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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDI'R T'EI-CARA'TION
<br />I hcr.by Jnd r drr lcnalry.f nc'jury rhd I xm crc'nnr fnnn rh. c('ntJcn)( l-ic.n\c hw fd rhc n'lbriiS rc.$n (S( 7u:rl:5
<br />BtrsnBr nnd Ptuf.snnr Codc) Atry Ciry oi (-outrry shi.h r.qxnc\ r Fr'ni( ro connrud, alrcr. nnl]'orr. dcnnlish or rcprt any
<br />srrucrurc. pri,trro ns issmtrcc- lls rcqun r rhc atplid.N forstr.h ncant ro tilc r siEned snrcnE rhit hcor shc is liccn*d puisuanr
<br />k'rhc|n)vi\i.n\orrhcCdnra.ktreLi.cns.dLawlchnprf9,Conrc.nrgwirhSc.ri,7000olDiviriotr3ol'rhcBu\nrssand
<br />Pmlcshn\ Codc)orlh.' hcor \hc iscxcnu rhc.ciofl!trd rhc brsis lorrherllc8cd c\.nDtion. Any!n iotr of Ssri,n ?0.r l t hy any
<br />npllicurn,apcrlnilsul,jcchrhcapplic,rio!civilpcnilryoanotBtrclirnli!chuidr.ndolla^($5tD)
<br />-1.
<br />as owmr of rh. pmpeny. d ny .mployes wirh ss8.s !s tlEn $h omlcnsrior will do rlE qdl dn $c sEulc i! mr
<br />inr.d.{ o ofd.d fd sL (Sa.7O!1. Busi6. ed Piofc!.iotri Codq Th. Co!ur&ro'3 Li.cM Lrw d.G mr .pply lo m owns of
<br />rhc ptutsrr sto Laih, tr inpmrs dEdr ad eho d6 *h mlt himslf or lENlaor rhoogh h or ls ow..nplor6
<br />,ovidcd th.l such iml,bwnls m mt inlodcd trofcrcd lor soh. lL hoftE llE hoildir8 or inpmwmnt ir mld *iriin om y@
<br />ot@mrh0olr rhc Owmr AuiUd viu harc tE b|l^k. of lovhg $.r lr n ihc did rcr h0ild or inprcw lhc FDpcly for tlE pq8 of
<br />-L
<br />asowncrol$. poFdy. rE.xclusiElyconlraciine *hh,i.cnsd co r0clom lo con(rucl th€ pojccl (Se.,044. Bu\irc$
<br />,!d hofcrsbn cod.: Thc conreld'r Liccn.c Lrs des nor lprly ro d ow.d .t 6Fay who builds or inpmvcs lh.r.on.
<br />and *ho onlracls for su.h pmj..ls *irh ! Conrruto(s) licnsn pursuat rorlECo te1oas Ltcne L,w).
<br />-l
<br />anercd ondf SdIon-, B, & P.C. forrnk r.$on
<br />Drter Ovner
<br />woRKF{s cri iENs,rri(N
<br />DEII,I&I.IIAN
<br />I hcrcbyrflnmuMcr pctrdllyofNrjuryon ol lhc lol[]e ir8 dshrdnnNl
<br />-Ihrvcrfriwillnri,air.Ccniriclrcoi('onen'ros.lal,NuErorwortcN'.orlprnsdrion.tr\F.vidcdforliys6ln,nlT0Oorrh.tnbor Cod.. lorrhc ncrloflrutrcc oarhc work lor which Ihc !trnit is issucd.
<br />_l hcvc and wiu tuinhin sork.^ .or{Erslrtu. inrur0rcc. as Equircd by s*! ior l'700 of rhc rlho, C.de. for rh. psformme of
<br />\Frrnir a n$cJ Nlyq'rkc( comnctr\ nn, iNurrn.c.rrirr rnlt'l'.ynu $d nrc:
<br />1
<br />-l
<br />c.nify fiat ir th. p.rformm. oirnc wori for whkh lnil p.roln is issu.n.l sh.ll nol cmploy dy pcEon in.n, nsmr
<br />e es ro bctom sbjer ro ric sorts'@n{rB{ion la$ of Cllifomia. .nd re@ rhd if I slbuld hom subirl lo rlE
<br />woltor' .omlEnqrn,n tovisions of Sedion l7(r0 of lhc llhor Codc, I rhall. lbdhwnh .om0ly wilh lhop pmvisions.
<br />WARNINC: ljailurc h surc er cF oDpcnsrion cnrcase
<br />cnil Fnc. ur tn om hundrcd rh.d\trnd dnlldr rllno.{x)nr. in
<br />S.crion :10?6 of rhc Inhr Codc. inr.rcn dtul atodey\ rccs
<br />r M .nplorrr ro fininll lEmltics and
<br />ior dr@B.s !. prcrnrd for lh€
<br />ff 1lr Ru{tr.\\r*ll,nnrsrnN('(tr!c, rRin,f lrcD{ n in lnLllnirrtrtl.ll..l
<br />Iosa<'otIlr
<br />q)NIiIAIjqII()NIENDINIjIIiEITI
<br />I hcrchy dlirmuMcr Enrllyofptrjuryrn rh.rc h r &nsrrucrioa lcdils lscDcy r,r rh. t^-rrontu..c or rh. \ ork for $hic[ rhh ltmir n
<br />issucd (Sc. 1097. Civ C )
<br />A.IILTCdNLI2ICLAAAIION
<br />Itrtohtdlnnruitlcrt^- nlryol lirjutonc.l rh.nllk,trnr8d..ldrrri(,1
<br />t).'n)liir t'crnrirs A\hr\ro\ N.rificrrnr licdcrrl Rrgulxru\ iTirlc.lr, Prn6)
<br />Rcquncn l1I.r of Noriliclri(rr
<br />)diry$atutc,tq,trcs!rrr'on\.!(,rins,.-4{n'cmn!nrrcnn.ird*ohhr.,hFnn,}rr
<br />E{*"*}*,,***,*^ro rarion old {arc rhd rhc lhovc inro',etio. is coror. I lsr to on{ y *rh {rr (irr and cnunrr
<br />ordiMm.s 8nd srarc llws EhrinS ro huildin8 rcprcrcn'alivc$lrhis Ciry!tri Cornry ro.!r.r uF,n rhc
<br />fiorc nriri(nra pn't{ny f(tr nr\r..notr
<br />Appli.n.l orAEdlSiInslurc:*," q.c.y1.
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptori Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />Ptrap/Drain Line
<br />Ivlain Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq 1/ l'>/rs 5\39
<br />Final Gas Test
<br />Meter Release
<br />FINAL lt/4/ ru ,AW
<br />Notes, Remarks, Etc
<br />-", AL.loo
<br />I.nJ.''. ,lJ'c$
<br />Waste & Vent
<br />Roof Drain
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