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PLUMBING.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS owNuR I!(,lLDltR I)l)-CAR Tt()N
<br />I tur.hy Jrlnnr undn Nnrlrr o, pcrjltr.y lhir I nn cx.nrfl t rn rhc cotrrir.rorr' Li{nsc hw lirr rhc iollowins rclso (S.c Toll 5
<br />Bu\nt\s trnd I''.fc\\i,,n Codo) iy Cir, or Cotrdy Nnich requirc\ r l{nnir ro con(n'd. rlrcr. i fmvc. dctrn,li\h ,tr rlnn Iny
<br />slntrurc. fio o ts dsr.i.c. nho lcquncs rhc+tli.inr for soch l.nnirt,lilc r \i8ncd I c f, rhrrtr.or (hc i\ liccn{d l[Nurnr
<br />k, rhr pn,vi\nnN .l lh! Corrrckn \ Liccn\cJ ltrw (Ch plcr g. ('.nrnrcncing $irh Sccri{)n 7({X) ol Di!ti,,n .l of rht llusi'rc\s nnd
<br />Porc\non\ CodcJ or rhrr hr or \hc i\dcnrrr rhcturrndr.d rh. h!si\ larrhl Jlc[cd.icmnri{,n Anyln'larionufScd nT0]15hyrny
<br />rtpli.r lu r llcflnir suhjNis rltr amli.dnr r, r.rvilpcnikvol ioi nrrcrh ln. hu ilr.ddollnrs(S5UD
<br />_1. .s ownc, ol.h. pmp.dr. or ny cmployei snh s{ecs &s rhcn $b dmpcnqrion. sill do tlr vql ad tlE n dm is mr
<br />idend.d or o6.Ed for eL (Sa.roa4. Ausims ed Pbfcsiom Codcr Th. Contmclols Lic..s tlw docs nol eply lo atr owrcr of
<br />rh. !qEr, *ho hilds or lmpoEs rh.@'r urd who do.s st s* tins.lf or hcr*lfor rhtulgh hh tr h.r o*n endolei.
<br />rmvidcd rhar sch irpownrs e mr i.t ndd o.oftcn ror Bh. li hotrlk. tlE b{ilding or irFDr4nr i.c $H silhin orc J4roforpLton. ltE Owmr BuitLr will h.k dF hrdu of Foving lh.I hc o, sh. did @r huiH or in{mE rhe pbpdry 6r rrE plrloE or
<br />-1.
<br />as owncr of rhc pmFny. am cxclusircl, conlfuring wth lienkd conlrclou to m.sldct lh. r,ojd (Sa. 7044, Bulim$
<br />$.1 Potilb{Codc: Thc Co rr6as Liccnsc Lre docs rer ryply ro ano*.er ofprcpcny{ho brildN or idl,olcs rh.rco..
<br />ad sho conrra.rs for ssn Imjels with ! Co.rrdo(9 lietr*d t uBmr b ihc Conr0dols Li.cnF L{w).
<br />-l
<br />m.xcf,pl undcr Sdlbn-. B. & P.C. i,lnk reason.
<br />}ABtrIIIUIQMTJNSAITQN
<br />IIECI.AXAIII]N
<br />I hcrcby llftn undcr lcn.liyolncduryom otlhc i'ollo{ine dccl nrhN
<br />_lhlvc md q,llnui ain a Ccniaf,nrc oiCotr*d to sclr-lnrurc ror sorkc6- co nr!.nsr r ion, rs pmvidc{l lor hySccrbn 3?Oil ofrhe
<br />L.bor Codd. lor rhc p.rfonE,ftc ol rhc work fr whkh rh. n r6it ir issucd.
<br />_l hllc lnn aillmintoin qo*c^ compcnsalion insENc.0s r.qun d hySccrion 1700 of thc kbor Codc.lor|lE Iof.lr1@. oa
<br />Lhc work iir which rhh pcm is irnrcd My{ortcrs conwnsolion insumncc c$icr d, rolioy nuat ei e:
<br />Policy NumbclJitiEsl
<br />-l
<br />ccnily thol in thc pr ormmc of lhc Bork for wni.h lhir t mir is i,sucd. l {hall not .mploy 0try p.son in any mmrcr
<br />$ as ro bcatu subjd ro rhc wo 6'.on{.nslrion Lws of Calitomi!. md33Nrhar itI shoold b6om slbier rorlE
<br />workcF'comp€nsrtionpmvnionsofSEtionlT00ofllEkborCodc.lshBll,forllBilhconplyqithrhospovisions..
<br />WARNIN(; Irrihrc n' *"^.u( qorkr( co fri\rrion bj.ct rn cnploy.r to ninhal Fuhis Md
<br />civil lin.s up ro 6rc hlodrcd lholsand dolla lll .on{Enerio., d.m8$ .s providcd for d.
<br />S.clion l{}76 of thc Labr G)dc. imcEsl .nd a my r fes.
<br />D.t :- Appllorl:
<br />I h.rby !finm undcr rcnllry ot pc,jury rfilr I am licu*d n ofChaptd 9 (conmminE lnh SEri,. ?000) otDivirio! 3
<br />of 6c Busimss and Pof.ssioN Codc, ond my liccn$ is i, tull
<br />I tun6y afrrm und.r F!dr, oa pcrjury dd rhctu h a si{Mri6n
<br />issucd {se. 3097. civ. c,)
<br />.8.nc, ror rhc Frfoll]r,N of E work rbr *hict lhn lEmil is
<br />AIPLI(SNIDECI,AE{II!'B
<br />I h@b, nlim und€r Fn.h y 6f p.rjory oft.frhc folloBins dcchnrt,ns:
<br />Dcmlirion P.irnits.Asb.stos Norificarion l,cdcral Rcgtrn i.trs (Tirlc40. Pan6)
<br />-Rc!uncd
<br />l.xcrof Notifi cllhn
<br />-l
<br />€cnify rhot lhc lcdcral rqularioDs rcEarding lsbcsros rcmov0l m nor 00dicable ro rhis lroJccr.
<br />-l
<br />ccnify thsl I h,vc rcd lhis f/ica
<br />ordinoks and Srarc kws Elari,e ro b{
<br />3lorc rhar rh. atnvc inlorrorio. is consr. LBre ro con ly sirh lll Cirra.dOounry
<br />of$t Cnyed Countyto cnr6 onon rlE
<br />trhovc mtrrioncd pml).ny for inspdion
<br />.\DIli(rnl or \rr l Si!nnl"D.t.i-
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rou gh Water Heater
<br />POOL/SPA
<br />P{rap/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 q r/r8 t,i,^ArrGu4
<br />,_)
<br />Final Gas Test
<br />Meter Release
<br />FINAL 7,lrx tr.?),-rt:>b)
<br />Notes, Remarks , Etc.I
<br />APPROVALS
<br />L.nd.is AddEs:
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<br />TOP OUT
<br />tollr"llt1
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