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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder lloor
<br />Gas-Underlloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Irilain 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
<br />Final Gas Test
<br />FINAL h-lilu ln nda)
<br />Notes, Remarks, Etc.., I 'l
<br />ot{Ntta sull_DER DEt,cARATtoN
<br />I h.rhy nliirnr un(lcr E-nrlly ol ncrirv (hrr I crrn,pl iom rh Coftrcktrr l-i.cn\c l-ls f(r rhc fdlowin8 rcrv)n (SDc 7o:ll 5
<br />Bu\]tr.s\ rfrt ltrofosn,n Codc) n, C(f or Counry whi.h rcquir.\ n N.nit r) coo(ru.r. rlrr- if,,p(rc, d.nrl^h r rcnrn nnt
<br />ntuckc, tritrt, ir\ n\ud'.c. rl\. r.qunc( dc rptrli.rDr lor \u.h !cnn( b rll. r sisncJ {rcnf, r rl r ht.r \hc n li.cn{cd ftrsu0rl
<br />h rh. |nolnionr ol lhc(inrrricttr\l-icctr\rdljNlchipr.r9.(innik.3qfhScdion7(Xxrotl)ivhion.]ofrhcBr\incl\rnd
<br />arplnrnr turNnnn (uhjd\ rhc imlritrrro rcivilpcDrlry.lrnr.!,.rhrn fi\c hrnd.cd dolln^115(x))
<br />-1.
<br />$ owft, of rhc I'DIEny. or oy cnploFs v[h ws8!s s lheir sL oiPc sdion. eil do ll.r eqi tld llE n lr1r h ml
<br />i crd.d or of,cEd f sL (Sa.70a4. BrsiB ud Pmfcsk'ns C.dc Thc Cnnmcto, s L@n* taw do.s ml +! , lo dn oMd of
<br />thc nn{.n, vho hoilds or irproB rlrtur! od wlD d(B sh s* hinsctf or lEelf or llmtgt his or lEr om cnlllo}tcs.
<br />l,revid.n rhr s!.h in{mm.l3Nmt inlcndcd orotu fm sh.lf. t[*er.llE ttildine d i'qmEmfl i. $ld eirhin ore r@
<br />of.drphriorl $. Osrcr BuiU6 BiU law tlE hlr&! ol pmvjr8 ${ lE or slE dn d bulld or iqmE d* Foldry ftr rlF poipo. or
<br />l. $owftrofrhc tml.ny. ercxclusirclyconldclin8 with liansn conrtulo ro..nsmd lh. pbi(t {Se. ?044. Bu$rcs
<br />ond Prof*bn Codc: Th. ftora.roa. Li.cnre Law des noi lpnly io M owmr oi prop.ny who builds or improrcs rhocon.
<br />rnd who snracls ior sucn lmjcds rilh ! Conrmro(, li.cnsd l,usulnt ro rhc Conractoas Laen* tiw).
<br />! dn.xcnu udcr Sccrio B &PC lhrrhis rcason
<br />UqBf,EXS.I;OMIINSAION
<br />IECLASAUA!
<br />I hcrchy aflnD undcr pcmlryofpcrjuryonc olrhc lollowins deldirioni:
<br />Ihrvcdldwillnui.r.in0CcniarsrcotCon*nrroSclllnsurcfor*oltdr'.or{rns,'io6.NpmvidcdfoibyScclioi3T00ollhc
<br />trlu clxlc, fd rhc pdld'mn.c of rhc work fm whth rhc ,cnnil is hsuct.
<br />I hav. ond will roitrrain wnrtcrl comFnsarion id\lramc. &s rcquied by s..r bn ]700 of th. L,b{tr Cde, for the pdtomrc. ol
<br />dh ,crnir is istu{. My workga onll'cnsation itriuramc €ricr rnd plicy nunbcr B:
<br />-l
<br />..nifr rhar in rhc pcrlormmc ol thc vork lor which thh p.rnril is hsucd. I rhrll n l .mnloy ,ny p.Mn ifl My m rcr
<br />s s to trccom subjd ro rhc soridl comr.nsl ion hws of Cllifomii. md egm rhal if I should tEro* subjsl lo llt
<br />trorkcG ompcns ion Im*ions of Serjon l70O of rhc Lrb.r Codc. I shdl. ionhwilh otr{,ly wilh rhos Pmvirions,,
<br />W,{RNINCT Friluro ro {cuE trorlcB'compcnsorion mrruBc t unlavtul and rhall slbjel d @plotri ro ainiEl lrmhies lnd
<br />lddirion 16 lhc co{ of conp.ndior. dsm8cs as tmvid.d l'or rhc.ivil finc! uI to on. h!.drcd t
<br />I.ICENSND-LOLI&I!:ITB
<br />t lir!.atsdrloN
<br />I lrcrcl'y rliir on,lcrp.nrlryortdrjuryrhd I d lircn*dundcr pmvisia of Ch{frcr 9 ( comDrtrc ins wiri S..ri,n r0o0) .i Divisim 1
<br />o, rh. Busircssn d Prcltssiors Codc. {n,.y liccn$ i\ in n,ll l{rc nrxl.r..r z{T1
<br />lll liI8lll-ll0llill2lt{Crl(iEl.(.I
<br />I h.ruhy rrltm undd r.mliy orr.rjury(h,t rhcn is r.uniru(rio. LndirS 0rcncy nr rhc psfornMc. orrhc sork ior whichlhn I)c mil is
<br />isucd rs( 1097. ci! c r
<br />a-tlu(]\rll2[cl al!]&n
<br />I lkn$r_a,Lr!tr,1.r p!irlrtol I)rrJUryo r ol rh. n'lktr1 g d..li,rriotr!
<br />l)ctrDlirlor I'cfln r\ \h.{o\ Norificrri{n F.n.r l Rrgrhri,n,s r'lirlc.10. I'nn6r
<br />_R.qun ,l Irnorof Nor'lirro
<br />-l
<br />cerily 6d rn fcd.6l E8ul{io.s eSeninS lst slos Emv.l 0E ml aldttbL ro $h toid
<br />-l
<br />aniay thot I hovc rcad rhh !!kurionand {arcrhdrhcnborc iir.marion kdonccr l rEre ro clmnly wirh ill Cirr nnd Counry
<br />tlildinBconrr .rion, anl hcrbysuihoinc *rds altcs ol l hi\ Cn, ud Counry b mrc, uron lrroalinomcs and Sllrc Lrss rcht
<br />ohov. mnliomd nrcD.ny for lx
<br />I
<br />Area./Storm Drain
<br />Meter Release Ur4lrf-daz^
<br />V
<br />42
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