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<br />PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER IIUII.T'ER DEI,CARAIION
<br />I hcchy.lft undcrlcn llyol E rtury lhri l{ncrc n ftoD rht (ir n.rn l-i.crsc ln$ lilr rhc tulk'wtrrg !.r!r (Sc.7o:ll5
<br />lru\i,rc$ rnd Pmicsri,,n C(dc): Ar) Cny r C.!trry trhi.h rcqunc\ n Nnnir h c.n( cr- rlrcr. irnpiinc. d.Nnin, or rcntr r !
<br />nrucru!.. pri,n io it i*uatrcc. al\o rcquncsthc 0lplrrtrr ror such Frnir lo filc ! \iskd {dc f,trr rh l'. or shc is li(tr{d nnr\uafr
<br />ki rh. nntririrN .f th. Conkrclor\ l,iccn\cd I n{ lChr,,rcr 9. Coinncn.r! snh S(.lion 70(x) ol l)ni\n,n .1 oi rhc rr$in.\\ !.d
<br />rlplicrnr tffapcnn subj..r\ rl[ rpplicrtrr to tr.ivilt'ctrrllyol tu' nu. rhrn lir. hunlr.d d.ll r(55(x)).
<br />-1.
<br />Ec o*E of tlt ptuFn!. or ny crploFer *nh srgcs s the n bh otr{Enslion. eill.h th. e(t !!d tlE drtE b hl
<br />inrsd.d orofrcEn fd eb (Se.704. AusiEss&d P,Dr..rkrnsC.d.: Ttc Co n lo,'i Lktr€ trw do.! El.Oply lo u owM ol
<br />rlE FoFny sho buil& or iqmB dEe'! sid who dG nEn ftrt hiNcll or lrelf or lnrcql his or hs 6m .nplor..s.
<br />pDvidcd rhlt s.h inlmwm.ls N ml hl.d.d olofr€Ed for slc, lt l-Ew( llE buihinS or inprcwrnl is $ld,ihin on Fa
<br />of.omphdon. $c Oq6 Auildd wil lErc tlE hr&n of pmvinS tur lE or shc dil el hild o, inplrN lhe P'DFlty for th. Frqne of
<br />-1.
<br />uso$n.r.lrhc pn,lrdy, r cklusircly.oilr.rir! witI lrccnsrdcontucroFb.on{tucrrht pt,].cr ls( 7(},l4.lruri"rs
<br />rid thrlissi,tr Cod. lhc(onlricktr\l,iccnscl,,*doc\norapplyk,MowncrofPa)Fnyrhobuild\orn Pi{,rcs rhcrc.n.
<br />rn sho ..nrracr\l(lr\uchrrr..!r Nirh rConh.ktrl\)li.cnscd puhurnr n, ihc Coft(rol t Li.ctr\c Lrw)
<br />-l
<br />n cxcmpr unicrscdio B & PC tur lhh,s,s'i
<br />WORI(FIL\' COMPENSAT!(IN
<br />DEIIATAIIAN
<br />I hcrcby aUiro undcr p.n.lry of pdjury oE ollnc lollowin8 dslelions:
<br />lhr\c mlsill.ui'nri0 x C.dil,.rrr ol C.tr\cnr b Scllli\urc tur \ork.t\'.onrr.n\rri{nr, r\ pm!idcd ntr hrSccri,)n.17{xrolrht
<br />t]htr C(xn, tur rhc trr li,r N .c ol rh. (ork fi r shicl rhc t^-nni i\ n\ucll
<br />_l hr!. rn<l wiu n$inrliri sorkcN comFnsalion in\utunrc. as rcquncd b, Sccrnr .r7(r) of rnc L.bor Codc. lo. rhc tFrormn.. oI
<br />rhc erk for whi.h rhh Dcrmh is nsln.
<br />ystrlcB
<br />mn{.Ndion in$, ncc rMitr rd Fricy nnmt'lr ,rcl
<br />sl-l- €--
<br />a
<br />iayrh in rhc Dcrlormmc of rhc wo* fo, whichthisFrnn k issud.l shlll mr cnDloy dy,E sni!lnyruftr
<br />y, r\ h l{.r r q'l+.r tr) rtu { o'k.'\ .. rt)ctrsriotr liEs.l (rlifornii. nnn r!rc. rhd ifl nuld b.r rt !ul,F.r [, df,
<br />\Frkcri.oDrIcf\nri,rtx,vi\n)i\ofSc.r(nr:17(X).irh.l-nhtrCinlc.l\hrll Inrhw:rh.,trnIly qilhrlr)\c fn)!isi,nn
<br />WARNINC: Frilurc ro suc $o*c* con rtrdi.n .0BBEE is un,.wtul. ad ihall slhj.tl & .mnlolcr lo sihinol |xollis and
<br />€ivil fincs u, ro om hufldGl lhousnd doll6 ($l0O.O00). in addilbn lo lhc c.sr ol cot{Enerion, dtm8.s !! fovidcd for
<br />'hcSerion 1076olrhc hhor
<br />\"' slnl<
<br />(olc, in'cron dtnftt s lccs
<br />'rPPl*nr' Vtetq'€4f t tro-t +-
<br />UrliNELEANlBAl]l)A
<br />LuilLAa raN
<br />t hcrch, lltn,tr rrp.iilryorI[rjMrrl rIinrlico\L\luodcr!!ori\nn'olch,flde(!\rnnrncins*ilhSc.rion7fx))orl)irision.l
<br />ol rlE Bulms .nd Pmi.ssn'ns Codc. dd 'ny li( \c h r tu ll ri&r itrd c lltcl
<br />K
<br />c-o 7L\ 1<'
<br />Itc conrr.do. fLM ft},. LLr {r*
<br />I
<br />EOn BrL(Ila}-lJlll!}1ir!e!!(I
<br />I hcrc$y rlrirmrid.r l.nalrr.r!.4trtrh lncrcisacon(ru.lionhndinsarcN!rorlhcPclforNreolrhc(orklor*hichlhnP.rmin
<br />ksuc ls$. 3()97. Civ. C.)
<br />AIILlcANfDIilL/BLlIAN
<br />I hcNby o,lim undcr pcnalry.rptrjury orc ol rhc l'olhwnrS dNlnrarioni:
<br />Dcmlirion PfnitsAsbcnos Noritu i,,. Fcd.rrl RcBUhrnJrs lTirlc&. Pan6)
<br />-Rcqut.d
<br />l.rrcr olNorili.rli.n
<br />lrodilyn r rhr lr(lcrilrcAulili.f\ r.!rdingN6.n,N'rnn)rtrlxt ornl,drrhl(hrhi\nn!.tl
<br />-l.clifyrn
<br />l tuvc rcad lhn!!,l,licali.n arn nr&lhai $. arDrc inlormlion h coml I agtc '. @nq,ly *nh . Cn,mdConnry
<br />ordi@er od Shr. l:qs Ehrins lo blaldan8 .onsro.Ikn 6nd rEEby,uthriz. Eprc*nllrivcs .l lhk Ciry 3nd Counly lo cnlcr us,n rh.
<br />rtrit nrrrioncd prur.dy ror insFdion
<br />f,,,*,or A€n( SiEnrhrre:
<br />k****,t@
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />\
<br />POOL/SPA
<br />P{rap/Drain Line
<br />lVlain Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meler Release /n\
<br />-27-7a r,w\(\
<br />Notes Remarks
<br />\
<br />Pool Heater/Gas Line
<br />Gas Service
<br />FINAL
<br />Etc.
<br />Efql'r
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