|
PLUMBING.INSPECTOR RECORD
<br />APPBOVALS DATE COMMENTS OWNER BTlII,DER T',EI,CARATION
<br />I hcrchy rllirn udd.r Nmlry of Faury rhdr I dr crnlPr io'n rhc co rrhs Li.cn* tiw for rhc a.,lowii8 rca\on (Ss ?0.11.5
<br />Busirr$ Nxi ft.i.slnnr Codc): Any Cily or Coutrty vhi.h rcquncs r p.anir Io conslrucr, rllcr, nnDrovc. dc.Flhh nr rqri, utry
<br />sro.rurc. [iorx) irs is\rin.c. rho sluncs rhc lprlicrnr fitr srrch lErnit x' filca \i8ncn ialcnrnr rhd hcor \hc i\ li.cned nu^u$r
<br />tu
<br />'hc
<br />pmvrion( or rhr Coit,cror's Lic.ned tjs (Ch,fl.r 9, C. nn.n.i.! sirh S..'ion ?(xD ol Dnniotr I ollhc Businc\\ und
<br />Ptr,acrsion\Coderor rhrr h.orshc nexcmpl rherciromand rhr bash forrhc allqedcrcmrln'n AnyliolarionofserionT0:ll5hymy
<br />rppli.nnr li,r!ttrmn sxhjdrrrhc rypli.rnrb !civilp.nahyofnor nrtr rhrn ll!c hundruildollris (J500)
<br />_I. !. owncr of fic l,mo.ny, or m, .nployccs with luges a rhcn slc oqxnsriotr will do tE wdt ald llE slBlw ii ml
<br />inlcnd.d or ofi.Ed for sb (3(.?044, Busim$ dd Prof.sk'.s C.d.: Thc ConrEdds Lhcns Lrw {h.s ml ryrly to s owcr of
<br />lhepDFny wh6 hikl\ o, iqe6 Ur@tr arn who.lia tun h hidElaorlEelf or lough his or her dM.a!ploy6.
<br />ltovilcd lt t srct tnsmtNrr. G mr inrc'xLd o. otu for sh. ll hkM, rlE hliuins or inrrcrcmnl ie $ld *itlin otu ,@
<br />of.orplcrion. tlE Owrcr Auibcr wifl hlr rlE b'id.n ofFovin! ttld lE tr sh. dn ml hrild or inpmr th. pqpry tu rlt p{rJEs of
<br />-1.
<br />os ovrcr of rhc pmD.ny. !m ciclusivcly contruclinS with lic.nscd cofllmloN to con(tucl liE rmj€r (56. '7044. Blsin.s
<br />rnd Pro&sioo Cndc: Thc Cdnrr&roas Liccr.c Liw docs mr lpply to ao 6rnci .t pbpcny who huildi or inprows 6cr.on.
<br />lnd qho co.rEds for such pojccls *irfi a Cont@ro(o li.cnsn pmulnr ro rhc ConrEcrols Lt.ns Law).
<br />-l
<br />amcxclnpl undcr S.crioi- B. & P.C. forthis rcesn.
<br />uoaf,[B&-coltrENsArro!
<br />DECIAMIION
<br />I hcrby dflim und.r pcuh, of Friury orc of rhe follo{ing d.rlrnriors:
<br />-lhlvcnndwill'mi
<br />trinsCcnificDrcolCon\cnrhSclllnsurclor{orkc^compcnsnrnr,uspDlidc.tl bysc.tionlT(x).rrh.
<br />La$r (\llc,lo,rhcpc bnrunccoffic $o* lb!Bhich rhcNnnir i ksucd
<br />I hatc and *ill Minrain Bo*cs oo0cnsarion i$emq ,r cquned by 56r i.n 1700 of ih. Llbor C.dc. lor llrc Frfommc of
<br />l& wort fr ehi.h this p.mjr ,s i!$.d. My *ortcB .rnp.nssdon insultN .rmer alrd Fli.y nunbcr ml
<br />SUr,te s^^l
<br />.'1 ot)\4 -7 -7
<br />I c.difyrh, inthco.rformreof rh. wo* for which rhk pcinn i! issxcd, I shall not cmphyonypcrson in.nyro.mr
<br />$ as ro h.sm subFr ro rhc worts oqrcnerion hws of Cfllifoni!, .nd aEEc rhar if I sholld bctod subi.r ro rtE
<br />wo*cd' conpcnsation tmlisn,ns otScction 3700 oa rh. Lrhor Gd€.1shall. fonhsnhompl, wirh rh.s tmvhions..
<br />WARNINC: Failurc lo wrrc uortds comrrnslion covcmBc ir unkwful. lnd shrll \lbirr !n oq,brr !o ainl6,l Fmllis and
<br />.ivil fincs up ro om nundEn lhousnd dollss (31(x).000), in rddirion ro ttr cosr nlcompcnsarion. dlmg.r.r pmvidcd for rhc
<br />l,lff anl. i.rcr.n snd ar
<br />2"r
<br />ulli!$ulqNrxrglJx
<br />DTCLIaAIIAI
<br />B s/3b3
<br />z/>q )t t .^,^^* *,[ SLo l)nllr.t4-T^b /o-/-- -- r-
<br />CI}ISIBUCIIOX,!ENDIIG.AGENCI
<br />I hmby !,Irn under pcnd[y of pdjury ther lh@ i3 , o.smdt n lending ag.Ny fo. ih. Frfo,IMc. of lhc *ork aor which thir !c.mi i\
<br />iss!.d 1s6. 3097. civ. c.l.
<br />A.TTLICANfDICLABAIION
<br />IlrhbyrflitrLtrdd Ptnrlryof lrtrtryo of th. f.llowinsdcchrarion\:
<br />Danniri,,nl,c,nrih A\lr\rosNorincrrion ltdcrul Rc3uhrnnr\(lill.lo, lhn6)
<br />Rrqutcd If, nc. ol Norilicarn,n
<br />-l
<br />.cnify rhar lhc acd.Bl rcElbrions E8srdio8 BlEsros mmvd aE nor rpplic.bh ro rhh poj.r{
<br />I ccn ity rhd I n vc ald rnt ,pplii:arion 6,n {arc rtur ihc atnvc infomrn,n i cffi. I 38G ro snlply wilh rll Cily and Colnly
<br />.rdiian* .nd Sral. trws Ehrtng ro building con9fl.rion. ,rd heEby aurho.i& EpE*lrdivcs of tnis Cny ard Counry ro ent.r qi,n ir
<br />,hovc tunrioncd ,Dncny for i
<br />Appllcant or A8ert Slsmture W
<br />//rr,/ro los La.a,.z
<br />ttr
<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 />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drarn
<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 />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing ilql\g p4(h)
<br />Final Gas Test
<br />Meter Release
<br />FINAL Bl t)ltc, -LArID
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />I
<br />or rhc rrulin.\suni ltol$\i(ins Codc. r ryliccn\. i\ h tull rhrcc n cllc.r
<br />TOP OUT
|