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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DEI'ARATION
<br />I lrEby arrm und.r Fnah, of p.rury rh!| t m.i.h fron rlt Conuacro$ Ltense kv ior thc followinS rca$n (Ss.70l!.5
<br />Bu\inc$ dnd Profc$ion Codc): Any Cily o, Counry qhkh rcqliE. n pdiril Io 6nrdc( 8Xcr, inrroE. &mli.h nr rcptir lny
<br />srruct!rc. Fbr lo ns issuarcc. lho Ejuircs thc opplica for suct Frmir ro fik a iisrErl slarcm lhd lE 6r sh€ is lians.d pu^ua
<br />ro lh. Fovi\ioos of[E Conr&lols Lic.nscd tiw (Chlpl$ 9, Co,mcndng sith Seclion 7000 of Divhaoo ] of rh. ausincas and
<br />PrcfcssioN Cod.) or thrr lE or shc i crcmpr rhcElrom ud rlE bssi for rk alkgcd qcry!'ion. Any violslion of Scclhn 10.! L5 by any
<br />qrli.aor nr a Dcmir subjds rhc ,lrli.aot io a .iril pc.!lr, oa not mE ihe 6vc hudrcd dolhc (S5m).
<br />-1.
<br />$ owmr oarnc potErrt, or my .ry,b)es *irn wag$ as rhcn $E comfcnsarion. Mll d. rhc wok trld thc atrucrE n ml
<br />inrcndcd tr oficEn for sh (SE-7044. Burift$ ed Prof€$ions Cod.: Thc Co.r.a.tols Liccns llw docs nol !prl, lo e owft, of
<br />rhc FoFrty vho b{ikl( or inSoB rhc@tr.(t who &Es sh slt hirelf or h.rslf or lnruugh his or hd oqn enploye.s.
<br />provid.d rhrt such inpbsmfu ftmt intcndcd trotrcEn for eb,lt t wcw,llE tuildinB or in{mErin h $ld wilni. oE l4a
<br />of@nplcriotr thc Osn6 Builrhr wil h!rc lhc bordcn ot thvi.g iid hc or ihc dit mt tdild d irp6k rh. popdry for llE IrrF,$ of
<br />-1.
<br />as ovrcr of rh. rml'cny. rm er.loBiwl, onmdins *nh lic.nsn conradoa lo @nrru.l rtE pj.rl (Sa. ?044. Boriic$
<br />0rd nbfis$t Codq Thc Co.t6crols Liccnr tie dd3 @r lpplyb Mowrcr ofprcFrly uho builds or inprov.s lhfi@n.
<br />lnd who onrrdds ror such lmjccrs *irh sC.fltm.ro(I liccnEd plMnt torh.Conmclo r Li.cns Lrs).
<br />-l
<br />!m€icm',t uodcr Scl
<br />EOBf,ESa.S)Mf,ENSATONpEcl,ABAlxo!
<br />I hcrby amm undo pcndlry ol pdiury .rc of $e rolb*ans delelio.s:
<br />-lhrvesrxlsillmi,rruinrCcniltlrcofCon\enrr.Scllloslrctu{orkds'comp.nsarion..stmvidcdl'orl,ySccrion:l7mofrh.Labor Codc. for rhe pc.lormrcc o( lhc ,ort lor *hich thc lsnit h i$ucd
<br />_t nlvc and Nillnu,nruii $o.Fcn .unDc.\{nrn nNxrxn.c. r\ r.qxlrcd hy se.tion lTOl) ofrhc lf,6or Codc, t, rhc Frromm.d or
<br />ric *ort Ioruhicn rhis F.mir i! irtud My wolkcr' conpcnsrrion in\uE .c.ddcr Md prlicy nuDrbcruc:
<br />crrhr 'f".a.tc,"tc /4.,6,, 7rrt. a'o
<br />/- , ?aR ..; -L ,to/,,7/,,s
<br />_l.cdifyrhrr inrbc pcrfoinunccofrhcwork for which rhis pfimn is issucd.l shallnol cq)loy any pcron i. ary oMmr
<br />h N ro tr<nE sr$,.rr lo fic *o cu'comFn\.tionlowsofcalifornia. Md lsrcc rhd ifl chould lx.om subtrr ro lhc
<br />wortcn'compcnsarionpmvnhnsofSrcrionlT00ofrhcL3tnrCodc.lslall.fonhsnh.on ly wirhrhos tmririons
<br />WARNINGT lj,ilur. i. sur. $(trk.B omp.trsstiotr covcm8c is unl,utul. ond shall sutjecr an mtloy$ ro oininal Fnillics lnd
<br />civil llncs rt t, onc hr drcd rk,u\rnd dollaK ($l(x).rxD). n ion. dlmgcs Lr pmvidcd for lh.
<br />Sccrion 1076 ofrh.l,!b.r Cr c, inrcr.i old anormy\ f.cs
<br />uftgrlnAr&N
<br />I hcrcbyrlnrnlndcr p.nrlry ol p.rjurr rhar I rfr li.!.{d undd ln,visn,n oiChlucr 9 (conxRncnU wiih Sccri{h 7(lDr ofDirisi(Jn.l
<br />ol llrc Bu\irEsr a Profc$iinNG)dc. ri nrylic.n\c i\ in,nllfitr.d r ciirr
<br />-B ,/aof47
<br />D.br-E-44Lcontnto.
<br />IEIIICANLIIICI.AEAIION
<br />I hceb, allm undcr pcnulry of ,crju,y om of rlr rollowi.g delarario.il
<br />Dcmliion Pcrmils.Ashcslos Nolificdion Fedcnl Rcslla|nrns lTnt,r0. Pd6)
<br />-Rcq!tcd
<br />l.rrcrol NorilEdii.
<br />removrl rc nol Bl,pli.abk ro lhis pmitl
<br />h .orst. I !8re lo mryly wirh .ll Ciry and County
<br />rcpErcnutivca of lhis Cily o.d Coutrty to cnlcr uton dt
<br />rb{,!e arnrtrnrd pm|ray tur i'\tc.r'.i
<br />Pemtte mm (prlnt): ^(
<br />,OE /2.,,r-t..tt trz
<br />UNDER GROUND rl
<br />Waste & Vent td70 r8 ,hJ?-
<br />Water-Under lloor
<br />Gas-underfloor
<br />Buildinq Sewer
<br />Area./Storm Drain
<br />lnterceptor/ CIarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />It4ain 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 />Rough Plumbinq >\ 86
<br />Final Gas Test
<br />Meter Release
<br />FINAL iD IY
<br />Notes, Remarks, Etc.
<br />-4
<br />Rool Drain
<br />CAIIiIBIJCIIONIDIDINCAGENCT
<br />I hcEby aflnnr und$ lcnrlly of !.ljury thar ltcrc h r onsrruclion knding lscocy rdr lhc p.rf.rmftc ol'hc work f$ *hthll,is pdn,ir is
<br />isiu.d (Sft.]O97. Ci! C.,.
<br />trftlci\ Addc$'-
<br />Applienl or Agoi SlgmtlF:u!nn , 6,/a,/lr
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