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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTVN ER BUII,DER DEI,CAIIATION
<br />I h.rehr rlrtm undcr ocntrllyolFrjrry rnlr I i'n cxcnlpr rro'n rh. cofua.tr{ Lk. { liw fu rh. roll,)trins rcrsi tscc?lr.ll5
<br />axsincsr id Porcsion Codc): Any Cir, or Counry Lyhi.[ rcqun s r Enni' n) eNnr.', rlr.r, nn|r,u, dcnnlish or (,)llt n,
<br />{ru.turc. priortu its issu&f,c. rl$ r.quircs rhc+pltrnr 6r sochaf,rmirro lllc asig.cd nlrcm tn hc.rsic is lic.nTd puruinr
<br />b rhc lmvilirnr\ or rhc C.nkr.roir l-iccn\cd l]* (Chaprcr 9. ConxncNnrs qirh Secrion ?un of Dnision .1 of rhc Bnsimss and
<br />Profcs\i,,nsCodc)orrhnr hcnrshc iscxcnrl, rhcrcrn,n,M
<br />'hc
<br />h isrorrhc,lklcd.rcDDrion Aryldorio.oaSccrfiTO.ll5 hyuny
<br />rpPlicr.r lU rlcnnil subjah lhc appliclnl ro icivilpctrrhyuftror morcrhntr livc hunded d.llrr{ ($50O).
<br />-1.
<br />6 owmr oallE pmtrcny. or my .nplotBs wi{r ssg.i &r *rcn sb ompcn.d,on, *ill do rt s6t dt lhc fln lm ir rcr
<br />ir.Lnr,.d or o,IcEd for slc (Sc.?044, BBims snd A!f*rio.3 Cod.: Th. Coturd's LieB t w .tEs mi lpply ro u oeBr of
<br />rlE ForEny *ln hoildr or ni{mB llEon, drd wlE do.r Mn s& hiBlf or h.tulf 6i 6muli hk or lrr ow. copLr6,
<br />pmvid.n lhrl ruct i,F nErni! e d imcrdcd orofM for slc.lf.lbw6. rh. loildingorinForEnr is sld * inofttur
<br />of or9!c on. tu Owffi Boildd sill hlw rh hdlcn of pbvin8 thd tE or sltc did ml boild oi irpE* $. pDpdy hr ,E puF$ of
<br />-1.
<br />a osmr of thc ropcn!. m cxctusikly co.racli4 vht lian*d conrrtou ro .ontucr rlE prci..r (Se. ?O4{. Busim$
<br />8d Eof*bn Codc: TlE Conlr..lols Lkcnsc tiv dng
<br />"or 8!ply io m ownc, or prtFdy who buildi 6r impmE. lh6@n.
<br />and eho coorets for .kh proirls airh r Contredo(s) licnscd l,urunr ro rhc Co rctol! Lixn* tiw)
<br />L'ncr.nnt trnri.r s&r
<br />Orrer:wol(r'ls' coMPmtsaTtorl
<br />DECIdaAIIq!
<br />I hmby 3filrm undcr pcMlry orl,crhry onc of lh. aollowi.S d(LBlions:
<br />lhJ\cJ'{*'lltuinrJ'nnccd,fi..ula,{rd hsellln{".ttr{.rkc6conlti.nsrlion.0(Ji()vidcdntrhysc.rionl7fir.frh.
<br />Lhr crJ.. rir rhf Frfornun,.c ,,Irh. trnrl l rhi(l rhc B.' nr '. h\uAl
<br />f)A*." *r ',,,..,,, "
<br />*, {rr^' u xn..n.JrBn, ,n\urunc.. r\ rcquncd by sccrFn .r7(x) or rhc rrrsrcodc. rorrhc pcrro'nnnc.o,
<br />h hsue{ Myworkcs ..m,t i,r nNurrncc cr"i$ rnd Inir, tr$cr xrc:
<br />- 2b-l %
<br />l.cdifl rh in rhc pdaortunce oflhe sort for snkh rhn pcmit is hsucd. , sholl nol cnploy any lJcson h 0ny mn.crs s to bc.onr subFd lo rhc workm' .ompcnslrion laws ofcllifornia. ,nd aBd rhlt it I \hould h.com slbjel to lhc
<br />sorlcn'oq,cnsrionpovisio.sofsdb.lT0OorihctlLrC.iclsh!U.n,nhlnhcoollywithrlFepevirionr..
<br />W,!IrNING] Failnrc ro tcue uort
<br />^ o,q,cnFrion covcB8c is unlowful, md shrll subFl on cmnloylr lo aiminol pemllics atrd
<br />.ivil fin.s ut, t. onc hundrcd rhousnd dolls ($ltr0.$0 cost ofcompcflsation, daMScs as pmvidcd for thc
<br />Sc.rirnr 1r)76 ofrhc l]htr1o
<br />I hcrcby a0nmu"dcr p.mlly of Fr.jrry th.t I on liccnsdl nndci prcvkion.rChlprcr9(.ommncinS wi'h sc.rion ?fi)o) orDivkion l
<br />of thc Busircss ud Pmfcssions Cod.. a mylic.ns ii in tuu
<br />a-
<br />qNSIBI]IUONIEIDIIG.&CENSI
<br />I hcfthy arfifln undcr rEndry o, Ilcrrlry rtur lhcrc n a onslflcliotr lcndin8 !8cncy aor lhc ,rcrfornuncc oi lhc work hr uhich rhn lf,mir is
<br />iss&d (Scc 109?. Civ. C.).
<br />d.t.PLrC NfDECLiIBr[lQN
<br />IlMhy rltinnnndcr pcnrlry nl |x jrry one olrhc rbll,,wnr8 dc.lrn'lions
<br />oc'n,liit,n t'jcnirs Ashc\ro\ Norificrrio.ltd.ral RcEulrridrs fl ilc 40. Pfi6)
<br />Rd{trn d L.tcr of Mnia,.rri,n
<br />_l ccnify Ihur rtc fcdcrrl Eg!&r iotrs EsudinB a\h$ros rumrnl uc nor applic0ble ro lhis lrcjd
<br />lcLnifyrh{rlhrv.rcrdrhhanplkllionind{ crhdrhcrlnvcinforturionncodccrlacreroomplywirhlllCiryrndCou.ry
<br />ordinam.\.trd Srd. trw{rLri ro btrilding @trdtuliotl dd hmby aurlbriz. errenr.li!6 olrhk Ciry ajd Counry.o c c ufsn$.
<br />rtxrc nrnri(n!.d pr)pcn, tir L-l ppllclnl or ?\genl Signot 4
<br />UNDER GROUND
<br />Waste & Vent
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Rool Drain
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pi pinq
<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 />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />{'21-lK x\rlil
<br />Notes, Remarks , Etc.\7
<br />Water-Under floor
<br />Gas-Underfloor
<br />Tub/Shower Test
<br />FINAL
<br />Lrnds\ AddN'
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