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PLUMBING-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />WalerUnder floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heatericas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />ll
<br />FINAL I s Ig,/..(W(tj.,
<br />Notes, Remarks, Etc ll
<br />OWNER AUILDER DI]LCARA'I'ION
<br />I hDrchy rfinm udcr ncnnlry,)l IcrJury rnd I rm cicarpr ft,m rhc Conrrxcn,i Li.cns Ldtr for rh. ft,llosi'rt rci$n lscc.701l.5
<br />aosinc\\ d Pnnrsion CDd.): An, Ciry or Ci)unry shrh rcqunu\ r Jtnnir lo cuNrrucr. altcr. nlrl]rovc. dcnxni\h or rcplt t
<br />!flr.tu.c. I'rid ro irs i$n0ncc. {1$ rcquncs rh. a,rplicM ltr nrch llflnirro nba ri8ncd { cnrnr rhnrhcorshc i! lir.nscd tuAurnr
<br />n, th. Frviii(rt\ of rh. C'ontr.r.fs Li..n*d hw (Chd cr q. C.nnrtrking wirh S.dion 7(XD oi Divnio. ll oi lhc Bu\incs lnd
<br />I'tuic\\idrsCodc).rrhrthcorsl[iscxcmprrhcr.lrom!tdrhcbrsnfrthcrllcEcdc\cnrrli.n.Anyvii,brn,torsccri,,n70.]l5hyrn!
<br />applicanr tu rFnnir subl.ch rhc npplicanrroocililpenahyoaiornrrcrhrnlivchu drcd dounrs (s500)
<br />-1,
<br />ss ownd of rh. prDlf,nt, or my cmployss *ith wsEcs G rhen mh compcns on. will do rhc aqt ltd tlE slnEnn is ml
<br />inrdrtcd or ofredd lor slc (Sr,7044. Auiircsr aod Profcs*toB Codcr TIE Co.trclols Lt nE Lr* do.s not a0ply ro !n owncr or
<br />rhcImFny who hillsor iqmwsllEmr a vh. dG sh hrL hii.clt or hc6clfor lnmu8h his or h.r oBn cn loyccr.
<br />providcd rhrr ikh inprrE.B @ mr inl..d.d trottu atr de l( how.E dE buildk or irymtmnt h &ld winrin om JEr
<br />of otr{,htbn, lbc Owncr Blillc. wil hsw tlt hirdcn of pmvinS rhll lE d slr dil rcl hoiu or iqmrc 0E ,,olsly for tr pu4,s of
<br />_1,4{ownf .lrhc poFny, an.rctusiv.lyconrmrinB wirh ric.nscd .onlEdor toconsmd rhi pni(l {S(.70d4. ausncs
<br />ond hrision Codc:1hc Contrcrois Liccnse l,ar dcs nor aprlylo !nown.i of p.or..ly wfio builds or nnprcrcs lhcreon.
<br />and vho onm.rs Lr .uch poicds wilh r Conrr.crorl, Ii.cMd l,uBmr ro thc Con[actois Liccne L!*)
<br />-l
<br />m cx.npl undd Sftion- B. & P.C, for tnis Ben.
<br />]lAatrDIN:g}lUENSAIIq!
<br />DECLAAAIO!
<br />I h.Eby a,llrm undcr lxmltyofpcrhryom onn followin8 delmtions:
<br />-l
<br />hlvc a1d *ill minlain, C.nifrarc ofcoEit lo Seltlosurc for edkm omp.f,sdhn. !s pmvided for by S(lion l?00.fllE
<br />Llhor Cde for rhc pdfommc of rlE wotl f6 qhth rhc Fmn i! issucd,
<br />I hrvc rn sillnuinrrin $orkcrs conlxNrri(nr irsurri.c. r\ rrqutrcd bySLrri(nJ7{x) l rhc lrhor(ndc. lnrrhc ncrlnn'$1rcol
<br />rh qork tur shith rhnl.nn i\ h{Nl. My sor k.tr' .o'nNis nr NumNc.(nEr rfrllxllisynumt.ruc
<br />c,",", S-r4'rc: tr\i,jD
<br />\l'71 '3 i o '? - | -'z-.1<
<br />-l.cnify
<br />lhll in thc pcrformrce of llE work for wtth lhii psmil is irtlcn. I .hall no'.mrloy an, Fson in any munncr
<br />s !s ro hcmrc subjd ro lh. *ort 6 omFnslion hws of C,lifofria. lnd a8m thrl if I should tccotu slb,f,r ro rlE
<br />No*nr @nlf,nstion pmvisions of Sdion 3100 of tn Labor Codc.I shau. fonh*nhsmdy wirhrh6e pDirions..
<br />WARNINC: FliluE ro wE aortc6' ompensrhn skEse is lobstul, lnd shill subict & cniplo,cr lo qinind petullix sd
<br />civil lincs !! ro oE hlnded rholslnd doll6 (t100.000), i. addnion ro th. coil of mqE.$lion. drNg.s rs pmeid.d for lhc
<br />Scclion 1076 of lhc tjbor Cdc inbrcn lnd aflor*y s fecs
<br />ai-rppr.-,r, TrtP Q+_
<br />LICI'NSFI) CoNTRACTOII
<br />I]ECIA.BAIION
<br />Ihcrubydflnmund.rl)Lnshyorr.qtrryrh l.D li.rnst undcr tmvtionolChlpter I (ommncins rirh Seclbn 7000r ofoivilion l
<br />of lnc BusnEss rnd Pnfcssion\ Codc, uxl ny liccnse t ir tull,orcc udc(t cr.
<br />l-,**"
<br />"t..,
<br />B Liense Numb.r
<br />qtalg'72_
<br />EL
<br />COISIBICUI)NIINDINC.AA$IqI
<br />I rrrby dfllrm undcr tctr,lry olr.lurythtrt thcrc n r con(ruclhn lcndinS oacncy lor ihc pcrronnMcc.lrhc work tur qhich lhis IEmril i!
<br />i\\ucd (Sa.3047. Civ C)
<br />AfIUIANI.DESAAAIION
<br />l6y oltim undcr pctrllty oa pcrrrry onc orrhc n,llowinl d(leurions:
<br />D.nFlilion PcrmirsAsbcsros Nolilic,rio. Ftdcn I Rclx lar iohr (Tir lc 40, Pdn6)
<br />-Rcquncd
<br />L.nc. of N.riicdiotr
<br />I ccdiry rhd rhd lcdcralrcguldiotrs rc8udin8 !stE(o\ rcrmvulrc nor {'Ili.ahlc lo rhn poj.rr.
<br />El ccnily rhrr I havc md rhis ntrlicar ion and shrc rhlr rhc rtovc infornu ion i. coft.r. I .gN ro onDly wirh lll ciry lnd Counr,
<br />ordiru.ccs and Srare Llws EIlrins r. huildins con(d.!ion. !.d nfthy lurhori,x rc,,.r.nrariv.s orrhis Ci'y otrd Counry ro.nid rB,n rlt
<br />ahovc mn'iomd pbpcny for insF.rion ile+Appli.onl o. g.nl Signolure:YZL-
<br />t^ill;
<br />("r- l7
<br />IAPPROVALS
<br />TOP OUT
<br />Gas Service
<br />Meter Release
<br />Dri.:O*n.r:
<br />,*", 6-(-lX ".**"* {
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