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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />v-'lt)1Water Piping I iL/
<br />Gas Piping t ut'"
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />r-l ,^
<br />FINAL I\-1-
<br />Notes, Remarks , Etc.v
<br />OWNER DUILDER DELCAR ON
<br />I lEeby llfum undf p.Mlry ol pedury rh.t I m cxcq)l iion ftc Conu&rc Lk.n* t w for lhc fotlowing @$n (S(.70J l J
<br />EusiNs lid P.oLsi.i Codc): Aly Ciry o, Coufly shth rcquirc$ r p.mir ro conlrdcl. allc( iqlrow. .h@!iih or rcpin any
<br />smctuE. prior lo ns ir$.re. .l$ cauiB th. E plk&r for sh Fmir io lih. riSrd shle@nl lhll IE or sh. b li..rsd puBudt
<br />lo llE provbions of rtE Conlmclols Lic.nsd ttw (Cnaflf 9, Commenci.g snh S.crion TOOO of Division 3 of rh. Busincss lnJ
<br />Pmtcask ns Co&) or rhlr hc d slE n .x.mfl rhcEfron and thc trsir for rn dkgd .rcn{,rion. Any viohrioi of S*rion 701 L5 by 8ny
<br />applicur lor r Fmi sbhck lhe al'plica.t to a civil t r@lty of mr tur lhli fi(c hu<lr.d dolld! ($5OO),
<br />-L
<br />6 ownf of thE p,!!cny. u ny tntloy6 wnh *!EB rs llEt $lc onrpcnslion, will do lhc qort a,d llt stffiw is ml
<br />i cidcd or olTcdd for slc (Sc.7Ol4, Buriftrs and Phacssions Codc Tfic Contreror'r Lic.n$ Lrw doc. ml lrply lo m ovffi ol
<br />$. pDp.ny who tuilds o. iqrcws fi.@n. rrd vho dcd ssh m him*lf or h.celf o, rhougt hG o,lF, ow..nploFs,
<br />proitlcd lhrl mh inprcEmnts m ml inLlrd.d orotM for$b.li hoftq, iE trildrS or irtD@wmnl ii sld within om )Er
<br />oaonq,Lti,( llE owmr Buirtc win tqE dE hrl.n ofptuviq thd lE or dE did ml build or nr{,mw dE PtDFrry lor ln l)lrlr$of
<br />-1.
<br />!sowturolrhc Fmp.ny. rmcichnivclyconrrmrinS *i$ liansn onrrutom to conntud rhc pmi$r (Sr.7044, Burhcs
<br />ond PJtrfcrion Codc: Thc Conk{cror's Li.cnsc Lrw d.$ nor applylo 3n osn$ oaproFdy wlD builds o, nnprovca lh.rmn.
<br />and who onlmcls for slch t'misls wirt ! Conhcro(s) liccns.d r,usurnr ro lhc Co rEcrols Lic.sc l2w )
<br />_l an.xcmfl lndd Serion- B. & P.C.lorrhis rcen
<br />Dule: (rqm.
<br />UQAf,EBI.:COMfINIUI&!
<br />DECLIaAII9X
<br />I turcby lffrn !.dcr Dcnslly oa n&i!r, onc of lhc aollowiD* debhdo.s:
<br />_l naw drl will mintlin 3 Cenific{e of Cooscnr ro Sclf.l.s!rc for work6 oflpcnsrion, os [ovidcd for by Sarion ]7(D ol rlE
<br />Llhor Cod., ftr lh. rErformmc of lhe mrl for which lh. Fmil t issu.i.
<br />-l
<br />h,rc ond will m,inroin wor*cB corpcnsarion i.su.!ft., !r GNi&rl b, SEr io. l?00 or rhc Lihor Codc. for lhe pcrforurcc of
<br />thc wort tor {hi.h lhis pcmn is issrd. My worlcl cooFneiion insnrm.c cactr ard Flhy rumb.r m
<br />-l
<br />anify fid in fic p.rlol1,M. of lhc wo* lor whi.h.his pcrnir k Bsucn. I sh{ll mr .,ploy any pcMn ir any mnmr
<br />s $ 16 tx{om subF.r ro rh. $rt6 6r!*.sarion hes of Cllifoniq and asre rhar if I slslld ltom $b}rr lo tt
<br />worl€* ompetrsi.n !ovi3i6B.f Scction 1700 of rhc L.bor Codc. I shlll, lonhshn @q)ly silh rhos povhiors..
<br />WARNINGT F ilurc
<br />'o
<br />surc worlc* comp.osorion mvcmgc is unhwtul. nnd sh,ll suhjer an cmplorcr to aimiMl Irmhics ond
<br />civil ,iner up lo nnc hudrcd rhousaod dollcs (S|0O,UD), in sddnion ro rhc .osr .l .oq)enrario!. dr@g.r rs provi,.d for fi.::;#dz:
<br />I hcr.hyrllir ul(.ls rcoalrrofpcrjlry rhrr I!m lien<n undcr rmvhn,n ofChaptcr I (comnrh-'inr sirh Sltrior 7Cx)0) urtrili\n]n l
<br />of rhc Busincssand lto,t$nnrsCodc. o .ry liccnsc is ir rullntr c rl cllLrr
<br />IONSIBII(:I]I)iiI.ENDINGIIiI'ILCI
<br />Ihc'uhyrf,lrniuJ..|xrlrtolpcrjrrrhdrhcrcisxcon{n'.tnn[ndingrgcn.tfitrrhopcrtrn,rn..ofrhrworkn)rshrlihhFnn,i\
<br />i\sucdrsc. ll)97 ( iv a r
<br />A.EUqAUI.DICLA8.&IION
<br />I hcEby ufinn utrdcr licnalry oI,Erjury.re ofrhc ioll{,win8 dol$alio"s
<br />DenDliti{nr PcflnitsAshrstos Norilicorion f,cdcml Rc8uhhns (Tirlc.10, Pun6)
<br />_Rquired I.rrcr of Norifi cariD
<br />lc.nifyrhar rhc f.d.r l rcgxlrriois mtdiding d\h.ior rdnx,vrl *. *n ap/kihh lo {hi\ piorc.l
<br />I .cniry rhd I hov. rcad this a!,licltion ,!d {a'. $ar lnc uiiovc inlormarion ir .oroL I rgmc lo comply *irh .ll Cily and Counry
<br />ordimRcs and Siar. LrM Ehri.g
<br />'o
<br />buildi.S .oo rucliotr ,rd h.Ehr ourhorizc ft ofrhh Cnyand Counry ro cnl$ ulnn rh.
<br />,txxr ftnrioncd pmp.ny tu itr
<br />ADplicnnt or AE€nl Signniur
<br />'P-
<br />$f}Es{u
<br />COMMENTS
<br />4Dt I q'
<br />Water Service
<br />Meter Release
<br />-,, 7//?/e-
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