osowmrofrh.rmp.ny,.n.icllsivclyconiroctins pnh licnr.d conrtutoB ro.oa{md rh. pDjdt (sd.7044. Busines
<br />rnd Pmftsrr Code: l h. ConlEclor's Li..N. Law do* mr alply ro a. ow.r oflmn ny uho t'uildF o. imDroe.s lhron.
<br />lnd who contE lr for Nch poj.ds wirh . ConrBcro(, lic.nBd plBur1r ro rh. ConlEclor's Lt.trr bw).
<br />-l
<br />am.xcmpl und.r Sdrion , B. & P C. for rhis ,!&n
<br />lUOBtr,8SteOll8EtSArq!
<br />DEqdSAr!!)!
<br />I h.,cby amrn u.d.. ,,.tuhy ofp.rlury.E offi. tollo{ioe ddhnliotrl:
<br />_lhrvemlwillmainrrinrc.n'licdrolc.n*mbs.lflnsur.fin\orlcrsconrpensiridr.rsp()vided,i,rhySecri,,n:1700olrl*
<br />l.ahor C.dc. i(trrhcnurLmanc€ofrh.{o'{ lor*hichrhe pmnir N rsn.d
<br />_l hav. and willmadain workers conDensltion inflEnce,.s requircd by Scdion 3T00oflh€ Labor Cod.. for
<br />'h.
<br />pdfomMc. of
<br />tr'h'.hrh'rncmi F rN.d Vv wo, Ld r .o@.nrihn ,nqmftc cnn '.r indp.l() numh( &.
<br />'S]---L"- F"n^.L
<br />to ?-?r.{1 \\-l-l (
<br />-t
<br />cdiryrhar in rh. I,€.lormm..frh. work tor which rt( pernilr (fl.d,I shillno' cmploy.nyp.fon in ant ronEr
<br />$ a* ro b..on. sub.i6l ro rh. wortm'smn.tr$tion hw3 of Crlifomid, .nd nsc thlt il'l sh.uld b.coft $bjst ro thc
<br />w.** ohp.rsrion tmvieiom of S..lion lrl)0 of
<br />'h.
<br />L,b.r Cod., I stbll. fonhs'ith comFly wilh rtD* porirfB
<br />WARNINC: ljailo,. ro E.@ m*d' on{esrior @v.6sc ( lnhwtuL r .,Ell flbj.rr r. mph}lr lo simnd Fultis and
<br />16 o.. hundEd rh.u.,nd dollnB ($100,0091, io add[i.h b (hc con ofcomncNliol damscs as Drovided ror rhc
<br />s.dion 1076 ofrlE Latnr Cod., inr.r6l and.liomey !f-.. <- L-i r-
<br />l)tct A.8r!9[
<br />,h.r.6yimnnud&penilrrolp.'ltrrylhdI.nliccnscdnnddlnJ!'sionol(huerI(mnnncrcingqirhs*rioo7000)olDrvsril
<br />ol ih. Busrcssanl Pmfcrs'ons cod.,.nd nryl&nsc r,n lxlln,rc.drl.filcr
<br />5-11 ,s-c(-.!
<br />-l O "-o*N
<br />caNEraucllQIl.llDtdclctiacl
<br />I hcrhyamrmu e. Fmhy of p.r!ry r hd rhse k d Lrnstucrirn Lndin! .8. y lor th€ l).rlommc oI rlE (ork tor $hicn rhn tdn( r.
<br />hsu.d (Sec. 1097, Civ. C )
<br />attttcAlr"DEclaaalla!
<br />I hdlby aflim unds ,.nAlry ofndjlry on. of rh. hlloeine ddhErioni
<br />D.mlition P.mirs'Ash6tos Norilicslion Ldcml Rqulalions ('l illc 40, Pan6)
<br />=t&.quircd L.rr.r olNotifr.rhn
<br />I c.ni&rhar rh. l.ddal..8!ltrh.s E8mrlin8.si*{os r.mv.lar. nor oDplic.bl. l. lhis nmj.Tt
<br />-l
<br />.tn it ll[l I hav. E d r hir aDplication afll storc llul the atrrt inltm,ri.n h cor..1 I rlG r. 6q)ly wilh all Cily rnd Count,
<br />by auohrizi ..rmr^htiv6 oltht Cty rnd County lo cnlq l|xln lh.odimmcs and Shr. L.,s Ebrins r.
<br />obovc mntiomd pmpny for
<br />-" \ 1.,/raAppllca l or Aseur sunrlurc \-
<br />c-
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterce ptor/ 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 Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler /A
<br />Sanitary Sewe/Ca'p)l-2'l?).\41U/
<br />Back Flow DevicY l,/
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release A\
<br />FINAL , -31"11 .\.\ul{)
<br />Notes, Remarks, Etc v
<br />,*4a-I-fl
<br />L.ndn'! AddEs:
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