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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oWNER BUII-I}DR DILCARA't'ION
<br />I hcrchy rmrm unds p.Mlty of perjur, rh.r I m cxempr lm,n thr (onrrdo(' Liccns. ta* fir rhc nrbwinS rc.sn (S{ 70ll 5
<br />Burinds rl Pn,fe.sion cod.l Any Cny or coutuy {hich rcqxrc. a ,'.trn ro mnnrucr, oltd, impnnq dcmlish o! EDan any
<br />nructurc, Drirrro s hsu.N..0horqutr4thc.ndica.iiorsuchp.mnlrofil.rssrdlsl.remenl rhlr hcor sh. i.lic.ns.d purtuad
<br />Io rhl pnnisionr olrlt contriclols Lic.n*d Law (ch.tr.r 9, Coom.ncr8 wirh Scction 7000 of Division ] of lh. B$nress lnd
<br />FmLssionsCodc)orrh.th.orsh.bcxempllhcr.tomandrh.basieforrh.0llcsedcxcm/irn.Anyvn,lcnonofselionT0llSlty.ny
<br />omlicanr for a Dcrmil shjectilhe aprl'canrl.ocrvilDcmltyolnornrclh!.filchundr.ddolldm(S5U0)
<br />l. ds oq..r oflh. pmn ny, or my .nphrd *nh wns* N rh.t sl. oqrtrsrior sill d., $. srl ,id th. ddw !' ml
<br />i.tord.d 6r oltccd for ih (56 7044. BusiB and Pot6.io.. Cod.: th. ConlE.lo/r Lic.rk L,w .b.! nol arply to on o{n r or
<br />th.Dmpcdy who hil& or if,rmq t,se ad wfio &* $ch mi( hi@.lr or hcs.lfor thmosh hi! or h.r oM.mplorc.t,
<br />rovid.d rhal sch impmrnrfli e ml td..d.d orotrd.d 6r $L. l[ hee, tE hildins or Epmrnfl h$ldwnh'n.ft r@
<br />ofmnpLlhl\ rh. Owrcr Auit r wiu how tlE bu(kn ofpovi,{ ihd lE or rlE dil mt hoild or irromw lh. r'Epqry for t E ,IIFE ol
<br />-1.
<br />as oM.r 6frhe Dmlory. d.xclu.iv.lycodrddins wirh lic.n*d cod@x16ro codtud rh. poj.d (Se. 7044, BuriE$
<br />!fld Pmltsin Cod.: l hc Conrricroai Liccns. Lsw doB mr .poly lo 0n o*nq ol p.orJeny *lF builds or impmk! rh.r6..
<br />and who 6,r6di for .h pmFG wi6. Coder.(r lieo*d punuad ro rhr Conrruclois Li.dr t w)
<br />_l an.x.ofl und( Seri.o_, B. & P C, fnrfit r.isn
<br />D.r.: Oan.r:
<br />]TAAEDIE.GOIITIIIAIIITB
<br />IECIAAAIIO!
<br />I h.rcby iilrn u.&r p.mlry of Fru.y oE of l,E followinS dftlmrion!:
<br />I lB!. nndwillDrinIlin,Ccnific cofcon*nt lo self-ln{rc ntr trorkcre' conu.nslrnrn, !s pmidedlirrhrs..ri.n17m.iri.
<br />Linor Cod., for rlp pdlnrnrMc olnE "or* aor qn(h rhc Fmhtr is s.u.d^,.21+.. ",,r " '
<br />r rn.' 'nl.' rn s rr.ts' rrnn.mar r 'n ,nsuraNc. tre rcqu rcd hy s.cl
<br />'on
<br />r7rr0 ol rh. tjlx, G)'1., for rft rBlitrDnncc o I
<br />catr'.r rrtl polLcy ntn,h.r art
<br />1 1- 2i. -tq
<br />-l
<br />cenily rh.t in rh. tdfomrce of rhc wort lor which rnh p.mil i. Rfled. I .h,ll nor cnll)loy 6.y p.mn in 6ny mnmr
<br />m a! b b.6ft 3uhj..r ro rh. $o.lcu'smph{rion laos of Crlifomiq lnd ssE rh.r if I 3fiolld b.tom {bj6l b tlE
<br />w*e' omFElhf, 0m\tion, of S..lion 3700 ollh. L.bor Codc, I sholl. finh*ith comrly wirh lh.c lelirions.
<br />waRNINc: rarLrc lo rcrE work.B mnp.nsron cove6s. n rnlastuL .nd sh.ll subl..r an mnloy.r ro siminol Feltii anl
<br />civil no.. un ro o.. hund..d rhou..rd dollm ($100,0001. o addnion to rh. co* oaomp.Nrior'. &rus.s os tolid.d for tn
<br />x."])ltctaBAual
<br />I hcftbyim hund* pcBlryofpc.turyrh.r I oin l(.n*ltrnd8 trerNor.l( haDrcrr) (mnnncncinE Nirh S(lion 7000) otDrr(n,n l
<br />of rhc 8us'rc$ an<l PmLssions Codc. and myliccnk N m tullfirce rrd rfla{r
<br />(-3la^q6reT\
<br />K*,._l\{-Im,-",-
<br />caNsrauclla!.Jiullllc3clxcl
<br />I heBby .flirm und.r p.nrlry o aD.rjury rnar rh.E h n mnstdcnon lcndins aserc, for rh€ I'crfi)lrM* olr h. *brk hr which rhii Fflrir is
<br />irsr.d ( se. 10s7, civ c.).
<br />Affl.lCANfl)jiCLAtr.&lION
<br />I tf,Rtry8ftnnund€r r.n0lry of ncriury on. olrlk folbwnrr dsl.r.rions
<br />D.mhrion Permir $ 3h.sros Nor r,ic0t ion l;cd.nl Rc3!l.rioi.{ l tle,10, Pan6l
<br />Requircd Lller oaNolifi carion
<br />-l
<br />ccniiy thir lhc f.dcml rc&lations Essdins .sh.sr.s Ennv0l E Bn !p i.al,l. ro rhi pmr.{r
<br />-l
<br />cdliry rh.' I h.k,.ad rhii atplkrlioo ard sr.tc hl {i. afiow infomrioh is coE ct. I ur* to comrly*nh 0ll Cnyand Couly
<br />ordiqlB and Srar. Lak Elding to buildin8 con*ru.nol\ d h.r.hy.urtbriz EpEs.r 6riv.B o lthh Chy
<br />.bovc mnrioed nop.ny lor iq)..1ion l!4bs.
<br />@wVo\lb
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />\
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler I
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL //r27/t4 -,4,W-ttl
<br />Notes Remarks
<br />cI
<br />L.nd.'a AddRr'
<br />-
<br />Gas Service
<br />Etc.
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