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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.OlVNER BUILDER DI]LCANNTioN
<br />I hcrchy rlrtrn undcr rnah, {,f perjory rh3r I un crcmrr rrom rh. contlr.F Liccnsc lj* lor lhc fdlo*in! (r$n (s.c ?0115
<br />Bu\in$s and Pn)ic$n'n Codc) Any Ciry or coxtrr, whi.h r.quircs { Fnnir lo con(od, trhcr. inrovc. ddmliri or roIiair'!ny-
<br />nrucrur. tlrif ro irs nsrrcc. also lcqlncsrhc lppliclnt lb, {uchpcn r b nh, sisncd s0tcmnr rhar hcor shc i{ li.rnrcd pnrsxdnrr
<br />ro rhc pn,vtt,ns orrli Corkacrors Licctrscd tiw (chsl,cr 9. ComDcncins sirh sc.rk,r 7mo.i Divkio.I ot lhc Blsines rnd
<br />Pd,rc\\n,n\ Cod.)orrh,r rrorshc iscrcnrrr lhcrcrioDrnd Ih. bnsis tu rhc {llcgcd crc lnrior AnyviolarionolScdbnT{).rl5hy!.,
<br />nppli.nN nrapcn nrhjah lhc applicur t' rcivilpcnllryolnor nDdrhin fivc hundtcddollns ($500)
<br />-1.
<br />rs o*nc, of !h. IreFny, or ny cryloy*s wilt wa8cs as thct sb conqEnsion. will do (E sck !d llE slnrte n Dr
<br />inrei(|cd or ofi.r.d for elc (Sc,7014. Busircs dd Profcsrions Co<le: Thc ConlElols Lkcns Law dfts nol t'Idy lo n owmr of
<br />rhc I'nrEny sho hril.tr or inpows rlEmc .id who d(H sEh mrll him.cli or icMlf or rhrcugl hB o. hcr own.orlorcer,
<br />prcvid.d rhlr such irymemnts m rcl hrcnd.n o, oficEd fd ob. lt thwE E buildi4 or inlmtm is $ld wirhin orc ]w
<br />ofcoq)lclidtr lrE O"nc. Suilhr will lEw tlE h,&n ot povinS $!r b d lhc did ml hild o, inpore dE ptDIEly for tlt Attte.r
<br />l. $own.rofrhc Imrcny. !herchsiklyco ricrins sirh lie.ed onriddou ro.onnrud ifu pmiccl lS(. r0{4. Burims
<br />and t'tDlis\i{Codc:ThcCd.r0crortLi.cnsckwdmsnot.pplyromoencroapropc,whohlildsorinpnvcslhcrcnn.
<br />nd *ho oflrucls fd su.h ro.iEls wiri r Conlacto(s) liccnsd pu^@ fi! rh. conrm.ktrt Liccns L!q)
<br />I a'ncx.mDt undn SLruon .B &PC forlhkrca6n.
<br />D.t.: O*mr:
<br />TOAf,EIIfI]OMPJIIAIION
<br />PECI,ASAIIAN
<br />I h.rcby afiilD und.r pcnalty of p.qury orc or lhc folloqinB del4urionrl
<br />IhrvcMdwillnrnnir!(tnificalcol'Conrtrll,)Scltlnsuclitr$or[..ohrpctrsrlion,nsPnvidcdforhyScdnn]70Oolrhc
<br />trtxx Codc. r$ rhc pdrhi,n .c ol rlE uork tu $hi.h lhc pcnnil i\ is c.l
<br />,l havc and wiU minrair vorkm conpcmarion iniuhtuc. rl Equircd by Selion ]T(]O of rh. Libor Code. for rhc n norltEflc oa
<br />rhc work for ehtt rth tE.djr iq iinrd My work6 oopendion iNur!re Micr ed plty Ndrxr m:
<br />o c0 o l.\q
<br />-l
<br />ccnity rhsr i. rh. p.rlormncc oflhc wort for uhich lhh pcrmn is irsu.d.l.hall mr cmpr,y trny pnetr in 3n, mnkr
<br />$ s ro hcsnE subJ.li io rh. wo*rl cotr{*Nlrion bwr ol C.lifomi( dd slG lhar if I stFuld bc.om subi(l lo th.
<br />mrk.s'compns.liontmvisiotrsofSdtionlT0OotthcL,borCo<lc.ldull.fonhwilhomply*ilhltbePovirkns.
<br />WARNING: Failurc lo scurc workc6' comrcnsalion colcrasc
<br />.r'l fincs ut x, om hundKn lhouland dollls 'i100.0(I)r, in
<br />S.crion 3016 oathc tjbor Codc. intcrcn ud atrormy r fer
<br />is unhwtuL and stull suhjd
<br />(,
<br />I ncto$yn,nrdund.r pctrdryolpc+ry thal I am nnlision orChiprd 9{.om,rncing enn Scclk,n 7fi)) ofDivhion l
<br />or rhc Bu\incs and l'rorcsknr Codc. and my licctrs is inInllforeundell(r
<br />coNgra!,lcuoxLrNuNclclNg
<br />I h.eb, ainn undc. Fnshyoit€r.iury rhar thcrc h..onsldction lc.din8r!.ncy for thc Frrbrroncc of rh. wo.k fttr *hich thk IEm n
<br />hsucd (se. 1097. civ, c.).
<br />lrlucaNrl)[clrlaalllt!
<br />I tlnhy dlinn uincr Fc.0hyofp.lury onc ollhc aolk'wins dcclamln'ns:
<br />t).mliinrnPcnnih Ask{o\Norifi.rrn,nFcdcral R.Suluri.rs(Tirlcilo. ifiO
<br />-Rcq!tcd
<br />txrrcr ot Miifuri0n
<br />l.cnily rhd thc ltdcr0l !cs!hrn,nr rcsadins fi.io\rcn!,!alrr troripflic.blcln lhi\prorccl
<br />7-*niry 'r', r r,,^. -"1 rr',. dpnl'!
<br />'on
<br />dld n0rcrhr rhcirFvc i 'onrErion is coftd Iasrmtuconllyq'ithnrlcilynid(i,unry
<br />odiumcs lnd Srare l i*\ hlarins h huihn$ cotrs (n,n.rnhcrchyaurhxi/crcnr.{.rsrivcsotrhirCirya Counry ro cnr$ ulx'. rh.
<br />otovc m"r mdrmpcnyn, iN0c{rion
<br />Appli.onl o. r\86l SiAMluF loc.1 .t
<br />u
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waler Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heatericas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 0/1 ,lg
<br />Final Gas Test
<br />Meter Release
<br />*/n/ n >\fr(
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Waste & Vent
<br />POOL/SPA
<br />Gas Service
<br />FINAL
<br />,***.r*, 6 .o"""" n,.*, I,t>o?oa<-..
<br />*,., \r.'1 - I @" .-'^.. P-Lran<-.
<br />txnnri\ AJdrcs:
<br />-
<br />c. -r
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