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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.OWNER IIUILDER DET,CARATION
<br />I h.rcby nftnn u d.r I'cntrht oI itrijury rhar I am cxcmrl from rhc conhdcrtrl Liccnsc Lr* nn lh. rollowin8 tcosn (Scc 70.11 5
<br />BusnE$ ad Pofcsi.n Codc): Aiy Ciry or Cornrt whi.h Rqunc\ 0 ncmrir lQ condfl.r, rl'cr, nn[ovc. Lhmli\h nr rcFr rnt
<br />{ndurc, rrhr ro irs hs!&cc. nl1o r.qutrsrhc 4plicatrr lor suchpcnnilrd nt s \ig.cd narcmtrr rhar hcorshc i! lic.ns.d pur{.nr
<br />b ihc f' vi\tuns or lhc Co rocroi\ l,ionscd l:,w (Chrlrc' 9, ConnncNirrs wirh Secrion 7tm or Di!i!n,n I of lhc B!\inc\\ tnd
<br />PDfcsi()nx Cod.) or lh t* or sh. i\ crdnrpr rhcnft.nr s rhc h$is ld rh.lllcgcd.rcmpri{,n A.yviohlionolScclionT0ll5btany
<br />sppliqtrrrd3r.ihirsxhlc-hrhcrpplicinrroacivilpcnrllyornornborhn fivc nundtcd dollds (!5LtJ)
<br />-1.,\
<br />owtr ol rh. pn,,l.ny. ot my.mnloyccs wilh wua.r !s lhtt s'h conrNn\rrio.. *illd.ltr eort 3rd rlI \rtu1m n toi
<br />i,n.ndcd o. ollcrcd for sk lsa 7194- Busirc\s and Pft,r.sln,ns C.dc:'lh. Conto.roii Lkci{ Lnw ddi nor.,Dly b !.osncr ol
<br />lhc pupcny *kl hlilds or i'rFrovcs rhcmn. ona who des su.h $.It hn.scltor hc.slrot rhn,uSh his or h.r orn.mpbycc\.
<br />Drovidcd rhor srh irnnmvcmnh m mr inrchd.d or oflctud for srtr. It. htw$u. rhc boilding or i'll|tm!. r is soB wirh'n nn! rr
<br />oi compkrion. rlt ow.cr auiUn *ill hnE lhc ttrnjcn ol pr,lirs lhd hc or rl[ dil mt hoid or inllmtc rhc Pn [dy ror rh. PU{n* ol
<br />L i\ rwn.r ol rh. tmleny. amcrclusivcly.onrracriis wirh liccn*d ( {reto to co,(dcr rhc tNj$r (s.. 7(}.l4. 8uriru$
<br />a Eof$si,n Codc ThcConracror'sLic.nsc tjw do$ tror iotlylo 0nowncr orpn,pcn!who builds or imnovc\ rh.rco..
<br />ad *ho.odB.Ntusuchprejccls*nh!Grnln.iorlrliccnf,dplr\urhrr'thcConllrn"st,i.cn{l-nwl
<br />!48$BS:!:0M!ENSAIION
<br />DECI.AXAIIII!
<br />I h.rcby .fftrn undcr Fn lry oa pojrry om of lh. followinS d.chmlions:
<br />-lnnEfliwillminrointrCcnifi.rrcorConsctrrhSclf.lNurc{orworkc^conrF.nsdtun,!srrovidcdlorbySccrn,nrTm.rrhcbhtr Clldc. f(rrfu pcrfornuneolrhE woll rotshi.h rhc p.rmn ir hsucd.
<br />-l
<br />havc and will minlain workcs compcnsation in$rncc, 6 rcqxicd hy Scct ion 1700 of rhc khor Cod.. lor lh. pcrfomfte of
<br />rhc sork tur uhich rhis ,finril is hssd Myworkcn Lln1Pcnrlr raNc cadcr ad s,licy nldb.r m:
<br />I ccnify thd in ihc lcrformnce olrhc *o.k fd which p.rn t tsued.l snollnor cmploy.ny p.rson inu.y6dncr
<br />s N ro h€$m s!6iri lo lh. hdGs .orp.ns.ltun laws of Coliforni!. lnd ,gN thd if I should bccoft rubl.d lo thc
<br />wo,kcG' ompcnsar ion peaiilB of Sdiotr lrGJ of $. Uhor Codc. l shnll ronhwith o q,ly w n rhe t ovirions
<br />WAIINING F0ilu.c ro surc aorken compcn\oln,n NrcBg. i\ unlaarul snd stull slhjccr d cmPlorcr lo aiminal lr@[is Md
<br />.ivil fincs ut ro om hundr.d lholsaod doll{r (Sltlo,ooo), in rddilbn !o lhc cosl ol.ofrp.nsorion. dlmBcs rs Pmeid.d ror rh.
<br />rhc &nor C{nc. inrcr{ rhd ortuy-s rcc\
<br />2 C1 c Dla I
<br />LI!ENSUrI,:0,:II3A.qIOB
<br />DECLTXATAN
<br />ol ittr Uu\i'r\\rid Pr.'lc\sids Cod.. lril my liccnsc n in tulllamcmdcllccr
<br />I
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<br />(ONiIBU!.JIQNUNDINC.{AIXS
<br />I hcrhy.ffinn utucr pcDllryorp(rjlry rhrr rhcd n d cotrsiru.lhn lcndins aEcncy rttr rhc lErrornurcc oirhc $ork n, shi.h ihis Pcrmit i\
<br />is\!.d (S.. 1097, Civ C.)
<br />ATELICANLDSCI/IIAIIA!
<br />I r.r$yfiinnu c! rcnalr, olp.rJxry or. ofr[c nnbwin8 dcchrurion\:
<br />Dcmlition PcflnirsAsbcslo\ Norificlrion frd.dl R.sulnl ions (Titlc 40,lrrn6l
<br />Rcquircd L. crof NorirElioi
<br />-l
<br />cenify rhd rhc fcdcBl Eeuhtions rc8lrditrB asbcslos rctuval src nor ,pdic.hlc to Ihn pnirr
<br />I .cn ily rhd I hdc read ltis !,,Ilicalion and sriic rhat rh. d$rc intormrion is .orccl. I rFe i6 6nll)1, *nh aI Cn, a.d Colnry
<br />ordinan cs and Sl,t tjws Bllrins $ blildinB.o.{ru.r ion, drl h.rcby aull$riz rcprcsnbrivcs of rhk Cily ond Colnly kr cn'cr uF,n E
<br />*," 5/zdrt
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor 6-(3-(s \>t6qq
<br />Gas-Underf loor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent L ...r9 . r^G{,
<br />Water Pipino t,)d'6.q-
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Servrce
<br />Waler Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release n
<br />FINAL 7*lq.-lv i{.v{-}t
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Fill Line/Back Flow
<br />-l
<br />an cx.mpr unrt . Serior- B, & P,C, fot rht5 l!&n.
<br />?a
<br />1. 1.". \JJ'rs
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<br />Jhrr nEnuotud nn'*nv lor in\Dcctiotr Durmrci
<br />Appr(onr or As.nr srq*ro*: ZZ-L
<br />II
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