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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER NUII,DT]R DI]LCARA ION
<br />I hcrchy aiir utulcr runllry of F juy lhlr I rn crcnu liorn rlrc Conrtrlots l-i..nrc trw nn lhc nnk,wiig rcrsn ( 5(.?011.5
<br />ad\inc\\ dnJ Pnntssh C{nle): Any Ciry or C.trnl, whi.h rcqute\ ! Ilcrnrl tu ..n{ru.r. 3lrcr, inrrort. d.nrlth ot EPan 8nv
<br />(ru.ruic, trior lo ns hsuan... rln) rcquncs rhc lPplicanl tx \Lch litnxr h filc I {irncd {dcnunr Ihll lt., dr n li.c td Pursunnr
<br />tr rh. pnri\i, i ol lhc Conrrcl{tr\ l,ic.nscd tjw (Chqrrer 9. Comnthcnr| trnh Sc.lion 7t)q) or Divisi'n 3 ol'rhc Au\nr\\ ,nd
<br />Pmrcssi.nsCodc)orrhalhcorshc k .rc.rrr rh,rclior Mn rhc h!si\ r.r rhc,llcBcdcxcr.Prion Anyvn 0lionofSrcrir.TOll5bv.nv
<br />drpli.a lbrr pcflnir sohjc.Gthu ,mlicanr ro r.ivilpctrtrlryormi nn cihatr 6rc hundhd d.lhts (5500)
<br />-1.
<br />ar owmrof ln porEny. or ny.n!loF6 wnh w!8.s er lh.n sh @rFnsalion. eil do tE *o* &d tlt rB@ ii 6i
<br />i.Edn or o,Lrcd fo; sJc (Se 1044. Buritusr md Ptuf.sioN C.dc: TIE Co.lr[Iolr Liene bw dd! tul uiiplv to u owmr of
<br />$e pepdy vtb ttrikk or iJrpoB Ill@n. and wt dms sh wtt hinrctlor IEMlIor lnreogh ht ot lEr osn cnploy.cs.
<br />Eovidcd $ar ilch in{m$mnlsmml i cid.d orotu for $lc.lf,IDEE E building or in{rcEcnl b oU widiinof vw
<br />otcoophrio., llf Owtur Buildd will tuw tlE bmlcn of proviiS $s hc or dE dn d boild d ar{mw dE l,oFly tot th purpog of
<br />-1,
<br />as osffi ol rhc pmp.rly. d exclusa{ely co.hcri.8 wilh liensd .on!.eron to o.sltucr tlE Ftiel (Sc- 7Oa4. Bu.iic$
<br />ord PrDf6sim Co<k: Thc ComEror's Lic.nsc Llg dG ml smly lo afl o*ns of Prepcny vho buil& or innrcrs lhcr6n.
<br />lnd eho conn .ls lor such prc,xl, wirh a conr!..io(o liM*d I,!6uim lo thc Conlrdlor's Li.cns t w).
<br />-l
<br />amcrc'rrr lndcr Sccr
<br />Osn.r:
<br />TAETESS:COMSINTAIIQN
<br />DECL/T8AIIITN
<br />I hcEby alrrmun&t FEllyof,crruryoe oftlE rollowinS dcla iorql
<br />IitxtrcGlc. rirlhcpcrtonmnccorrh. w.n{ n} shicn rh+ P.nnir n n\ucn
<br />I hlvc lnd sill tuinhi. wo*m cohpensarion instrBncc, ds Ellitd by S.criotr 3?00 ofthc Llbor Codc. for ltc lcr[otrl1!@ of
<br />rhc work for whi.h rhis p.mil is issu.d. My *dlc( 6np.Ds{ior inslec cmt. aIId poli.l nuf,bf e:
<br />S-og F""D,
<br />14-72 4to ?- (- ?.o(a
<br />l .cn ili rh.r in rh. nlrr'ontu'n.d or rhc quk tur whi.h lhn p(nnir i\ isu .I stullnor.ill,l()v rnv pctson innntm,trncr
<br />w nskrh.(nm \ubjcd n)rhc wo cn comp.n\r ion ld*( of Crlifonriu. rnd agN that if I should tr$tu subtd ro t hc
<br />tro*c'\ co lPh(di, provnion\ ol Scdnr :l7t)o oi rlt trtxtrCodc.l d ll. Ldhqlhc.nr ,*irhrho*tnrvisius
<br />WARNIN(;: ljiilurc t, {cur. workcrs .on{crs'li{n,.ovcn!. i\ unhwrul. rnd \hrll \lbjccr 0rr cmPbvcr h..rnrimlPcruhics 3.d
<br />.Nil llrcs un k' otrc hundrcd rh.usdn dollars (SI(x).OlX)). i'r rrufnr h lhc co{ uf.o'nfcnsrrirnr. drnu!'s n( ProYid'J for rhc
<br />Seion 3076 oa rhc L!h6r C.dc. i.l.rcsl od lllomy s fft'
<br />o",., D-(: Ltpu*t, ?+tP @L_
<br />LICFNSFD (:ONTBACToR
<br />DICLA8&IION
<br />I hcrby linnundcrNnrltyotptrpryrhdrI lic.cd undcr !o!irn,nofL'i! cr 9 (snnm(ine silh Sccl ion 70fi)r ll. Divi\i'tr :l
<br />or lhc Burircss and Pmt $ionsCodc. and my liccn\e ii in lu ll rd.c .tv.l clisl.
<br />qtat 8 )2--R
<br />9-1- 13
<br />(l)Nir8lJ!:rl()IilllDllcloENrI
<br />I lErcb, trflirn uM$ ,En.lly ot pcrj!ry rhdr rhcE t a con{tocrion tnding i8crcy fot rh. Frlnnnn.c olrhc work fd which rhk lsmil is
<br />i(!u.drse.' :1007. Civ. C )
<br />AITI.ISANI.DECI,AEA:IION
<br />I lEnlry lrm undcr ncoalry of D.rjury orc of rhc lollowing delmations:
<br />o.mlirion Pcdits-Aibcard Nolificdbn F.ndd RtgolllioN lTnt aO, Pafl6)
<br />-Rcquircn
<br />L.ucr of Norilicarion
<br />-l
<br />cenify ihar rht fcd.r,l rc8lhtions 6g,.din8 0sb.sos remvol arc nor lpplic0hlc Io lhh [or.r.
<br />\Ll ccnrfyrhd I huw rcld rhhrFtlKorrfl0d sarcrh,rlh€at vc inro.motion isconc.r' I lsrc ro comrlv wnh nll Cirv.nd Coontv
<br />ord lmcs lnd Sl.tc liws El,ring to huildin8 consrtucrio( ard hcr.by aultbri& tqrcscnr,'ivcs ofrnis Citv and Cou.tvlo cnls ulo. rh.
<br />ny lor insp.{ion l)url[ss.
<br />Applicsnl or Ag.nl SiEn.tu p)+Fr2L
<br />a
<br />_ Drte:_6>-dg
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />P-trap/Drain Line
<br />Ir,4ain 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
<br />Final Gas Test
<br />Meter Release It
<br />FINAL q \9,\\9.l l,w4(\)
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />POOL/SPA
<br />?-Xect-
<br />*-n*--"rn,,, Ph;lliP
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