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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lr/ain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />Back Flow Device
<br />Rouqh Plumbinq t/r91X s8t1
<br />Final Gas Test
<br />Meter Release
<br />FINAL 6('Lt/1'tr +Dqg
<br />Notes, Remarks, Etc.
<br />OWNER BTiILDNR DEI-CANA'IION
<br />I hcr.hy rmrn nid.r rr Jlry olFrjury thdl I on cxcnfr rioD rh. Q rdcloF l-i.cnsc l,* itr rhr li'lk,wirrs tcrlin (sc.?o:ll5
<br />Au\irc\s kl Pi(,rc!\i( Codc): Atr] Ciry.r Coutrr, whi.h r.qutrc1 r Frnrir ro cor(ru.I, rlrcr, nntn,v.. dcnlolish nr rcnJt r'y
<br />{n'.ru'c. lnfi!) n\ ir{unNc. rl$ r.qonrsrhr rpplirmr tur \u.h lurnirt,lllc r siENd {dcnrd rh$ l.! or \hc is liccnscd Pursurnr
<br />r. rhc [ori(iotr! ol rh. (otrhdois l,iccn\cd trw (Chrprcr 9. ConrnEmn,g snh Sc.rn TrXD ol Dilisn,n 3 of rhc ,1tr\i',c$ rn,]
<br />fdcssi,) 0\ Conc ) or rhrr h. or \|rc hqc.rrr rhcrcliohhd rhc hr\is turrh..llclL\tc\cmpti(nr Ary \iolrrion.fSr.rni?011.5 hy rtry
<br />rpfli.atrr fd a lrmrir sxbjccrs rhc 0t'Ilicnnr b r.ivilt'cNnyol Nr nnmrhm rnc hunnr.d d.lh*IS50OJ.
<br />-1,
<br />&r owrcr oflh4 prc0eny. or my cmploFc. wiln vsges .s thcn sk .onp.nstrion. qill do tlr worL .!d ,f, srlrfu i! Nt
<br />inrcnded o, otlced for sh (S(.7Ol4. ausin.ss snd Ptofcssioff Cod.: Thc Contr..lofs Lien* bw do.! nol lpply lo sn o*rc, of
<br />Ih. FlFny sno hilds or iqftws {Eei. dd who dtB sh sit himscllo.lB*lf or lltmuS! hk d hd os .np!o,lc.,
<br />previ.lcd rh s&h hpol*lri e nor htod.d o, ofttlrl fo el U. h.wE, dE hidi.g or i,prwEd is $lr! wilhi. orc J4&
<br />oa6m0htiotr llE O*N! Buil&r sill haE tlE h,&n ofpnving dbr lt omh. dt d toild or i,pmE dE I'oFly for llt Blroc ot
<br />-1.
<br />s owr oa thc popcny. m crclusiv.ly @nt .ling wnh [c.hsd .ontEctoE lo onsrtul lhc ,eiel (Se. ?044. B$ifts
<br />ard PDlesbn Cod.: Th. Conlrecrols Li.crsc Law des nor q,ply ro e o*o.r of phF,ry eho huild5 or inprcEs lhcEon.
<br />and *ho o 6cts for sh tmlrts airh a Co @lo(s) Iiccnsd puBunl lo lh. Cnfltddols U.cns Liw).
<br />-l
<br />m cx.rpl uo<l{ sc&n+ B. & P-C, for this l!si.
<br />-lh!rcardeillNi
<br />dio a Coniff,arc ofcon$.t lo S.f-lnsurc for ert6 onlEn.dion. as FoviH for by Sction 37m.f ltt
<br />Lih.. Cod. td rk p.rfM. otrlE wrt fd *hkh lh. p.mil b iatud.
<br />-l havc rnd will 'uintain *orkcB corycasar ion insurrtuc. !s r€quird by S..iion 3700 of th. Libor Codc, for $e pcrfoMc of
<br />is pcmil is kn*d. My workss omtcnsolion insurec 6kr tnd plicy numbcr a
<br />r.l \,co r 7 \ .\.\r
<br />-l
<br />cMify Ool in ll* Frlormrcc ot lhc vork for uhich thh Frmil is issucd. I 3hall mr mploy ent pcMn in any tunhr
<br />s es ro bc.otu ilbj6r ro rhc worldl colq,.nsrion laws of Calirorni,. ad aBE lnal if I lholld he.oft snbiccr b llE
<br />trik6 omf,.nsation pm rions of Sclion 3?m of fic ljhor Codc, I shall. fodh*ilh cory)ly {irh thos tmvbions..
<br />NARNIN(; Erilurc ro *curc sorkc6' mnEnsalion covems. is unhqf!1. !i,t rhnll \uhiNl rrl ctrlploycr ro qimiul Ftu[icr Md
<br />civil fincs up ro onc hundrcd thousund doll{rs (SI00-000).
<br />sdion 1076 ol rhc t trr c'ode, inlcrcn and an.mt s fccs
<br />in lddirnJn n, rhc co{.1 ion. donDBcs !r tiovidcd for rhc
<br />**AUGJI3 2018
<br />DICI.ABAI]I}N
<br />I hcrhy Drlirn nnd.r p.n0kyofFrjury rho! ! um liccnrd undcr pmvkion olCh(plq 9(.ommncing wnh Scclion ?OO0) o, Dilhion:l
<br />ol lhc Burimss and Pnrcssions Cod.. ml h, liccn$ Ls in tull rom oi cffcd.g,\ Oatl g<,
<br />Di,a.r^ lltr S ?n18 b,.{r,11"
<br />truru v--
<br />catuf,!cuq|l.l,uDlNlilcEN.lI
<br />I hcrcby ,l6nn undcr pcnalry of ricrjory rhd rhcrc ir a cohrrfl.thn Lndine lecrcy for thc ,'crforrone of rltc *ork ror *hich this rcmir ir
<br />nsucd (sc..1097, Civ. C.)
<br />AEU(ANLIECI.,ABAIIQN
<br />I lHrby r0im undcr Nn.lry o, perjur) onc oirhr i{,llo*ing.Lchrlrn,n\:
<br />Dcnolirion P.rnirr^\b.ros Norili.ltion,'cdcrul RquhlnnN alillc 40. P,n6)
<br />R.qun lrn.rol Norili.liiotr
<br />-lccniiyrlnr
<br />rhc lcdcrulrcs h(nrsrca&lnr! r(.*,\r. rhl[c n.rrrplic$lc n, rhi\pnr$r
<br />f,.-,,,,n,,,..,..,,nnJt,|)ltrrrflMdn.crh rhc Jh,vc nrlnnnrri nconr.r lnrrrc.hcotfl!Nirhrll(-nyaDdCounly
<br />ordmrn..s 3dd srrr.l]wsrLrira ro htri dd hm$y.ulhorir rcprc€
<br />'livc!
<br />ofrlis cny lrd counly lo cnl6 ulon llE
<br />nbovc mtrliorcd prolcn, tor i.sFcr
<br />Appli.snl or A*Hl Si*nslo Ln
<br />I
<br />I
<br />Water-Under lloor
<br />l,v()nl(rqs' coMPrNsarr()N
<br />IIECIA.EAIXIN
<br />I hcrcb, .ffirm undd pcnclry of Frjury oE oallE fouowin8 dNlarolions:
<br />P.mxcume(pdnr):k'q
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