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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDI]R DELCARATION
<br />I h.rcby,llirrn uM.i Nnalry ol Frjurr ln!' I arn cxcnDr lmm rhc ContrachF l-iccn* LL* lnr rK( r lluqing rc.sr rscc.70ll.5
<br />Busirr'\i n Pnntssion C.dc): Any Cil, or Counry which rcquircs a pcmir k, ..n{rucr. ulrcr. irprovc. dcm.li\l' or (nrir rny
<br />nruduc, lirx !, ir\ h\!aocc. rlyr ftqxiBs rh. ippli.rnr iitr skh li.rhir h [h. si8nL.d qarcmN rhnr h.orshc h li..n\cd l,u^ar.r
<br />ro rh! pm+nnrs oi r,r Conlracntr \ l,iccn*d l-iw lChuprcr ,. Con,ntdtr! *irh s..rion 70(x).f Division 3 olrhc Busincs trnd
<br />PDlts\i,)n\Codcrorrnnrhcor\lr i\rx.'nfl rlrrcfi.nrlld rhc ha\i\ nrrhc rllcBcd cxcnr!rion. Any !iohrn,trofSccr6n70.ll5 byan!
<br />rmlicnnr n n!.rmirsrl'j..rsrhc.|llicrnrto0civilrtr,lryornornlxdhrnlnrhundrcddolla$($5Ol)
<br />l. u\ osrcr or lhc popcny. o!mrcmtloyccs wirhwrs$nslheir solcconrp.n\rrt{. silldo rh.s(/k{ rtbsruduEi\nol
<br />ntrc'iicJ orolf.rud frr{lc(Sc..7(}!. Busimssa PkntrsonsC{xlc:ThcConni.tnsLi.cn*tawd€xnol.rr,!ylo!nowncrof
<br />thclfi)Fny El$ l{ilds or iryrrorc! lhcEnn- ard *ho d(rs ssh wo hn.s.llorhcrclforrhou8hhisorhcrDwi.'npkJyccs.
<br />pmviicd rh r such imnrcvcn.trls 0'c nol inlcnded or oriqcn tu {t. tt h$rr, rhc huiktinS or im|^nt'n ir sld wirhin o.c )w
<br />orcoDDldk^ r ()wtrcr Buildc! will hrrc !h. hxd.n of l(Jvin8 rhrr hc or shc dil Dor huild or inltlm\c rhc pDImy n, d. llqrM or
<br />-1.
<br />.6 ,,$ ncr "ll hc Dn,trny. onr .\ lu\ilcly runrr!(rinr $ir h ti$nsBl cofuncbn t, ..nsru.r rl'c lr&cr (se 7tl44, r,uvnc$
<br />did k,r6\irn Codc: Thd Co.kr.ror'\ l-i.cnsc Law do.r tro! rpply ro nn oqicr ol[op.rly gho build! or nnpro\c\ rh$.oi.
<br />rrd wh..unh.Bio.suchrmlcds*irhrConrdon9liccflscdpunulnlr.rhcContdr'sl-i.cn\cLrw).
<br />-l
<br />rm cxcnlit lndr Sdlior-. B. & P.c- for lhis t&{n
<br />l)dr ()sn(
<br />IA8f,E8S:.COMEEIIAIIAN
<br />DFCi ,ll t.|oN
<br />I h4Ebyu,nrmun&rOcmlryof Fju.yomof rh.followhedelnralio :
<br />-lholc.ndvill'run
<br />liiiCcnilrdcofcoi{nrk,Scllln\urcfors.rkcn.omr.nsdion.as tmvidcd lor by Sccri.o l7m oirhc
<br />LrtxrC(x]c, lorrhcpcrfornurccof lhcwork forwhth lh.pcnnil is nsucd
<br />_l hdvc {nd sall @i6l,in *o,kcn .onFmarion insuram.. aq nqdFd by Scciion 3?00 of thc tit or Cdc. for rhc ldfo,fucc of
<br />rhc w6rk ld which rhl{ ,cmir is issEd. My wortcu @npcnerion iNurm. cmiq dn policy tumbcr ac:
<br />-l
<br />cenifyrhd in rlr lcrfortuncc ofthc w6rt tor whichrhhpcrdit h h.ued.l shrll.or emptoy lny Frsn in rny hd*r
<br />$ er ro b..oft subrer lo ih. wort.s .onp.oelion lows ofcalifomi,, od ogM lhll if I sholld bcsft rubiftr ro rh.
<br />wo,lcs Nmpcniario. povhions of SNlion 3?m of th. tjhor Codc.I ntrI. aonhsilhomPl, wnhrlbsl,ov ionr..
<br />WARNIN(: I.rilr. io {curc sr crl $n,mn\ rion ovcmrc a sh,ll suhj.rr M dnplo'tr lo
<br />crvrl finc! ut t. urc hundrcd rh,,u.,nJ d ll,'\ ,llcro.{mo,.
<br />S6rion 3076 olthc Llbor Codc inrcrcsr lnd arormrt fes.
<br />fr d- rdo
<br />D[cl.tr8rr.1DN
<br />Ih.Eh,altrnloncrEndryotfrrjuryrh l rnr liccns.d ututor |r.risio oiChrlrcr9lcomntrcingrirhSc.rion70U))ofDivirbn:l
<br />ol rh. BNi',.ss 3nd Pror'cs\ionsC(dc :unl 'n! licnsc h i'r lullforcc aftl ctltcr
<br />9-9-,4
<br />COISIIIICUONIENIIIILAGENCI
<br />I hceby xmnn und( Fnnlry ol p.rury rtu rhcr. h . con{dcrbn lcnding agcrcy for the n domn.c of I h. sotk for whih lhis Fmt t
<br />hsucd lsa. 3097. Cir. C.).
<br />AITLICANLDECI,AEAUAX
<br />I h.rct'y trfitn undcr pcnal'y ol Fr.jury om of rne nnhs ins dcchnr n,.c
<br />,_Dcnblir n P.nni$A$.\lo\ Norificaln F.dcrrl R.8ullliotrs (Tirlc 40- Pan6)
<br />,ra-Rcqurcd krkror N.nierEn
<br />-1-,*nrr,*,* "u."1rcsuldri.$
<br />rsodrns u+tqo\ rco,val . nn! 'mlrshlc to ths fmFt
<br />_l.diry lhar I havc rad rhh.rDltarion dd llc lhar rh. abovc I asE bomnly,irh dll Cirynnd Coun'y
<br />.rdi'rn.cs Md Srrrc Ltrssd.rir8 h
<br />ator mnrioncd rroFnr l i.spccr
<br />ivcs ofrhis Cn, lnd c.xnrytu dnrd xro.lh.
<br />,\pllicsdl or Artnl Si,inrlu
<br />-9-t3
<br />UNDER GHOUND I I
<br />Waste & Vent SIZ.l l8 &3+
<br />Water-Under Iloor lr
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />?
<br /><\
<br />Waste & Vent 1D'i0 7)
<br />Water Piping
<br />Gas Pipino b)-te ;*a\t€ (,E-*-e-t-
<br />Bool Drain /t-u-tq 4? 4?
<br />Tub/Shower Test fu9 tt4Vte /hL-L
<br />Rouqh Water Heater -, *; n'---/
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq (04(-ta aeA n
<br />Meter Release /z'?/?'Tczz
<br />FINAL /z-3-/8_4zz)?2) /br4
<br />Notes, Remarks, Etc.
<br />h(?, /k' a,c //'6 -/RWL od ./-u.*,*<- //e€d4P nt fir.a
<br />L.ndcrs Addrc*:
<br />-
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Final Gas Test
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