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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.t)tl NUR BUIt,OllR l)!lt,C;\RA I'I()l\i
<br />I hcrcby ,f,irm unds pcnllty of Frjury fi l am.rcmpr rmm tn. Co.rEd6 Li.ens L!* for lh. followinE rcrsn (Sc()03t 5
<br />aurineis !{n Pmfesio. Codc): Any Cny or County ehich rcqutca , pcmir to onslrucl. ahr, inrpok_ dcmthi or Epdi a6t
<br />nMr@. prtu lo irs hsucc..ko rquircs tlE lpplhsr for sch Fmil to flc a sag.cd rrat.mnl lfi. E or she b ticcnrd ltlNer
<br />ro rhe pnvisions oatc Conractor's Liccnsl If,u (Chaprc. 9. C.nmeins wnn Scctio, ,OoO of Diririon 3 of th. B8in.s. ao.l
<br />PDf.srio.s Codc) or rb,i lE or she ir cr.n{ thcEnom d lnc tEsis for rn. atkS.d crcftption. Any viol,tion ot Serhn 70] I 5 by lny
<br />dt rlicont for a pcinl subjrcts lh. lppli.ent rc acililFnrltyolnor norcthdn fivc hundEd dours (S5OO).
<br />-1.
<br />r\ owncrofrhc lnlrny. rn nry.nulorcs wilh wlrrs D! rhct snc onD..\nrion, wiU do thc wort Md rh. nturm n nor
<br />intcftldl or oacrcd aor sh (Sft.7(}.l4, aurincs! und Proicssi.ns Codc: 't'hc Conr,tuht! l_i..n* h* doc\ nor sppty ro trtr owncr or
<br />Ihc pmlrny $,|.n) ltuild\ o, iq-rorcs rhcB,n. dxi wh) docs skh *.* himrctaor hcrrtfor rhmuth hi\ or hcr.Nn enuloyscs.
<br />providL\i rh{ str.i i,npr,vcrn$ m ior inrc' cd .r oflar.{ f{n u c t( hwcvcr, rh. buiuina o, i.Ipovcnf,.r rs *,td wirhn urc r(ol.orqLrn,n,lhc Owrcr Build$ willhlw rhc bunlcn.tI'oli.3 rh! hc or shc drl nDr hitd or iDr0n'rc tu ImFny for rh. purF,r oi
<br />_l.rtosn$olrh.lropcny,rnrcxclu\ivclr.o.rrlclirSqirhticcn*d$nrra.lonron,rro. trp(*cl(se.7o.l1,Bujn.s
<br />rnd lbl6\ionCod.: Thc Contrrols l.iccnsc Lnw docs nor ut'lty b rtr.s.cr ofpn'Fny lho builds.r nnpn)vcs rtucon.
<br />utrl who .onrqcrs ,i'! surh Di(,jc.h wirh I conr0.rtr(s) li.cn\cd puruan|lolh.co racktr.s Liccn\c h*)
<br />_l am cr.mpr undo Sdrion_ B. & P.C. tor thh rcsoi
<br />woru<i t-s. coMPFNsATloN
<br />DECIJAAIXON
<br />I hcEby amm und$ pcn lry of ,,orury om of th. fotlowinB dc{learionsl
<br />Ihr!.!dsillnDi,rinaCcnificilcolCo.\cn oSclilnsurctorsorkc(cotrpcn\xriIn.r\rr^rvidcdrffhyScrrnnr.lT0r).,rhL
<br />l,ahor Cudc. lnrr)r pcrlirnMNcofrhc *uk for which rhc psnir i\ nnhd
<br />,ill mi.rdin w.rtcn conpcns.rion in\lrarcc. as Bquncd hy s..ri.n 3?O0ofttc tjbor codc. ror rhc
<br />wortcn onrEnsdlion insur c. ceicr ,rd nolicy numhcr m:
<br />P,,ri.yN,,.h., 6^ru\r(.ol?.tD?-o E,Pi'".l:l.ta,
<br />-l
<br />aniti thol in c FlfornERc of rhc worr forwhichinis pcrnir it irsucd.I sh.tl nol cmrhyan,Frsn inlnym!.m!
<br />m es to lE om slbicl ro ltE w..16 @sipcnstion ta$ 6t C.litomi!, ad a8e rhnr ir I stDutd tr.om subj.d b E
<br />*ortcrs $mpenrrion pDvisirns or S&rion 3?00 of lhc tibor tu . t nElL todh*nt ompry sirh lhns povisions .
<br />smp.nration svsrSc h uohwtul aid stall subj.cl an nlr)l.yc. ro sininul rENlris and
<br />dollN ($100.000). in addirio. to thc cost olomp.nstion. damscs as prc{ided for thc
<br />IICIABAIII.INIh.rcbyulirnu cr pc.ilr!orp.rrn.y rlur I am lia.sn undcr Frvisn,nofchrprc. g (rshturcin-! wnh SNrion 70m) oroivirion lol lle llusincss und Pmrcs\ins Codc. and my li...sc n io tull n,e md cftei..s.
<br />APPI.I(:AN'f DECI ARATIoN
<br />l)t{by dinnundcr |).nrlry orp.rjlry oN oilhc lollow'ns dcch,ariotrs:
<br />D.holirion trrir!ir\.Asb.*o\ Norirrcarion lrcicr0l Rcautatior (tirt.40. pd6)
<br />Rcq0ircd lilcr oi Ndlifi .!rk,i
<br />-l
<br />..nify rhar rnc fcdcrd rcsulnrioN egdliaS &!tr(os rcmldl e nor epticlble b lnis pbj..t
<br />f ""n'rr,n., , **.no ,n,, a'pli.arbn ad s.,rc rlur
<br />ordinarccs md srdc Llps EhrinB lo building con{tucrio
<br />thcl&)vc info@rion i concd ! nEN ro 6frp1, with lllCilt!trd Counry
<br />n. flId hcrcbyrxrho zc rcprcsctrhriv€s ofrhis Ciry ud Counrylo cnt.r upn rhcah)t mnlioNd pDpcny for inspcclion luqssqs #qn n 2018Appliunl or A*.nl Sisn"lu
<br />I
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underfloor
<br />Area/Storm Drain
<br />lnterc tor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Roof Drain
<br />Tub/Shower Test
<br />Rou h Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Fill Linei Back FIow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Back Flow Device
<br />Rough Plumbing Clt-z.lt9 -ce/ra )
<br />Final Gas Test
<br />Meter Release
<br />FINAL ?1oehs ./D6y
<br />Notes, Remarks Etc.
<br />COMMENTS
<br />Waste & Vent
<br />Building Sewer
<br />Water Pipino
<br />Gas Pipino
<br />Main Drain/Pool Pipino
<br />Lawn Sprinkler
<br />Sanitarv Sewer/Cap
<br />lOa?rq,n
<br />'sil++l!l8- cd.-"'r-
<br />C(TNSTNIl(:TION LFNDIN(I A(:FN(:Y
<br />Ihcrcby mnn undc, pcnoht ol rcrjnry rhrr rhcrc h a consrru.ihn lcndira r8ctrcy for rhc l.rromMcc of rhe work t'or ehi.h rhis Fmt h
<br />issucd {s(. 3097, Civ. C.)
<br />tJn,jq . \drrx:
<br />L.Blc, ( Addr$'
<br />I ]
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