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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR.AIION
<br />I h.rcby afiirm undcr IEMI!y of Fdury lh l m cxcmpl 6Dn rhc Coir.rcloa Li.cnc t e for rh. followine E"sn (Sa.7oll5
<br />Business ud Pmlcsshn Codc): An, Cily or Couf,ly whkh equiEs a Fmn b 6n$rud. all6. improrc, d.mlhh or rcp.n My
<br />shdur.. prid ro irs i$u!m, alo rcquirca thc ll)nlbet for sucn pcmi h nlc s si8rcd srarcft thlr h. or sh€ ii lieNcd purMnr
<br />ro rlE pDvisk'ns of rlE Conrtrroas Liccn$d L!* (Ch!r.. 9. ComminS wirh S.crion 70fi oa Division 3 of rlr Busi..s snd
<br />Prcfesions Cod.) or rh{r h. or slE ii cxcm$ rhcofrom and rfi. tEsi for llE llhgcd cicnprion. Any liolarion of Setion 701 1.5 b, !ry
<br />applica fo. . p.rmit subjcck lhc rpplicanr lo a.ivil,'.nalry or tur tur rhM fivc hudrcd douas ($500).
<br />-1.
<br />a. osrcr of rht ptufrny. or n, rdlloyes *ith *agcs ss lh.ir $lc onp.nslion, will .lo th. w{r* .,n lh. s1rlctE b ml
<br />int r/rn ororcEd for eh (Se.7044. B$inc$ and Profcssions Codc: Thc Conrndor's LtctrE ljs docs mr apply ro&o*M of
<br />thc pElt ry *ho ldildi or in{m6llEon. ajn sho dms Mh Mrk hin*laor h.elf or lhmu8h ht or lEr om ctrployc.s,
<br />,mvacd lttrl sch impmwnls @ mr inr.rld.d or ofcr.d fut eL. lr. ho*B, rlE hildir8 or i4rmEmnt k $ld wirhi, oN Fa
<br />oaonphtio.. rhc Owrcr Buildq wi! hrE dE bldcn of tftving $d h. oi $€ dil rcl buiu 6r inqDw 0E ,rqEry fo, t E pu.poc oa
<br />-1.
<br />as own$ oarhc poFny. rm cxclusircly co ndhB wirh licc.{d ftnfia.rm ro llnsrud rh. pojd lS*. 7041, Buiircs
<br />lnd P$rx*bn C.dc: 'l h. Cont cbr\ Li.cnqc ljw docs not aDFly ro o owncr ot proDcny wno bu ilds ot ihp,.res rhc@i,
<br />aod who conrmG fo, ruch pmj(r virt! Cotrr@ro(s) lk.n$d puBuor to rn C.nhdols Liccns bv)
<br />I amcrcmn' undcr SRlion ,B &P.C ror'hirEMn
<br />EOAf,Ef,I.COMTBTAIO!
<br />DECIASAIITA
<br />I h.Eby.rtrmlo.hrFdllyof F.iuryoEollhcfouowing&il^! ionsl
<br />l:'hr({rt..lnrrhcn. onnrNc.trh!\orkntr}hichrtun.nnir i!i\\d
<br />-I haw .nd will nli ain wodcn comp.osrrion inrunncc. ds rcquird by Sc.tion l70O 6r rhc Lrbo. Codc, for tl[ psfo@mc of
<br />lhc wrr for *ni.h lhL pc@jt is iss.d. My wo.tcB onp.nsrio, i.su]ie @tr lrd lblic, .umba @:
<br />Polic, Nutr$.r: Erpircs
<br />-t
<br />ccnilylh.l in rhc p.rformnc€ oflhc wo* {o! which lhh p.rmit is issucd. I shsll ml cmphy any lcmn in ony &unc.
<br />s os lo lr.om subier lo lh. rol*dC .omr.nsrior lrw3 of Calitomi( md rgm rhai if I sholM tr.om .uhj(.l lo rh.
<br />*orlsl comp{nslion pmvisions of Selion 3?0O oa lh. L{bo. Cod.. I sh l. fodhwnh soply rilh lnos pmvisions..
<br />WARNING: FliluE to surc wortcm' mmFns.lion mvcBgc n unhrtul, lnd shall subjd rn cnrolor!. to aiminal FEhts 8nd
<br />.ivil finc. up lo orc hundmd thousand dotl&s (Slff)
<br />Sslion 1076 of lhc tibor Codc. intcrc( and 0normy\
<br />.(XD). in oddirbn ro rl[.o{ ol nsrio.. d!@g.s .s providcd lor th.
<br />?'J>-rt'
<br />LtgirsIl)_(:oNr.&|(:ra.&
<br />l2lrtdf,{IlaN
<br />I hcruhr- rtlirn uftl.r |E.rlry olperjurv rhrr I a'n liend Ln(ls I)r.\i\ion olChrp(cr I (co'nftNin! snh Sccrhn 7dx)) ofO,rAion 3
<br />oi lhc llrsiocss ond Pnni*idrsCoilc. xl nry h.tnr i\ h lull,nr.c dMcllc.r
<br />,,*^.""r.L. 3 b o 7
<br />'at>-/
<br />(;OljiIBUqIl()NXTNPIMirl1iflLl
<br />Ihcrhy rffirnrn,l.r lEnrlr, ufp.rjur!rhar rlrcrr i\ n .onhcri'n hndingrgrtrcy furlf,Frlnntunrc ofrhctri tur trhtrlrrl$ trflnir (
<br />i\\0clrS( r(l)7 Civ C r
<br />A.IEUIAITDICLATAIII.IN
<br />I M,) a,rm undcr pcnallyof pcdury onc of thc ri,llowinS dR.-lnrorn,nr
<br />D.molirn,. PcirniF^sh.ios Nolifi.rrion Fcdcnl RcguLrn,ns (Tirlc JO, Pan6)
<br />Rcauncd htr.rof N.rifi ..rhn
<br />-l
<br />ccnilylhnr rhc fcdcra I rcsnlnl io ns rcsrdiry osEn.s rcmoiil nrc nor opplicabk ro lhn prcrcr.
<br />I c.nili rhar I hrvc ftatl Ihh nprlf,,r io. ,rrl sorc rd rhc ah,lc itrttr u'i.n i5 .oNr I dlrd r. ..nlply
<br />&d Counry lo cntcr upon thc*fr;;';**"**':,',"''
<br />atrrt rnri,)ned fnD..ry fff
<br />Applienl nr AF.nl Sisndlu
<br />U I k- a->4t-
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing
<br />Final Gas Test
<br />I
<br />FINAL I ih.Blrt l.?{nb4?fr lK?/
<br />Notes, Remarks, Etc.
<br />qWater Service
<br />Back Flow Device
<br />Meter Release
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