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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNIR BI]ILDI'R DALCAI'A'I]oN
<br />I he..by omrn undcr Fntrh, oI FrJury lhd I m.s.nt leo rh. conl'acloc l,iccnsc Las lor lhc dhwins da$n (s.c?orl.!
<br />Busin.s ..d ProLsn n c6de) Any Ciry or counry trhrh .equiEs a penDit tn con(rucr. .k(. impovc, d.nmlkh o. rr,.t iny
<br />srudur.. Drior ro irs B$aNc,0l$ Rqums lh. anDlrcanl lor cuch D.m n, file a nlNd shhr th,l h.or she h lrcened Dr$ml
<br />ro rh. nNvFoB ol rh. Conridois l,ic.nsd Law (Clmnr.r 9, Conrm.ncins wilh Scdion ?000 ol Divisn,n I oilh. Buei.css and
<br />Pma.snons cod.) or rhd h. o hc k.x.mpl th.r.frcm.nd rhc hash f.r rlE rll.s.d.r.nPrsn nyviobrn,nofstr'irn?0115 hy,ny
<br />ofl'licanrforapemitsuhj.ckrhearpl'cdnrt'ad!'lpcnalryof.ormErhinfivchundrcdd.lla6(S500)
<br />ft4r "" on n., . t,r'" p.p.n y, .r iny cnrn lnle! wrh $ucs .s rh.r s,le comp.nel6n. wn, &J rhc sorl afll rh. {MuE is mr
<br />im.nd.{ "r ollcr.d lr ele (Sa 7tx4, Buvnes an,l l^'fcssions Cod.r'l h. (onlractols Lic.ns. L1R docs nol amly ro an ow*rol
<br />rhe lmtfty *h h!'lds.r nr{in,G rh.m[.nl wtF dr6 sch s.k hrms.lfor h.rrlforrhruEh his ur h.r own cm!'loycca.
<br />nrovidcd r hat ,uch iq'mwnBts e nn inrcnd.d or oflar.n nr eh 1,. ho*6n, th. tdildrn! .r inl'mv.tunr h eld wirl n otr. rs
<br />ofcoDpldiol\ fi. oNn.r auiEr sill h.E rh€ hunlq of[ovins rlrd h€ or rh. did mr h'ld or i,n mr€ th. pmrr.ny for rh. pxqbs of
<br />-1,
<br />ow of rh. pmn ny, .n .x.lurirly conr6.rj.s e.rh licokd co.rdtoB lo offirocl th. Foif,l (Se. 7044, auilB
<br />rit !rsts-,n Cod.: l h. C.'n6dois Lic.n* L.e &16 mr lprly ro e ow..r ol0rcp.ny wl'o build. or ihrrcv* lhdoc
<br />.nd eho @ir6dr for ieh rFj@rs wth a Contrcro(o liccN.d puls.ri b Ih. conrtcl('3 Licc G kw).
<br />DEq.ASAIIO!
<br />I h.Eby !fftrm uf,dr p.Mtty of p(hry orc .frh. followi.3 ddmrio.s:
<br />I haE sn will minrain ! Ccnit(orc of Cotr€d to sclf ln!@ fo, mrkda ohp.nslion, a povi(H for by serk'n 1700 of lh.
<br />tati.r Codc trr ri. p.rfomftc of lhc turI for $iich Ih. n.mi ir i!s.d
<br />I lEv. ond *ill tuintain ed.6 @mr.nerao. isu,rrc.. ar ..quiEd by Sdion l?00 of llE Libor Codc, fo, lh. Ffomm. ol
<br />lhc work tor *hich rhiB D.rmi ii istud My worta @npaerion insmm! qriq mn policy mlEr e
<br />Policy Ntnbs:-Expirct
<br />/A cenr& rtrar rn rtrr ncrrom. oIrh. work ror wh'.hfih p.mt h iss.d, I siallnor cmrloy 4., n mo io any n6.nr- $ I ro hdE ruhF! 16 ih. md(d 6mn Mrn I.us of C.lifomia, ltd alc thll il I dbuld tEom sbj..l lo IIE
<br />wrtd' omp.mdlion Dovisi.rs ofs..lirn l7O0 of6. Labor Cod., I dBll. fonhwilh 6oply wilh tlFP pmvLiotu.
<br />WAIININ(;] hilurc ro *!.. hrt.6 @ipctrsari.n co@gc as unlnqfll, affl sfi.ll sut dr an drlort ro cnniMl Fmhi* lnd
<br />civil tfts up to.* hundrd rhoeid d6ud (S100.0o0). i. addlion ro th. cost oaconri*tr$lior datu8c.,. lmYid.d lor lh.
<br />Cod., im.rcst 3nd anonry'3 te!
<br />A
<br />lllclaBAr.t0!
<br />I h€rehyimlnrunder pcElry o t p.rJary rhdr I dn l'&h{a! und.r lm,isnn olchinlB e (mmftrcrn3 wnh sero.7(x)lrl olDivhion l
<br />ol r[. ausin ,sond PmlcssionsCodc, aod nryl'ce6c h
<br />'n
<br />lilll ntrc.i .r..r
<br />l.'(n\. ( h\\
<br />-l
<br />rcDs. Nun,b.r
<br />$NIAUCff)NTTBDIN!AC.!]iCI
<br />I h.r.hyamrn und.r ,cnill y o t perjury I hal lhcr. h a drtr(rucl(,n leidrs ag..cy rhr rhc pcrr'omrncc olthe*ork litr which rhis pemnt h
<br />trsued(Sa 1097, Cn c)
<br />AttucANfutctaSarpa
<br />I h@trydnnnu.ddF(ihyo, ncrjury one ollh. lolk)wnu d.cl..0lions
<br />DeDoliion P.rm s Aih.ilos Norificarion l.drhl R.Buldtonr11 lc4I), F.r16]
<br />-Requir<l
<br />L.ltcr o I Noliliclrion
<br />-l
<br />c.nify rhll thc tcd.6l rcgrl,rions E8mdiry ash.slos rc mvol ire nol q'dicahlc ro rhis pmjd.
<br />-l
<br />dily rh.r I lEv. Rrd lhh aDr,liorion and .l!t. rhll fi. at v. infom.tion is coE4l.I rsrc lo 6mrly wnh aI Cny.nd Colnry
<br />odi.anc.s and Stole tiws rcLtins to tuildias constucr'o,!h..ebyrurh.riz Eprcscnlativs ofthh Cnyand c
<br />atnE c.rion n,mp.ny for iNp.{rion
<br />AppUc,nr or As.nt shNtur.:-"Jl A d
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />Waste & Vent
<br />Water Piping l-
<br />Gas Pipins SL.qflrrlw ,o-s-l I hrr,frr)i
<br />Roof Drain " l\7
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Ivlain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous . .^A
<br />Gas Service 10.4-,kJW{,)0
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing *tlt ot /ai ,-/
<br />Final Gas Test t. ''
<br />I 0r
<br />Meter Release
<br />FINAL 1-oY.'Lo o,-.1 ta>
<br />Notes, Remarks, Etc.
<br />TOP OUT
<br />1l>,u1i
<br />;:_[E{I[S(tioo-
<br />I .nder', Addr.is'
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