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PLUMBING.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS ()!rNt:ti lr( lt,l)t.:k l)l:1,( 1R:\ l'l()\
<br />t t (by amrm undq peBlly of Friury rhd I m crcn nDm llt C.ilrad6'LieN tiw for lhc f.uowin8 ffin (Sc{70115
<br />Blsincs aid Pr.lcsion Code): Any Ciry or Counly which Eqlits a Fmh ro .onsltu 1. .llo. it4!,ote d.mlhh or G!,t uv
<br />stuclur.. prior b ns is$aN. rls rcqutcs tbc apl,licsl for such lEmI to nk ! si8n.d slalmnl rhor lE or 3h. is licns.d Pu@3nr
<br />ro thc lDvhioB of 0! Conltulois Lien$tt tIw (CnrFr 9, Commsing s n Sedon ?000 ol Divi.io! 3 of ttE B$inesr rnd
<br />Pof.lsio.s Codc) or $d h. o, !h. is cxcEpl lhcrcfrondd thc bask for llE alkScd cxctPthn Any vioLdon of Selbn 703t , bv.fly
<br />oprlica for 6 ,mil subjftls ln. applic!fl lo u .ivil FuIy of ml mE lhan filc hu!.lr.d dollus (t100)
<br />l, !s oq ncr ol rlB pn)pcny, or
<br />'ny
<br />cmploltcs tr irh wrscs !s rtut n,l. .o rl,ctrsrr ior. $ill do rlf, sork nnd rnc \ltrrr. i\
<br />'nn
<br />inrcndcd orolltrcd ritr crlc (SN 7(!,1. Businc$ lnd Pn,rcs{nrn\ C.d. 1h. C.nlracttr * Li.ctrt tjq doc\ nor +llv ro !tr o-mr ol'
<br />rhcl)fi)lf,ny sho blild\.r in{rov.: rhcM.. rnd sh. des {Eh work hinNcll.r hcr{llor rhn,u8fi hi! or turown cnrPn'tccs.
<br />poliJcd rhrr {ch i'nptuvcEnh src Bn inrcnld .r oit d for *rlc lt hostvcr, ttr huild iE or i,nPr.rtninr h $ll wihln o'r )tr
<br />ol$nu[rton. rhc Owocr Btrild.r willh(rc rl'c hrdcnolpn,vin8 rhar h. or nr dit nor hui]d or nlll)rcE lhc FoPcny tu hc NrlxNc oi
<br />-1.
<br />as oeftr of rhc lhpcny. m crclusitly.onlncring wifi lietr$d colnncloN ro onslrucl llE P'ojecr (S(. 7041. Busincs
<br />Md Pr.t ss,r Codc: Thc Conrtulo/r Licens. Ltw dcs ml lpPly lo u ownr of lroFny who builds .r imPrclcs rh6con.
<br />md who ontnds fd such ptujocu wnh a ConrEclo(O lacen$d plrunl lo lhc Cottrtelols Ltcns L{*}
<br />-l
<br />! cxcmfl rndcr sdrio
<br />l)rrr
<br />SA8$EXS:COITIENSAIIA!
<br />DECIIIEAIIITN
<br />I lErcb, amrn undcr p.mlty of pojury orc o( lh. fouowin8 d(lrolions:
<br />Ih,vc,r willn[na a Ccnili.ar. .l G,r*nt b SclllNurc lnr wortds comllttrs.tiotr. trs Pmvidtd ft, by Sc.lion :l7l)O ., rhc
<br />Itrhor Gxl.. f.r rhc t rfoinurcc ofrh. $o* ft, whi.h rh. drnil is hsucd
<br />-l
<br />holcuod willnDintai'r Rorkcrc' compcnmrion in\ltdncc, s1 rcquncd tyScclion 1700orrhc Lobo,Codc. forrlt lcrfonnsncc of
<br />for qnich rhir pcrnil is issucd. My sortcF cdnw.\al
<br />ch c,Yl ca
<br />v\4")t11 ltJ+tblt lt6
<br />-l
<br />csnily rhar in rhe lc lormrcc of rhc work for which lhh pcrmil is isslcd I shdllool.nploy any fiion in rnv lMmr
<br />o !s ro h..6m subjd lo ltu porkc6'coopcnsdion laws of Cllifomi.. !.d lge thd if I shotld b.coft subi{ b rhc
<br />&*cis' @nllsn. ion lovisions of Sccli,n ST0O of thc Labor Gnq l slEll. fonhwilh omply wnn lho* pDvirions..
<br />WARNINGT f_lihrc lo sw rorkc*'comlcnsation o!@sc h Ia*tul. ad shlll subjccr e cmploFr lo aimiel Fdtin end
<br />.ivil fincs ur ro.re hxndrcd rhouslnd d.llus (5100,0(x)), n,Josl of conFf,s ion. dlmsca {r Pmvid.d fot ltu
<br />ihc uhr cnlc. i crcn$d{rktrtuy{q 0 a
<br />t heEb, rfftrm lndcr pcMlly of p.rjury fii! ! m licn$n undcr otch.rr6 9 (onmrcins silh Selhn ?000) of Dilnion l
<br />of rhc BLsioc.s dnd PmLssions Cod., ald oy li..nsc h in rxll roEc ud.lfer
<br />t7 144+z<t
<br />o
<br />I lErchy aflirm ond.r |Etulry ol Fdury th.t ltft is t cotrdociio.
<br />i$ucd (Sd. 309?. Civ. C.).
<br />a8cmy for lhc pqro'rl1*c ol the *o,t for whtn rnn P.mil $
<br />A.ttUCi BtDEI;LdnduQN
<br />I lmhydtfirnundcr pctrrlry.rP$jury.nc oirhc r'oll,,sinsdcclrftrn,n\
<br />I)r x)lirn PcnnirlAshcsos Nolificrrion Fcd$nl Rcttrldi.ns ( lirl.:ll). Prn6)
<br />RcqutrL{ txncr oI Norilr.aru,
<br />-l
<br />c6ify thar rlE f.nmt icElllalioN rc3s,rlira lsbcstos rcerll e. nor {I,Plkotlb lo lhk Pto,ctl
<br />-l
<br />ccnnythlr I hovc icad lhis lpulkdlion rhr rhc rh.vc inlbrnrlion h corrccr.I ogm ro.omPlyqnhlllCirystrd Counry
<br />ordirunes and Shrc lt*s rebdn8 aurhori* rc0r.* dires of rhis City od Counly io .nld lpoo 'lElbovc mnliomd pDpcrry fd
<br />Applicrnl or 8rnt Si*Elu
<br />UNDER GBOUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent t/,//r e 'lrffi
<br />Water Pipinq i/,.o/tr I 67
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main 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 />Rouqh Plumbing ,o/dLr a nffill|- t ,2-
<br />Final Gas Test
<br />Meter Release
<br />FINAL ftza4 /oi k//r/r{
<br />Notes, Remarks, Etc.
<br />/ohltr 6 rt tz-zYl>fran$anl".2/*Jr*;t/Z
<br />DATE
<br />4
<br />Lr c''. \J'r.
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<br />trl,lcr i Addrc(:
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<br />^,,,q f ofw
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