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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.oWNI]R IIUII,DT]R DTJt,CARA'I'ION
<br />I hcrch! aflnnr rndrr pcnrlty of trlu,y rhnr I nfl crcntn lnnn rh. C.rlrrc!tr\' l.i.cn\c l-xw lnr rhc n,l[){nlg nr\ (Se(]l)ll5
<br />atrsnrc!\ rtrd Pi(na*dr ((dc) ny aily or ((urty \hrh rclutc\ n J--rnil b rotrit.r, rlrr, nnB)vc, rlcnmlth ot rqxn inv
<br />(ru.rurc. |]rior ro il( i\{,iDcc.xl"'ruqune\ih.rpllicrrrlarsu.hFrniin)filcr\'!nlrl rcnf,rrhdhcorshcisliccNcntu6!nr
<br />k, rhc F)v'\trrN oi dr Coftn ror s l-rcn{d l-n! (Chifrcr 9, Connnc..i|! silh S..iiof 7(X)0 of Divi{n,n :l ol rhc tlu\nrc\\ 3il,
<br />lPfli.rd fd a pcnnir \u6lc.6rhc Ufli.Mr k, rcivilNnrlryol nur trBtr.rrtr livc l,u drc,l dolhrs ( S50t)
<br />-1.
<br />!s orncr ol th. l()penr. or nry cnTl,,y(s enh *+c\ A rhcirq,lcconDtNrrnnr, willdo rhc uoi( ind rtE (ru1h i\ ior
<br />i'n.ftlcd or offcrcd ftn slc lsc.7()$. axsirE\s nni Pm{c$ions (odc: fic Conlr ckn \ l-iccnsc Ijw do$ not.!ply n) 8tr owNr ol
<br />rhcpmFny $no huilds or nnpm!$ rhcmrn, drd who d(s \u.h sork hnnscll or hcAcll'or rhmugh hir or hcr oanchployccs.
<br />pnrvidrd rhar srch inpr,vcnrnrs arc mr inrcDdol d ol'cRi t)r \aL ll howclcr. rh. buiuirs or iq,oRnEN is sld wirhi'r nnc )(r
<br />olcomplciion. rhc O*ncr Uuildd willhrv. ttr hunicnofpmvint rhd hL or shc did not huild or inr{'rctt Ihc IimIEny f.r rhc PrFi{ of
<br />L as6wh.r.lrlE poFrry. !ncxclusilcty€onlBrin8 *irh liccn*d co r&16 ro @nsuuci rhe proj(rl (S(. 7044. BEirc$
<br />ald Poftssbn Codc: Thc Conracrois Laccns. ks d@r not ao,,ly ro u ow.n of protcrly wno builds or inprots ficreon.
<br />sd who smrers for rNh proiLrs wirh 0 Cnotr cro,ls) lk nsd punMr ro thc Coir.&toas LieM Lie).
<br />lr crn,d utrd.r S.crird .ll &l'( li,i rlr^'.x\tri
<br />WORI(Ef,S' COMPTNSATION
<br />DEIIdf,AITON
<br />I lErh, affirm uldcr pculry of p.rjury om of llE followi,S delmlions
<br />Ihr!c,ntsilln irinrCcdi,irxrc.fCoi!.nrroSclaltr(urclirsorh.rr(.nrlcnsrri,nr.tr\p'o!nl.Jl{trhySNrtr:]7({)olrhc
<br />lihor (ixlc.litr rhc pcrlonmnco ofrh. work f{tr shi.h rhc prnnir G is\uctl
<br />I Uv. lnd wiu nrinhin work.N co'nlEns.lioo insur!rcc. !s Equid by S€cln,n 1700 o, rhc khor Codc, for rh. pctfo,mmc of
<br />mpcns$ion insurancc cuicr ul rricy numb& rc:
<br />+
<br />Pnl'cyNuh$.r.7
<br />-[rn,F\
<br />-l.cnifyrlmt
<br />iirhc pcdonutu. ol rh. sork fd shich lhis i,.rnir k ksucn.l shdlltroi cryloyanyllcson i. a.y Frn .
<br />s !s ro hc.o(* subFd lo fic wo nl comtf,nsrion l.ws olcllifornia.0 osNrhar it| rhould tr{.m snbir rorlE
<br />aort6' co'nF.s.r b. pmvNions of Sstion l'7(t) of r hc Litor Codc. I shlll. i.nhvilh condy wirh 'th€ ,mvisions
<br />WAnNlNcr Failue to s@ $ortcr' €mp.ns.rion cove68c n u.bvtul. and sh.ll sobicl !n drlorcr !o dinMl lfBhis 3.d
<br />olconrtEtrs.rion. drhtrlcs rs
<br />I hcEby.mrn undcr pcmlry of pcrjurr lh0t I am liensd under pmvnion olChqprd 9 (onmmi.8 wirh Sdion ?000) ofDivnion l
<br />of rh. Bn\iNr{ and Pol'd*io.\ Codc. ind my liccnr t i.-7ote\t1
<br />AITUCANIjIECIABAIIQN
<br />I hcr..by allim lndcr pcnalr, ot farjury oN of rhc rollowing d.clern'nli
<br />Drmlirio Pcmirs+str{os Norilic.rion ltdcrtrl Rcsulalions (Titlc 40. Pan6)
<br />R.quncd bncr of Norifi.rrion
<br />_l .cnify rhr thc fcdfirl eErtlrio.s rcSanlin8 a,b.slos rcmval e nol lpplic.bk lo this toj.tl.
<br />-l
<br />.srify thd I h.v. rcod rhis applkatiofl 61d srarc rhat thc !bo!c infornrario. ir co@t I aeft ro 6q)ly wirh ill Cily and Colnry
<br />odinaftcs md Sl,tc tiws rc o biildinB con(rucrion. ud hcEhy-alllEi&-(sllEtc!|rrir"" or rhis Cny rnd Counly lo cnts uB,n ltr
<br />Appllenl or ABcnl Slanni
<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 Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool HeateriGas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq 7-25"{(Y"VlA
<br />Final Gas Test 7-25'lc ?W1q
<br />Meter Release /. -r\
<br />FINAL r-6-l{x^lJ\d
<br />Notes, Remarks, Etc v
<br />COMMENTS
<br />CA!SIf,IJCIIONIIi!DI!1i.&GENI.I
<br />I hcrchy rritnrudcr p(nrllyofpcriulvrhri rhm n r.o (ru.ri,n kndins as.tr.y for rhc n ,lbiitutrcc olrhc sork ior which rhis Fnnir is
<br />rstrcd (Sc. :lllgT,Cir C.l.
<br />trn,lc,'\ NJ,nc
<br />L.trd.l\ Addcs:
<br />-
<br />rh,vc nrcnrionrd Imncn, rar z/%18
<br />TOP OUT
<br />Gas Service
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