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PLUMBING-INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNl'N BUII-DER DELCARATION
<br />I hcrchj_ rmnn undcr ncnllrt orl{rjury rhr l ,n cxc.ln ftun rlt Conltrctn l.i.cne l]w for rhc loln,$ins tr{,n (s(?0115
<br />Eusincss nnd Pofc!\iiin Cod.): An, ciry or Coudy Rhich rL{tuirc\ a p.nnir k) Lrn{ntd. ,lrcr, imProrc. d.molnh fr NI[i rny
<br />nrucllrc. r,io. t, ir\ *sxr".c. rko rcqutcs thc lprl].rnr ln \(h ricrnrir h ilcr.isncd slalcmnr lhrr hcorrhc i{ li{n\cd IUnu r
<br />n) Ihc povnions of lnc Coirrarttr l l-i.cn$d L0a ((-hint.r 9. C.nnnencin! wirh St.rhn 7fi)0 oi Oivisio, I ofih. Butincs\ 0trd
<br />t'rottssions Codc) or rhdr h..r\hc ircxcnDl rhqcironra llrc hx\i\ fu rhc nllc8cd cxcnuiotr Atry vi,Lrbn of S(rb. ?0:l l Sbyuy
<br />,mlraf ntr . !.rnrir subrccls rhc oppliconr t, ncivilFnrlryofnor 'frncrhrtr livc hundrcl dollrs ( S5(x))
<br />-1.
<br />4s o*rer of rhc pbFny. or nt c'nploy4s wilh w0B!s &s lhcir *lc em!.nulion, wil & llt wt .rd ltE slrldE is ml
<br />inlcid.d .r ofcr.n fo, sh (Sa.?044. Blsiftii and Prcfcs.io.s Codq Thc Conlmclol, Ltcos. Lls d.d ml apl, ro an owrr or
<br />rh. pmrEny *ho hills or irBtrt$ tlEmn, ltd who &f,s tun mrl hiNrll or hcscla or rtmlgh htu or h.t own cqik vcc!.
<br />providn th.r sBh imprcvmntr G mr i.r.,r!.d motu for sk lf. hos.t( tlE hildin8 or idpmkftir h $ld wittin oE yw
<br />ot@ipbriotr iE OwNr Bui!.r wil h.t tlt lu&, of fovi€ rhd hc .t slE dn nol tDild m inpmE dE potEry for ll* puqD* of
<br />L N.wftr ollhc !ruJ,eny- amd.l6iv.lyconheriIg with liccnsd conrrddon lo oisdd rrE pttri$t (56 7044, Bus.cs
<br />a l Pmf6si6n C{*t.r Thc conlr{lols Licc.sc Las dGs ml rrplr lo an own$ ofrooeny sho builds or inrlrcvcs lhemn.
<br />md who conrEcls for such rmif,k wirh a C.ntmclo(O kcncd tunuont to lh. Conlmdols Licnsc Ljq).
<br />l0mcrenrpl unds Scction- B. & P.C. tirr this rc!$n
<br />Oen.r
<br />rlr8trE&t-c0lrIlN$Allo
<br />DECI.Af,AUO!
<br />I hcrby llfirn unrhr F.ndly oa t 6jury orc o{ lhc followi.g d(lualionrl
<br />-lhiv.dndwillmainlain{orkersconnnrario.in$rlncc.rsEquircdbyScclion:lTmofth.hborCodc,forlhcPdfo@nccorrhc work lor whi.h rhispcnnir i\ iss.n Mrwo snp.nsdion insur0mc cMio dd PIky .umh.r N:
<br />-l
<br />c.nify Uar i. lhc p.raolrum ofthc wo* fo! qhkh rhh l{.nir k issucd. I shlll nol employ.n, F6on in 8ny mdiftr
<br />o srob.o@ sublrt bln mrtm olnpcnsrion |tws of Cstifomi!, and .8r lnal ,f I sbotrld t .om suhjd lo rhc
<br />hrlc6' comFrsalio. pmvisions ot S.dioo l7m of rk t hr C-.dc I shllt. fdhwirh ohply enh rnos pmvnions .
<br />WARNING F ilurc ro sue wort6 ompcnsrion oErags is uila{lul, snd sh.ll subj€l m npliy.r m €iminal ,Emltis snd
<br />civil fincs up lo oft hundrcd lh.uend dollds (llutom). ir addilio.lo rhe.$l ofcomlensalion. ddmgcs as pmvit.n ror rh.
<br />Ao't'---1U-4 -(lo.. f
<br />UIIITTU-rcNIB.\!X)3.
<br />Dligr\&IIION
<br />I h.r.b, arlirnrtnd( rlnrkyol fcrjuy rh{ I Jtr,li.cneJ rftlcr rR,lni,n ofClrnlcr 9 (co'nmfring wirh Sccri(in rUXr) or l)ir(oi l
<br />ol' i|[ trusincs\ rid l,rot \n.rsCodc.aln my li.cnsc i\ in tullturc. r lcf&rl-2)1677CL1
<br />tal -tt
<br />ATILICANIDI:ITIBAIIgN
<br />I trNh!dfinnundcr I'cnnlry ofperjuy onc ofrhc rblloNinB dNl lrion\
<br />D.nxniin{ P.rnirrAshcslos Norific ion F.d*al R.grl ions (Tirlc 40. P.n()
<br />RLrturcd Lircr oi Norifrlrbi
<br />-l
<br />ccnily rtal rhc lcdchl r.8lhtions Bsodinr lsbcsros cnslll m not 3p! tahL lo rhn loj..r.
<br />-l
<br />ccrlify rhar I hrv. rcd rhk $plicorion lnd slsrc rh0r rh.ih,w i.ro.@lion iscoml.I aE@ ro ooply withlll Cirv d Coun',
<br />odiNnccs lod Srrrc Liw. rcl,rin8t'ldiry consmdion,,nd h.rchy {urhotuc rcpre*ortrriv.s oirhis City lnd Coumy ro.nr.r upon r,f,
<br />above mnriomd lnpcny for
<br />Appli.tr orAsenlSknllue ttr
<br />UNDEH GHOUND
<br />Waste & Vent ?^t. A ai ,t)
<br />Water-Under lloor .1 '1 v1', t
<br />Gas-[Jnderfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent ).t .l t..a)
<br />Water Piping 01 w U6 ry!'--(,/Z
<br />Gas Pipino
<br />Roof Drain
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL lt lw 6.'r 78)
<br />Notes, Remarks, Etc I U\ <-"
<br />APPROVALS DATE
<br />-l
<br />l,r!c riJ Rill hinr.ini(c,1ii.ulc.l'Corscort,Sclfln\trrcrff$.'k.r\'.ornp.n\rrnnr.rs nrovidcdlirbyS..rbnlTU)ofrhc
<br />L:'hn CoJc. hrrhc nnnmrr.col rhc qotk lbr {ii.hrhc pcnn n i$utd
<br />COIISTRI]CTION I ENDIN(i A(:T-NCI
<br />I hcrchy stlinn!trdcr p.ndxyolFrjurylhur lhct h ! cnnhdi.n kndn'g r8crcy for lh. pcrf{trtutc orrh. wort fot shth rhk Frnri' is
<br />nsu.d (Scc.1097, Civ C.)
<br />I .ftj.''\ Nr.r:
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<br />kndcr. Addrcs
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<br />Tub/Shower Test
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