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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNI]R BUILDI'R DT]LCARAI'ION
<br />I hcrcny riirnru cr pcnrlry {n l{tury rhd I ncr.'npr,n,mrtu Conrrct,^ Li..d\c lrs r.r rhc li)llosirg rcnlnr (Scc 70:15
<br />Ilu{trc\s d Pnncrtn,n Codc): Aiy Cir} or Coumy whi.h rcqunc\ | |rirnii m con(ru.l. ahcr. itn[i'!c. dcfx,linr or toNn aiy
<br />snrcrurc. ri, b irs issBftc. trl$ Equi(s rhc applicstr in (hrcfnirl,r liL! signcd slricn{ir rhrrhcor shc ( li.cntd f'tr$r r
<br />n, rhc nn,li\nnr ol rhc C.nrBcror'\ l.i..n\.d ljs (ClBprc. 9. C. nnckni8 qirh Scdi T0O(r ol Division :l ot rhc Bd\incs\ rnd
<br />rpplic!nr fi,r pcnnir \rhj(r\ rhc lnplicrnrh a.ivilp.trrlryoltror nxrcrhm liv. hundr.d dollo( ($5001
<br />-1.
<br />as owrcr oI thc ptupcny. or my .mployes sirh e38cs $ rhcir elc conp.nsltion. will do tlE *mt &d tlE smelE it ml
<br />i.r.ri.n or ofmd for sk (Se.r044. Busires .nd P,lf.ssbE Cod.: The Cnnlrsrols LiIn$ Lap des &r .oply ro an owE ol
<br />thcrftpcrry {no hildsor in!ftEs rh.6n. od *ho dcs sh krl hidsclf .rherslf or wugn has n hq 6vn enployccs.
<br />lrovidcd firl suh impmEmtu m mr intcn&,i .r ofidEd rd sl. l( trEE, th btr dna M irqmErnt h eld whlu om ,E{
<br />ofconplciion, E Osnd Buildf viu haE dE hd.n ofp,bving $'r lE r sh. dil iol buiit or inpow lhc PioIEry 6r ft |lrFs oa
<br />l.0sowncrofrhc pmreny. smcrclusivclyconr.€rin8 wnh liccnscd conrractos roconsttucr rhc Dmjccr (Scc ?044. Bulinrs
<br />lrd Eolislid Code: Thc Co.rmttr s Li.cnsc Law dei nor uprl, ro d os.cr ol prop..ry who builds or in?rovcs lhcNn.
<br />rnd who oituls ror su.h trci(ls pitn a Conlato(, liccns.d pursuo ro rhe CoflrErn s Ltc.sc ljw).
<br />-l
<br />u.rcnfl unncr Sdion- B. & P C for lhis rcen,
<br />UOITEBI:.COI'TENSAITO!
<br />DDCI.A.BAIION
<br />I hercby lffirm unds p.flally or perlry orc of fic aollo*inB .,.tlmlions:
<br />-l
<br />lurt old sill mn lin 0 Ccn ifi(lrc ol Con$nt h Scli.lnsurc for $ortss or.pctrerion, or Is,vidrd tx by sdrion l70l) of rhc
<br />Ldbor codc. forrhc pcraonnlnccoflhc wo lor p'rich thc pcrmir is Gsucd.
<br />_l haE and will mainrain worlc^' ..op.os,tion ins!6n.c.!s (I]xircd by Sdion 3100 of rhc bbor C.dc, for lh€ lErfofr1@c of
<br />My workc^ .oEp.n{dion inlurdc udicr np.kynumbcrac
<br />a
<br />-/.
<br />-l
<br />c.nify lh in llE l,c.forromc of lhc wort for which rhis p.rmil is ksEd. I shlll nol cmploy u.y F*on ir any dn.cr
<br />$ !sro bccom $hjcd to rhc {orkcF omo.nrarion lass olCrlifomia. lnd 8glce th,r ill shorld b.<onE subjEl h llE
<br />voltql cotr{Ensriotr Im,icions of Sdrbn 1700 of rhe LaEtr Codc I .hall ronhwilh .omrly enh lh.s pmvisions..
<br />WAINING: FnlUE b $oE wk6 snpcn$lbf, ovcs8. is un,.wtul. ond shnu $bid u .nptoy.r lo dimitalFolix.nd
<br />civil fii.i u,! lo om hudEd rhoNrid dolla ($100,000). i. sddirio. lo thc osr of on!.nrario[ <,amg.s 6 llmvidcd fo. the
<br />Scclion 3076ofrn kttr C.d., inlcresl sd anomy\ f.ca.
<br />i hcrhy arfiirn undcr !.MllyorI'crjurylhol I an liccn*d unds lmvision ofChoprcr 9 (conftncins uirh sc.ridn Tulo) olDivision 3
<br />6f thc Bulifts dftl PmIc{sions Codc, 0i1 my liccns. is in full fora ,Jrl clfer.
<br />luef'|1r.
<br />EQNI[f,lqPtL]:lDlN(ir\{iEXCI
<br />I lrcrcby rlfinundcr pc.rlr! ot pcrjurr rhar rhcrc is r connrudion h.din8 r!ci., rd rhc lirto m.cc oirlr work tur shich rhl\ |{iuir il
<br />i\rucd ISN :1097, (liv. C.)
<br />drfucdNtD[cllr.8auoN
<br />I hm'bynrmundcr p.ntrhyofpcijuryorc of thc follo*in8 delu0rions:
<br />D..mlirion Pcrdirs Ash.sros Norificarion Fcdcml R.eul0lons (Tirlc40, P0n6)
<br />R.qxircd LIn.rot Ndifrdion
<br />-l
<br />ccnif, ihal thc fedcnl rcSuLrions E8udin-q lstEsros emvol m nor a[,ltablc ro it! pDj6r.
<br />,fG,n,, r,",",,,n""nn,
<br />'oin'nrncc{rnd Srnrc tis\ Eurus r.
<br />i.ariotrnkl storc rhar rhc.t vc co,nply r irh all Cnyr dCorDry
<br />ofthh Ciry.nd Crlnry to c.ter ulon tlE
<br />obove trnliorud omp.n, ror in{,slion
<br />ADDlirtrnl or ,'\r$l Si!nah,rr:
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underf loor
<br />Buildino Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P-trap/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
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbinq 't/$/t4 1\6q
<br />Final Gas Test
<br />Meter Release
<br />FINAL t'/Wts ,x E(
<br />Notes, Remarks, Etc
<br />POOL/SPA
<br />Dalc: O*trcr:
<br />u",. (L. /1 n ru-",.
<br />co tdor ,4+- -
<br />tAdcic Addrs{
<br />-
<br />o,r., 4'c'&
<br />Pcml(e mos {print)l
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