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PLUMBING-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BUII-DTJR DEI,CARNTruN
<br />t hcrch, rlfim undo Fndry(,rFrjury thrl I a .xcnu fmmlnc Coikr.ion Liccns uw fttr lhc (nt,sinB rcd$n lscc 7(!l5
<br />B!\iics\ lnd Pnrrcl\i(,n Codc): Any Cily or Counly shich rcquncc , Fnnir ro onslrucl. allcr, inpnnd, drnn,lish ,{ rcluir rny
<br />sfl.rurc, prtu ro irs isnreEc. olw' rcqun \ ihe Elrlicmi nr \u.h l).rmn tu fita risncd {![tunr rhi hcorrh.
<br />'r
<br />li$.sd Illnulnr
<br />h rtu poli\nnN of rhc Conrrctols t-iccnsd Lar (Chaplcr 9, C.n nsn in8 snh Secrion TUrO of Divisi(,n .r ol rhc susircs\ trtrd
<br />Pof.sions Codc ) or rhnt hcorshc tcxchpr rhercfio and rhc hari\ fd rhc rlkScd crcnrnlion A yvnnarioofscdhoTO]15br!.t
<br />rptlicrnr rbr r p.rnrir suhJNr\rhc aDli.nor tu a civil l)cndry oi nor trktrclhon filc hundrcd doliirs(Ssfi))
<br />l,.\ owkr of rh. !()Eny. orflrycmtlo$cs wirh$r8c\ rh.ir v,lc c.mpcns.rion. * ill do rht uorl turl rtr {urm i\ mr
<br />irlcftld o,ofiircn lor qlc (S& 70,1.r. au$.ssrnd ltnlcssi(ins Codc:'l hc Contackn \ Li.cnsc Lrwlocs nr 0IPl, t, rn .wNr ol
<br />rhcfol.n, *h. htrrlds or irprovcs lh!ren, rid wb dds st.h $o hin\clf ot ,u\c li.r tlntuEh hn or hcr oan cmplorccr.
<br />prolid.d rhalsNh i'npohn.nBdfrn inrcnddl d ofLrol larsL ll l$*c\tl rhc $uilding .r i'qrovtnEnr i{soldvirhinonc ttd
<br />ol.omrLri(trlfi. owncr Euillcr *illhrvc rh burdc. ufpmin! rh h- or shc did mn }[ikl or ir{rolc rhc pmNly lbr rhc PU'P{ol
<br />-1.
<br />$ owflf of rhc rrcpcny, dm cx.lu.ivcly contraclins wilh liccnsd conrlc1on x! oBldcr th. t'sjccl (S.c. 70(4, Busmss
<br />&rd ftorcisbr c.dcr Th. Conl@lol s Liccos Llw dds ml arply to s own.r of PmFny *ho hil& o. inDowr th.@d.
<br />,nd who .ontEcl! f( $ch pmiEls silfi a ConlnctdG) lkcnsd flBuMl lo rhc Co.lrBcltr s Ltcnsc L!s)
<br />-l
<br />M q.mol ui<!.r Setiof,- B. & P.C. lot lhir @en.
<br />O*Dex-
<br />-]4QBTEE.:COMf,ENIAI(A
<br />DECIdSAIII]N
<br />I hcrcby amm undo p.Mlry of p..jury orc ofllE fouowi.s dNlar.rioN:
<br />I lirlc kl$illnDl riro(cnifrrcolCon\.nik,SclfIn\urctr$orken.onlncnsrri,,n.ns liovidcd lrx hySltIi{in.r7lX)ofrhc
<br />tr rrCii., turrhcNrf.nr!trrc ol rhc worl r{n $l,i.hrhc pcnni is n\ucd
<br />-l
<br />tlk .rd piu minriin vo,k6r .onqEmalion insEftc. a3 Eauied by Sdrion 3?00 of lh€ Libor Cndc. fo lh. pcIfol'lrld of
<br />Frmn is i$ucd. My wo*m om!,cnMlioo itr\uM. ffi$ !d,,lky nunrnc, e:
<br />t
<br />v u.rc ircs \.\. \z!
<br />I ccdily th{ inrhcpcrformrnaoflhe Bork ,or ehi.h rhk lc,nn t issu.d.l shrll nor cnploynnyp.r$n in etry tunEr
<br />s !s k, hccom slbier lo rhc wo.tdc ompcnsrion l0ws of Califomi!. and d8rcc lhar if I should bccoft lobirr lo rrr
<br />wo sl omp€nslri.n pDviiions ofssion l?00ofthc Llnor Codc,I shau. fonnairhomPly with lhrcPovisitnr..
<br />WARNINO: Failorc lo s@ sorkcs' onpcnslirn ovcEgc is onh*aul dld shall subitl !n cn{'lnFr ld dili.al tf,MllLs dld
<br />civil fin.s uD ro o.c hunded rhoDend dolim ($loo,0o0). in.ddilio.lo rh. coi ofcod{dnstioi. dadScs a. pr.vidcd for lhc
<br />::::ifiq"0r1qq:ffi,
<br />uqEtslilcaNraaclaa
<br />DES,A8{IqN
<br />I hcrchyaffird!tulcr lcn,hyofpcrjurylhal l0m lians.n undcr ,ro! iion o I C hatl.r 9 (ommrcins enh Sc.rion 7m0) oiDivisn,n 3
<br />of ihc BusirEss lnd Profesrions Codc. 0d my li.cns is in tull lorcc arn cficcr
<br />CANiIBUSIIANIINDINGICDNCI
<br />I hcrchy arfinn u.d.r rmlry ol pc,jury lhul lhqc is u drnsrtucrion lcndmg a8cNy for rhe Ffor@i.c orrhc {olk li'r s'hi.hrhk Frnrir k
<br />hsucd (Scc 1097. Ci! C.).
<br />tJnJurs \.rrc
<br />-
<br />L.ndcis AddBr
<br />-
<br />ATPLTCANT NN(] ARAT!oN
<br />I tmt'y alim undur n nahy of pcrjury onc ol rhc tolL$ins dsldar nrns:
<br />Dcnnnir6n PcrmiIs.Aslie\ros Norificdrion F.dcral RcSulnlir N (Tirl.40. PunO
<br />Rcqurcd t!rc. oaNolifE bi
<br />-l
<br />enily rh,l the f.dcral rcEuhliors rcsuding alEsios rc'rcval ac nol sPPlic,blc lo lhir Imrc.r
<br />#xlulr r I ttrlcrcidrhisapplicriion,rlnarclhdrlrdlrvcinn{mriioi i\.ondr I
<br />Sr.rc L{ws Ebti.g ro huildiiS consrtrrion. $d
<br />at rc mnriomd tmp.ny lor inspcclion flrpo*r
<br />lpplie.l or AH.nl Si*nnlum:
<br />,grero conlply wirhall Cirydnd Cou.ly
<br />ivcs ofrhis Cny and Counryro ctrrcr ulon ltr
<br />*. $iie 0'S 201
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipinq
<br />Boof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Linei 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 b/'2+/ltr tt\5'
<br />Final Gas Test
<br />FINAL 1/o4 /tt (*a
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />TOP OUT
<br />POOUSPA
<br />Meter Release
<br />Nurnbc,: ue.n161Klq^-
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