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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIINER BUII-T'ER DELC RA TON
<br />I hcr.hy affi,nr lndfi Fnrxy {)f pcrjury lhtrr I lnr c{c'.pr fro( rh. Contrchr' Li.cn\c liw r,r ihe r(rhni.a rclvtri (sN.70ll 5
<br />Bu\incs\ and Pftrfcsrn Cdc) Any Cirr.r Counry uhi.h r.qunc\ r ,iqml n) con{o.r, rlr(, nnlN!, d.nrnM or rc03n 0ny
<br />nrucrurc. prior ro n\ tsurtra. sko rcquicsin. rmli..nl l'or such p.n lb lilc r siBncd srdcm lhal hc or rhc n liccn\cd Dur\unnr
<br />lo rhc Prt,eilion\ orrr( C.nroclols l-iccnxcd lis (Cnanld 9. C(nnntNirrs $irh Sc.ri(,n 70(D oi Divisi'n I orrh' Bnrms\ rnd
<br />,']rorcs\n,n\ CoJc)orrhil lEorxhc tcrcmfl ($clio Mdrh.h$isntrlhelllcg.dcxcmlrion Anyviolationorsc.ri.nT0ll.5$v3nv
<br />rlplicrnr Ina Fmrir suhjccc rhc aprlic{trr ro rcivilpcnullyolnor nncrha.fivchundEddollrs13500).
<br />l.isosmrolrlEOopcny.orn,ycnfk,tccsrilhqrScsi\lhcnsobconrPc.srrion,$illdorltwolka' rh.s.Neisnor
<br />inr..,lornfi.'cdnrsLrSLi70r{.8u\incsandttofcs\nnr\C(xlc:rhcCont ktrsl,iccn\cl2wdoc\tror plvro!nowturul
<br />rhc pn,ncny who $uild\ or Nlmvc\ rhcrNn. od sio doN \u.h s orl hiN.li or h! .llorrhnnrgh his orhcr otrncdfk,yc.s.
<br />nnrr cd rh srh nnpmrnEnc m mr inrcrtlcd or offcNl n, slc ll h)$vcr. rh: hxilli,E or in{rovc.rnr is sl(l qirhi'r
<br />' 'n. )tr
<br />ofcomplcrhn, rh. Osn.r Buildc. *illhrrc rh. htnLnofpn,vin! rhd l'. or $rc dil mr buili or tntn,vc rhc ln,|xny tur lh. PUry){.1
<br />I. $ owncr dr rhc pn,Fdy, !r. cxclu\ihly ...htrcri[8 wirh liccnql conrlrctn\ k, $n(ru(r rlt t'rcjc.l (s.c 701'1 3usims
<br />a'nl Pn)lir\ir (i c:'l'l[Qn rrdrtr's t.iccnsc liw do.\ norrpplyh rioqnd olt'rcPrnysh,r htrildt or im[ovcs lhcrc.n.
<br />ud *ho .onrrcr\ for \uch ltr,)i{B snh ! (lr H(rlo li..n{d purumr r, rhc C.d rrror's l,icctrY trw)
<br />-l
<br />!h ci.n uidc. scli6i-. B. & P.c. lot llth lwn.
<br />IABtrEEJIIOMTTNSAIION
<br />DICIIIBAIIO!
<br />I herby.fti.m !.dcr Fmhy of pcrjur, orc ollhc iollowin8 dccldlrions:
<br />-l
<br />hlvc ond wilt mintain !CcnirEllcof Co.sc ro SclaldsnE roi woilss n'mpcndion. as Pmvidcd for by Sdion 3700 of thc
<br />Labor Codc. for fic pdaorn1,N of lhc mrt fm shkh lhc llcml h irsu.d.
<br />I horc md will 'nlirllin so.kctc comr.nr.lion insurtmc.0s rcquncd by Ssrion]700 oalhc Labor Cod. ror lhc PetfornMc ol
<br />smpctr$rion insu.lncc cfid arn policy number 4c
<br />(1 .\
<br />-l
<br />anily thar in rhc notorlMN of lhe work Ior *hth lhk lernl is iesu.d. I shlll nol.mnloy.ny p.Mn in !trv manmr
<br />s s lo bccom slbtcl lo lhp hrl6 oq)cnstion lsws of Califomio, and 4xti rhar if I should bc.otu sobiit lo th.
<br />w6*sd onpcnsarionrmdsions ofs€clioo ITOOotrtE t hr Cdc.I slEU. fonhwlh@nply vilhllDe pmvisions..
<br />WARNING r€iluE lo scuE eork d smlEnsln,n cove,asc is lnhwtul. snd shlll subicr o cnplols
<br />civil fin.s utt ro om hundrcd rt !$Id dolls ($ 100.m0). in .ddirion lo llE cosl of co
<br />Scrion .10?6 of llE Lstor Cdq imcEs ,nd aflormtt fces
<br />I hcr.l,yllinn unds |.ndry olNrlury rhar I $n,lidtr{d utrJ.r lnrisi(n o1( hnPlcr 9lconn,tncnr! nlh sc.rir ?(xx)) !r Ir!i(i'n 1
<br />of rhc Bnsi.$\ ud Pnn.\\i.n(Codc. ! yli.cnse i\ ir lulllor( a ltflc.r
<br />\oD114n
<br />CoNSTIIUCAION I I'ND!N(i A(;F]NCY
<br />Iircrch,ltfinnundcrFnalrroipcrjuryrhlrrhcrctr.on{tucriJ LiodirB r8cncy tir rhc P$tun:rn.c.frhc *ork nn shkh rhi\ lErnlt ir
<br />i*ud (Sc. 1097-Civ. C )
<br />AITLICIINLDIig,A&IIION
<br />Iltnbydlir u.dqNnrhyorFrjxryoncolrncfollo*'inrdcchr rn,n\:
<br />Dcmolirr,n PcnnirsAsbc(os NorificarkJd Fcdcnl Rcluhrio.s( lirlc JO- Pxn6l
<br />-Rcqutcd
<br />I !r!cr of N.rifi .rti)n
<br />9r -n'rv
<br />ify rhlt rh. fcdcr.l rcSul ions rcsadiis,\hcios rcm v(l irc r r r|rrii0hrc r,rhN t'ric.r
<br />lnrtr i,m ncotr..r I rlten)con,Ilyrh l h.vcrcdlhis anllicurbn aJt {rdc
<br />onlinrnc.s and Srltc t *s FI{rinl b bnildinB
<br />dbv. mnrnrmd pmpcny for iispEin,n
<br />Appllonl or Agetrl Siamlurr ru
<br />!d c. nrvt..nrn un'n dc
<br />03 2018
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underlloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing E/e /o tf\61
<br />Final Gas Test
<br />Meter Release
<br />FINAL W'Lz/g :$J 6g
<br />Notes, Remarks, Etc
<br />Ovn .
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<br />t ndc' s Addrcs:
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