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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUIT,DER DI'LCARATION
<br />I hcrhy rfltr uDdcr pctrilry ol Frjrry rhd L.r .r.nrI lntrn rhc Conkrtni t-i..nrc Llr lor rhc lnllowirr r;e (scc.7o.i 5
<br />ausincs !tu ltons\n,n CGlc) Aiy Ciy or Counry rhth rcquirc\ a P.mir k, .onsrflcr. 0llcr. inrporc. d.molhh .r rcNn ,ny
<br />srrucrurc. pr lo irs r\urn.c. rh. rcqut$ rhc |lPlliconl tustch ricnlir b filcn\i8ned (alcnrnr rhd h.orshc n kcnscd lurt r
<br />h rhc rrovnionr of Ihc Conrrcttr s l-i..nrd tjs (Chrtlci 9, C.nnncNing wirh SccriM 7{X)0 oi Division.l ofrhc Busincss rtrd
<br />fDlc$nrn\CDrlc)orrlBthc.rshciscxcmprlhcrcfroraDdrhchssnntrr[c.lLAcdcxctnlrion.Anyvn,hn)nofScli]o?0:ll5byary
<br />xttli.id ror o p.mIt subjcclsrhc a!fli.inr r. ncivillcnulryorn.r rmrcrhan fivc hxndrcddoll s(S500)
<br />-1.
<br />as owNr ol rhc fmp,n!. (tr my cmplort.s with w,sc\ ,s rh.n v,h .on[.Nrrion. sitl J. rh. w.rk lnd ltE (M!@ n nor
<br />lntrB ororhrcd r'or salc (S( 7o1.r. Brsftss d tuofc$ions Codc: Thc Clnn[.kv' s L i.cnsc taq docs nor arnl,t,uo$trsof
<br />rh. !$pcny pho blilds o. nrlt)rxcr lhcRr ad wb JtB $.h w(trk hinsclfor hc6cltor rhrclgh his oi h.r ou cnrpll,ycc{,
<br />pr.v L{ rh.r su.h improvc'En(,.,x idcndcd or ollcrl hr eh ll lDserr rhchiHiis or inf,mvctrrnr is $kl *irhin 't rtrr
<br />of.otrDLrhn. rhc Osncr lluildcr willhrh rh. hordcn ofrn'vinE rl[i hc or \hc dil nor hild or i'rProv. lnc pmlcny ti,r rhc p0rlx,*of
<br />-1.
<br />nsouncr olrhc nmpcny. rmcr.hsirclycofttrdins wilh li.cnscl coit,.nns h consrrucl lhc PrnFr Iscc.7(}1]l. su.imrs
<br />and Pirf*1b.Codc: Tic Gn rscrr's Li.cns.l-dw docs nor lfplrro io.unc' ol Pnl.dy qhn buildsot inDrovcsrh.ron.
<br />ond sho c.nrdcrsror {rh F,jccls wirh a Conlocro(\) liccnscd rursuttrr brhcCoDrrturoi$ Li.. \. Lxw).
<br />-l
<br />!hcrchpr und$ Ser 0 &Pc
<br />thl€:-_ (r*ner
<br />lulLlx,llll)N
<br />! hcrcby lffirnr hdcr pcndlry or Drjury om ofthc lolbwins dNlararn'ns
<br />I hnlc dwillnrn uir!CcnL[cicotCon\ctrrn)Sclf.ln$ncilrr!otkcr'mn|,.nsrnnr,,\ P(,vidcd lbr bySc.riotr l7(noirhc
<br />bhtrC, .. fdrhc NrLnnrN.ollhc (ork nnshirh rh. P.nnir ls isuci
<br />-l havc .nd will roinbin sorkc^ conp.nsslhn insurorc. as eqlidd b, Scction 3100 of lh. tibor Cod.. ior ltE Pcrfomte of
<br />the port for whicn ltis rcroil i3 irscd. My,orkc* compcnslion irslnme cdrit !M Flicy nunbcr ee:
<br />-l..diry
<br />thar in rh. Frformrccorlhc sork lor *hhh rhir p$mil is ksucd.l sh.ll nor .nplo, .try Fen in an, mdnd
<br />s N ro h.om suhiEl ro rhc mrke('comp.nsalion laws of Colifomia. lnd {gm thot ii I should b6om subrEi ro i,r
<br />rc sl @ryrn$lb. peli.ionsofscliotr !?mof0E L.hor C{dc. I .r[ll. lonhwnn onlPly enhlh.c pDvtiont.
<br />WARNING: Flilurc lo sure *o*c( conD.nuiion orcmSc is unhef!|, and shlll subjGt an ml,lortr ro dininal Fnohics tnd
<br />lo om hu rcd rh.uend dolltrs (!l0o,mo), itr .ddilion rd rhc co ol.on'Pcnsatbn. d.rogcs as !revidcd for th.
<br />Seiio. 1076 ofrhc htor Codc. intqc$ rnd .llormy s
<br />I hcEby ifm ondcr p.ndry ot DsFry $d I m licnEd lid€r lovisioi ofctuPls 9 (mmrci.g snh SNlbn 7000) of Dilhion 3
<br />of $c ausiNs and Prcf.ssi..r Cb&. srxl ny lkcM is b 6lll foE d c,IEt.
<br />Dorer Con(
<br />CITNSIAI]EIIQNIENDIIC.EG.UNII
<br />I hcrchydinundc. p.nrlry.iprjuryIhal rhcrc hocon(rucli,,n lt ingnlc.yforrhcNtlotntttuc.lrhcworkfornhichrhi\Filniris
<br />issucd ( s$. 3tn7, ( iv. c ).
<br />AIPLICANLD[clnIlAIllrN
<br />I lr r$y amm uMcr p.n,lry oi !'crjur, onc orrrt r.lk,aine d..ld,rnnN:
<br />Dctunirn,n Pdnir\ Asbcnos Notifr ion fcdcrul Rc! brn)n\ (Tirlc40, P.n6)
<br />-Requied
<br />trndr or Norifi mlion
<br />I cdilylhd lhc Ldcrrl rc-luhlnrns rgdding ssbcslos rcmlal orc nor lppli.dl,L io this Pmirr
<br />l.cnify rhlt I hlvc read rhi\ st tli.,rio..nd srntc lhal Ihc otovc infitr@r'on ircoret. I ryxe to comply{irh rll Cityand Counl,
<br />oxlin0nccs and srarc liws dl,ring ro buildinS co r.rd ncrch, rlridzc rFc*nlalivcs oa lhis Cny and Couniy ro cnld utDn rhc
<br />rlDh nrnriorcn FmFny for
<br />P.mlte!l.m (pd )r--1h'FP lt
<br />*,, Ce,f 02/20t?
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underf loor
<br />Buildinq Sewer
<br />Area,i Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Rool 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 />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release I
<br />FINAL K/,Y//,{
<br />Notes Remarks Etc.
<br />Water Service
<br />Ddc.--
<br />I ctrJ '. Nri'..
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