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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BT]II,DER t'[I,CARATION
<br />I hcrchy iinn undc, |xn0lry ol lcr]ury thor I 0n.rcmrr {nrn rhc C.tun.tun Li.cn{ L.v ldr rhc f.llosinS rcnsotr (5(.1}11.5
<br />Bu\nus and Pn)ksnrn Codc): Any Ciry or Counly,hkh rcquncs a pcnnil ro con{ru.1, allcr. inrprcrc. dcdohh or rcl[n !n,
<br />slrudurc. lrbrb ir\ il\u.ftr. nl$ rcquircs lhc applicair tnr \!ch Iicmir Io fib a signc.l ndcftnr rhf,r h. or \h. is li..nd plrsMr
<br />t, rhc pn,vti,,n\ of lhc Gnlricr(tr s Licens.d l-as (Ch.rt{r 9. Connncn inS wnh Sccriotr 7m0 of Divhbtr :l ofthc Businc$ and
<br />Prrtssions C.,1.) or rhar h. or shc iscxcnipr rhcrclion,ud Ihc br.k lilrrhc rllcgcdcrcnfrbn Anyvt,hrn'nofS rionT0:ll5hyrny
<br />rrpliclnl foro pcirnit hj(lsrhc.pllicrnrrotrcivilt'cmnyofnor r,rc rhin livc huRl,cd dolli( (5500).
<br />-1.
<br />B owrft of Oc prep.nr. or ny .mploFr with slgri as $cn $b @np.nrdion, wiu do rh. wBi otd 0E n,Er@ b Dr
<br />inctl.d oroficrcd for slc (Sd.70r.4. Blsitu$ ud Profssiom Cod.: TIE Co.urc'ols Liss t wdoesrclEI ylo!.osMol
<br />rhc nqEny who toildl or nr9mE llron. orn wno dm sh wo* himsclfor h.Mll or rhmugh hi5 or hcr owr .rploy.cs,
<br />prcvidcd lhar skh inprbEcnr3 @ mt ht nd.d o,o,Icad fnr elc, li lbr.w, dE tdilding or insrftmnr h $ld *ihi, oN J@r
<br />of onpk irn. $c olrM Suitlr will lEr rhc hrdo of FDving $ir ic m slF dn ml hiild or inptlw dE p'tFny for rtE l,urpoe of
<br />-1.
<br />rso{n*oarhc l]fopcnr, dcichsiwlr$ntractin8 vith li.crcd conrrocror ro onsrrucr tlr Fsjat (Se ?o44. Businc$
<br />and 6Di:sshn Codcr Thc Cotrtmctor's Li.uns tjw doci n6r tnply to dn own6 .f prop. y qh. bLild! o. inprows thcr€n.
<br />and sho ontrcts for suct prDFls *irh a ContEdon9 lienBl l,uRunr ro rhc Conhdols Ltcn$ Lnw).
<br />-l
<br />!n cx.nrl lndcr Scction-. B. & P.C.lor rhh uso..
<br />uoxf,E8[roMPiNtartoN
<br />DEI;IAIA.II!]N
<br />I hocby alfirdlndcr peMlr, of tdj!ry otu ofrhc followins delamtkns
<br />-l
<br />h,v. &d wil|mimd! r C.nifrarc or Con*fl ro Sclilnslc for ertc6 sopctrwion. !s tmvilcrt ao, by Serion l7@ orltE
<br />1,b.. Cod.. tur rhc p.rfomd 6t rhc ert fd which rhc pcrmn h isswd.
<br />_l havc lnd will minlain sorkcr' .oml,cnsllion insu.otrcc. .s rcqutcd by S.ction 1700 of thc l-abor Cadc, for lte lsfo,nucc of
<br />rhc aorl fo qhicn rlln pcrmil is isu.n. My workds co,np.ns0lion iflsurlncc cmis d loticy numbcr m:
<br />Poli.! Nunhq'-Expircs:
<br />I ccnir, thar in rhc F,i(r@kc orrhc work ror which rhh pchi n hsued. I \hallnor cq,loy an, ,lcron in a.y n,nn&
<br />$ slo b.ronE strhj.cr lo lh. workcrc'$Eptnsrrion h{s.rcslifomia, od lgtr rhd ill should txcom subic.r lo $c
<br />solktri q,mpcn$ari,rn pmvl\io.s or Scdio. l70O of rhl LihI Codc. I shall. fonheilh .od{,ly wnh tho{ provi\ions.
<br />WARNINC f3iIDT lo ccurc sortcE coflrri.rerio, orru8c is utrlowtuL and sholl \ubr.r an cmpL)fr lo f,ininal Fmlris lnd
<br />ci{l fioe\ up ro oft hundrcd rholen<l dolld (SI0O,00O), in addilh io.. dlmgcs as pr.vid.d ior lhc
<br />DICLNAAION
<br />rl rhr lluri,rc\\ rn(l ltolisri{,n\ C, c,! Dry licctr\. i\ i',lull h'.cudcllrcr
<br />{{o
<br />Aff[lCAIlLDElllA/l.IION
<br />Ii.rhylllhnu cr pctrrlry ofNrjry onc olrnc lollownS d.clrlriotrs:
<br />D.nrliriur l,.flnirs-Ash.{os Norirr.nrion Frcdcr0lR.!xl ion\ llitlc 40. Pdr6)
<br />-Rcquircd
<br />lari*.f Noriltdri({r
<br />_l en ify rhlr rhc fcdcral E8uhtion\ Essdin8 asLtus rcmval aE nor aprltol,lc r. rhis [m]cd.
<br />-l
<br />c.nify lhrl I hrrc Ead rhh appli.rl ion wl sal. rhd rhc atrvc inf(rmdion k.omr.l4N ro con{,ly sirh allChymd Counly
<br />nnl'n.trf,c\Jfd srJ(.lf,*! F.hnnE n' hu' Utrie r',,(iu,etr J"d hc'.h) ourhr/c '.rrcc.nrJhc\.rrahrc
<br />'n.n,n.m,r nnprd) i{ i'r.nc\ri,'q pu'r,{. I .. --->r. -
<br />Apph(.nror ^Eenrs*Mrum,
<br />/\'. l'l tt'V
<br />*u-^",rn*r------l fu:.r.unt-
<br />/6
<br />UNDER GROUND
<br />Waste & Vent
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ptng
<br />Gas Piping
<br />Roof 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 />Water Service
<br />Lawn Sprinkler
<br />Sanita ry Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Meter Release
<br />FINAL 1lil As -746t \0tu,L40'
<br />T1 vv \!_-/
<br />SNri.n 1076 of rhr ljhtrC. ..n crc{rnd an.fty \ lccs",'/tg
<br />I hcrcby oflirn undcr pcnally of IErjury rhor ltsc h ! snsltucriotr lcndiig 0gcncy lor lhc pcfornEre of lhe eork {6r whi.h rhi{ pcrmn is
<br />i.N.d (Sc.. 1097. Civ. C ).
<br />ti,x!",'. N,,m'-
<br />Water-Under lloor
<br />Final Gas Test I /\
<br />Notes, Remarks, Etc.
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