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PLUMBING-INSPECTOR BECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oWNER BUILI}I]R DI'I-CARATION
<br />I hcrcht dl irn undcr ffnilry of Frlury rhd I .n cxcnfr liom rh. ConridoF Li.en$ ltrr lor lhc followiis rursn ( S( 70.] l 5
<br />tru\inc\s rtol Pr.nssion Co!c): Any Cily o, Counl! Nhich ('qutc\ ! pcrmir ro con(rucr. rlrc!. i'npr,e.. d.nDlish or Eprfunr_'
<br />dturrun. prir h ir\ i*uan.c. rl\o ruqun \ rhc nppli.d f(x \D.h F-m n, filca \iBicd { .nrnr th hcor shc i\ liccnr.d pufiuinr
<br />lo rhc pmvi\nrN o, tlrc Conrr0.rtr s l-iccnr l-!$ (Chaprcr 9. ConDcrrtu sirh Socron 7{XX).i Dililn,n I ol thc Ausincss rtrJ
<br />h.tunn,h\C.dr)orrhrrh.or\hcscxrlFrrhcr.konrdrhctltrnturrhcrll.gcdcxcntptin. Anyvnn ionolscdionTl).ll5hrlny
<br />rpfli.rnl hr r Niinir suhl..rsrhc rlfli.rn' tu a.ivilrnrxyolnor ntrrcth livc hundrcd dollm (S50(,)
<br />-1,
<br />!s oei( of thc Ptop.ny, or my cnptorss {irh sages ar fict sh <,npci$ri.i. will do rhc wor!. and [r rrudm is nol
<br />in,cnd.d or oficEd fo, ek (56.?044, B!.iEs. a.d PrDfc$io.s Codc Thc Conlflclols Litns kv docs ml afl,ly lo M oan6 of
<br />rlEp lrny *ho bti!& tr ir{mr. rltE( lnd *ho d6 $cn M hid$lr or he*clf or rhftugh hh or h.r ow, cmployas.
<br />Imvidcd rhd iuch imtmvmds N ml inrdrd.d oroffcEd for slc. lt hwK. rtc hihins o! itrrpotc ir $ld wnhin oft,id
<br />ol sdpl{io.. thc ol,ftr Auilrh, wi[ h!* trE h'{<rrn of FDving rhd lE or sh. did ml hd]d or irymw lnc pDIEry for t E p!,rft 6f
<br />L * own.r otrh. p6Fdy. m crclusiv.ly .onlmring wirh liMscd o m.ron ro onnrod ttE prctcr (Sk. 7014. BEitus
<br />and ADftssim Codc: Thc Conhcloas Lic€nsc Law docs mr spplr ro sno*n* oflropcay Bho buildr or inl,mvrs rhcrcon.
<br />and who conra.ls for.uch poj.rk wirh. Conrracion, lh.ned pusuotr o rhc Conrocrols Li.cnrc trw).
<br />I ncxc\n undcrScclion- B. & P.C. forihhrcoson
<br />Date Ovn.r
<br />laaKD&tcQMrlus rloN
<br />DICIAIAIIAN
<br />I h.r.by rtllrnund.r r..rhy of pdjury o.c ofrh. followins dc.Lrdri.trJl
<br />Ihnvcd iwilltuini nrCcdirf,olcolconenrioSel niur. ror *ort.u' .ongEnel ion. &r p.ovidcd for by Sadon 1700 o t lhc
<br />khtr Cde. tu rlr |Jerfom(t .a rh. wolk for which rh[ Fmir ir i$ucd.
<br />I havc md wiU nainr,in wort rC.onFnsoliotr insuraroc.,s rcquiRd t y Scclion 1700 ofrhc Labor Codc, tot
<br />'hc
<br />pc.forN.c ol
<br />rhc work lo. whhh rhh Foil is L*ucd. My worlc( comp.nsarion insum^... caEicr od Flky nlubcr !rc:
<br />Slerg F s^Jr,
<br />- \L11?to -, - l' 2.- r\
<br />-l
<br />enify thlr in rh€ p€rformtuc o( rhc {orl lor whth rhii Frmir ir Lsrucd, I shdl nor .nploy my Fmn in any enflcr
<br />$ $ to h.com subirt to th. wortcs comp.rsalion kws of Califoma. ed !8rc lhat if I sholld lNft $bJc<i lo llr
<br />eort.r( $mpcnsion povisions of S(thn 3100 of tt kbor Codc.I shlll. fonhqnh 6mrrl, *nh rtD$ nrcvbions.
<br />WAININCT Fiilurc ro suE uorkcB .omo.nsaiion ov@gc ii unbwlul. .nd skll subj.{ !n cmtbrtr to djninal Fna[ia ud
<br />civil fiocs up lo 6rc huodr.d rhoNand dolhc ($100.0{)0), in ddnion ro lhc.ost ofcohp.nsation. dam8.s.i trovid.d for rh.
<br />sc.lion 1076 orrbc tjtrr Codc, inrcrcs {nJ ormy s fes
<br />-r- l?,tpprrunr:f PhP e-e-
<br />UCEISI,D-CO Ilnl:IOB
<br />DLS"$AIION
<br />I hcRby riirn und$ Fn,hyofp.rjury rhd l0m liccn<n undc! fmvnion olCh.plc! I (commncin8 wirh sNrbn 70Oo)olDivision l
<br />ol rhc Busincsann Pmft$ion\Codc. uii ny lic.tr* it in fullfd.c dxi clldl
<br />B q t1 ga2-
<br />.(-(-rl .-,-",-X P++" e-L-
<br />(Df,ral]cllaNlJrNl)ltc-alilrNt.I
<br />Ihcr.hyrl,iln!flcrpcnJlryofprrJtrrl rhsr i\3.onntdion Lidi',! r!$cy nrrhc J[tli,nnrrEt.i Ih. Rotk li,r which rhi\ r--nnir is
<br />i\{kd (Scc 1097. Civ C.)
<br />arrtrcANfDEcl/aallo!
<br />I he$y dlim under pcn!llyofpcrJuryonc ollhc lbllowinS dcclaroliotrs
<br />Dcnolirion P$nirsAsh.sr.s Noriticalion F.dcEl R.Bulations (Tillc,l0, Pfi O
<br />Rcqutcd t trcr orNdif$rion
<br />f,|,***ffi ;;ilffi;dffi ;;**,,i,,r*,,**,,**,*,.
<br />chovc ntr tr I ioncd ,m pcn y ior inspccl ion lurp.rs
<br />ApplicxDr or Asenr Sistr.(rrel ^ RS(P ar
<br />x hi ti
<br />8 -r- iE
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<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
<br />FINAL stfl ty ,.{,<4{f/
<br />Notes, Remarks, Etc.
<br />)
<br />Fill Line/Back Flow
<br />trttdcr's N.r:-
<br />tt
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