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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNI]R I]U[DER DET,CARATION
<br />I h.rc$y rlllfln undcr Fnalr) oi pcrjury lhat I an crc.r tntrnrh.(ln cro^ l-i..tr\r li$ nr ihr i,,llotrin8 rcr(n (Sr 70:rl5
<br />Bu\ir$s okl Pn)fr\\ioi (inlc) n, C[, or Counry whic[ rcqunc\ i lurnir b .oNnkr. .lrcr. nn[,rc, dctrnli\h or rcUn aiy
<br />{ruclurc. priorro ir\ i$urr.., rl$ rcquncs rh.,prli.inr ntr such Jr.nnirl,i filc a \isnc.l\r cmtrt tnlrhcor shc is liccnred nursu!
<br />ro rhc nnilNn r.f rhr (irnr&rtr 1 l-il{isctl !_rs (chJlrcr 9. cotrrrEtr.ltr8 wirh sccri(D Tr](xr ol oiui(nfl I ol rhc au\inslr.d
<br />Pflrc\\i{nr{()dc)orrhrr h(or shc Ncrc rU rlrrclio and rh! h,\n kn lhc rllcscncxcnDlion AnyviohtionolS.crirr0ll.5hyuny
<br />{flicrnr r(rr t^-nnn $hjccr\rhc 0ppli.nnrro rcivilNMlrtor or rrrrrtui fi\c hu dRldollrr (S50(D
<br />-1.
<br />$ owmr of th€ tmFdy. or my .nplolr.! wnh wlgcs es thcn $t ompcr$rion, *ill do llr *mt ud tlr stnxlft is ml
<br />inredlol or oilcred for ek (Se.7044. Busimss ed PDfcsions Codc, Thc C.nrd.rft , Liccne trw does not apply ro d owtur of
<br />lh.pmrcny who htrild! or inuors tlEen lnd who do4 such w,t hims.lf or hcrsclfor ihmu8h his or h.r oyn cmplore€s.
<br />ptuvidd rhar sucn imlrnrcm s @ mt inrcndd orofl.rd for eb.lf. hosk( rh. hoiHing or iryrcEmd is eki *irhin onc,€,
<br />oI onplclion. tlE OwN Auil:kr wiu h,rc Ur h!d.n ol rrDlins rhar l* or slr dn mr hiild or irymvc rhc pmtEry for rhc l'uqD* of
<br />-1,
<br />asoqmr oflnc pml,cny. m.rclusivrly.o.lrocrinC sirh lianai contmcloF ro mnsltu.t rhc pojecr (S(.7G14. Burinc$
<br />ard Pmf6i,n Cod.: Th. Conrr.croai f.i.cnsc Llw des nor apply ro M own r ol prop.rty who builds or inprov.. rh&.on.
<br />a.d *ho .o 6cB fo, slch lmjccrs rith 0 Conrrocro(n lisi€d punu,nr !o rh. Comr&rof! Lkcn* L!p)
<br />I rnrtcnrnr trndrr Sc.i
<br />I h.rcby ainmlndcr Il(mllyofNrjuryorc oiihc fcln'qin8 d.clddn,nr
<br />-lhiv.$dwilltui.i.aCcnifr.rcofconscnrloSclf.InsuElo,wekc*on{Ensrion.osl,bvid.dforb,S.nion17006arrELabor Cddc. for thc lErfommc oa thc m* for whhh lh. p..mir t i.sucd.
<br />,l h.vc aod will nai.hio workc^ .on cnsarion insunmc. as rcquncd by Scclion 3?Ol of ih. Labor Codc, for rhc l.rfomicc ol
<br />lhc wo ror which rhis pcrn is L$ucd. My *orlcro' cotrp..salio. insurmc. ffhr .rd Flicy nuEbo el
<br />-l
<br />€cnily lhll i. thc pcrformmc ollh. work tor which rhh rcrmir h hsucd.l shlll not cndoy My Fcrcn in an, donrcr
<br />m N lo h.com subjd lo lhc qo e6'c.m!.nsnlion lnws of Califomi{. r.d ,g@ lh,! if I sbuld becoft slbjccl ro thc
<br />wartcN' orycnsrlion pmvisions of SNtion 37m ol lh. Lnb.r Codc, I sh"ll. ionhwilh comply sift 0.s pbairioos..
<br />WARNING: FailuE lo sc@ sdI.B'dnpendbn @mee is lnb*tuI. Md dEll rubrc{l d emphy.r to 6injn6l FDlli3 and
<br />.ivil lin s!p to om hudEd lhous.d dollm (Sl@.oq)). in additio. to Oe cost of omlcn$rio'! d!tug.! e fovid€d ro! fic
<br />Sccrbn ll)'76ofrhe L.ttn (odc. inrcrcsrndJnorrcy'\ tuc\
<br />Dsle_
<br />I l*Eby .rrro undd pcnrlry of lcrjury lhll I m liensd unds prcvishn of Chlprs 9 {mmmminS w n Ser i.n ,0(D) of Oivishl 3
<br />of E Blsircss $d PDfcssions Codc. &d my licc.k i\ in tull fo@ 0d cfiecr.
<br />Liccnsccl,N: LicctrscNnnlf,r:
<br />CONIIBICIIONIENDIIIi.ACENCI
<br />I hcruby lf,irnudcr Fnalry otpcrj!ry th lncrc is.consrruclion hnding aScmy lor rhc pc.lormme oalhcw.rk ror whichrhk lErDir ir
<br />tsrcd lscc.1097, Civ. C.)
<br />APTIICANTDDCLAA{UON
<br />Ilrrcb,{,iianundci|)c..xyorr.rjuiyotuorrhcf.llowinsdccl alions:
<br />Dermlilion P.i,nns Arbcnor Norificari{ Fcdural Resrlarions (Tnb40, Pan6)
<br />-Rcqun
<br />d l.ricrof NrrilE,lbn
<br />_l ccnify rhlr rh. f.dc6l rc8llarions rcSuding ssbcdd rcmvol irc ft, ,prli.ailk ro lhis pn*rr
<br />-l
<br />ccnify lhal I hrrc r.od thn applicalion and srarc fid rhc alhvc inidmri.n hcotur.l uSrN k, comrlyqnh rll Ciry and Cooflty
<br />ordiMnccs ond Shrc hws mhrinC t, buildine cdonrucrion. ed h.rcby luthornc rcrrc*nrdivcs ofthis Ciy and Coutrrylo cnrd uFrn rlE
<br />abvc nf,nrn,ncd pmptny i,
<br />,\tipliunl rAq.nlSiqntrt,r.l *,,,?'17-tg
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area"/Storm Drain
<br />lnterce ptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pi i ng
<br />Roof Drain
<br />Tub/Shower Test I q Lu.4 )
<br />Rough Water Heater I
<br />P{rap/Drain Line
<br />Main Drain/Pool Pi pino
<br />Fill LineiBack 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 />Bou gh Plumbing lP t\$.A41(A
<br />Final Gas Test
<br />Meter Release lr\
<br />FINAL 2-X,Y48{
<br />Notes Remarks Etc
<br />Poli.vNumho _ E\n,(< _POOL/SPA
<br />5-l'1
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