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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oWN!]R AUN,DF]R DTI,CA&TTI('N
<br />I hcrby rmrfr undcr p.nnhy (,r r.rjury lhd | tun cxcru fn, rhc C.nl.i.to^ L,i.ctrB 1,* ior rh. nnhwi'rg r.i$tr lsc..?0r1.5
<br />Busirc\s rtrd Pronssion Cod.): Any Ciry or County shtch rcquircs r Ninil kr q,n{ cr. trlrcr, infmec, dcnrlitn or rFrn rny
<br />(ructuc. Dri(tr1{' irs isuMcc. o rcqutc\ rhc sDrrlic l nn such pcrnn t, nLa rirn.d {trrcmtrr tlur lt or shc h licc.scd Pur{anr
<br />ro rhc fmvisions of rh. cotrracbls l-iccn*d hw (Chanr.r l). Co.nncn!ins nilh Sccrn,n ?0(n ot Divnn,n .r ol 'lr Busincss 0nd
<br />Prons\ion\ c{xh) or lnlr ncor\hc kci.r.pr rhcrefro'nrnd rhc hn\is ro! rh. lcecdcrcnfltun Any violariotrofsccriotr 70.115 hy,ny
<br />aprlicur tar ap.rmir \uhj.crsrhc 0ptli.dnr r. a(ivilpcn,lryornor mJnthM firc hu.drcd dolhrs (5500)
<br />-1,
<br />r, owns of th. t openy. or m, .nploy*s wirh e.gs &r rlEt $!c ontE.$ri.r. will do 0E wort .,n dE srEr@ L 6l
<br />inrqd.n d offcEd t6. nk IS6.1x4. aBiB and Pr.fB.ion. Cod.: Thc C..lraclm s LienE L3w docs mr rprly ro u o*ic. of
<br />rh. pmFrry wts tiilds m irpoB rhclr4 ud *lD {&B tuh mdr him*lf or h.sclf or lheudr hL{ or h., own cmplorci
<br />rreridcd rhar rBt inprtllmls c mr i'{cnd.d orotu aor slc. lf, lb*cE rE hriUirg or iop@wn ir sld wilhinom
<br />'tsor 6n{,lcrion. rlr OwEr auiBs *iI hlr di hd.n of Ploving lh, lE or dr dU mt hoiu o, inFok rhc Fbpcny ror th. purFrc or
<br />l. n\ o*Nr ot rh. oopcn y, 3'n cr.lu\iycly .ont&riig sirh li.ctrkd coftadon ro conirucr ltr lnjcct (Sc 7M.1, Br\rn.*
<br />an<l Pntssim Codc: Thc Conl,.clols l,tctrsc L{u docs trol lprly ro an owncr ofp,op€n,l,uild! or irprMr dcrcon.
<br />ard {ho @nrek fo, ikh pej(k wnh a Conrracro(, lk n*d purumr b rh. Coni
<br />-I
<br />oncxcn+t undcr Sccl
<br />DECr.68A:ltrt!
<br />I h.rcby lftrrn oid.r Fnrlry ot !.rjury oft of thc folh$ing &rhBraoei
<br />l hr\.nrkl$rllnhi r rCcdil-r.nrcolCon!cnlk,Scllln\urcLr*or[.rr.omF-n\rri(,n,as!n,vidtdaorhyS.cri.n]TUrofrhc
<br />Lrtxtr a'dc. in rh. Ndnmrrc ot rhc sork r'or w[ ich rhc ncnnir is i\$rd
<br />_l h,rc md will maintsin workcft cohpcn\ari.n inslancc. as rcq!ilcd by s..rion l70o ofrh. tabor Codc. for thc lcrfomnce .i
<br />rhr solk fo. which thh pcmir is tsucd. My {orLcs conF.sdion in\!ruc. .mic. ard plicy nu,ft.r m:
<br />Po!icy Nunber:Ji,!ir.
<br />I c.niry rhd in rhc r.rrorroncc oflh. *.rt hr whi.h lhis Frnln is ksucd- I shall mr cmploy an, Ilcrsn in My mnat
<br />so N ro bccom slbJccr ro rhc so ol @npcnqrion Lws of Caliaomia du8m rhr irI should hc.om subjd lothc
<br />eorkcls.omrcnsorionpnlisn,nsofsftrionlT0oofrhcljhnCGL,lrhll.lonhwilhomplyrilhr
<br />WARNINO: failurc lo sulc workctr coq,.n\nrion covcmsc
<br />.i!il fincs !r ro orc hundrc.l rhoosand dollm ($100,00.J). in
<br />S(ln,n -10?6 oflnc lrtio, Codc. ior.,.sr tud a ortuy s ter
<br />)s ro qimin l Fdhts 3nd
<br />ion, damsss $ phlidcd fo. rhc
<br />I hcEby amm !.der ,cialry of pcrjury rhar t a6 lici*d lido lFvisio. olchlFo 9 {ommine ,ilh Scdhn ?il)o) of Diviiior l
<br />ol lhc Busin.$ md PmfcsioB Codc. lid hy lic..* is in tull foc an tff*l
<br />!:olgn!]clJlllt.L[NDlriii.&clNll
<br />I h.rby f6.n und$ p..rlly of pcrjury ln{ tlmc is r onsiruction Lndn's lgctuy r,tr rhc Frrormmc or rlr work lor which tht IEmir t
<br />i$ocd (S.c l(rr7. Civ C )
<br />AIPIISAIfD}:ILABAIIO!
<br />l lEr6y.Ifirnr u dcr pcnuhy of pcrjury onc otthc followins dslsolhns:
<br />Dcft,lirion Pcrnirs-Asb.nos Norificlliotr Fcdcrrl RcSuhrn,ns ('rnb.10, Pnd6)
<br />_R.quircd Lctr.. or Norifi.arirn
<br />_l ccrrify lhar thc fcncnl rc8llarions
<br />-l
<br />cc ilirhrr lhnlr rcrdrha rfnricr'ui a d cotrccr. l 4re rocomplysirh allc
<br />o'Ji0nn.c\ rnd srsrc ltrs\ rcLrin! r, huiklina
<br />atnvc mnrt'ncd rroDcny tr in\
<br />rclrcscnr$ ivcs otrhi\ CirY 3nd
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Waler Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh 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 Plumbinq
<br />Final Gas Test
<br />Meter Release II ,/'J
<br />FINAL Elbl lts'l lvt*tWt (vy
<br />Notes, Remarks, Etc.II , uJ
<br />lrah'r Addls
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<br />rlPrv ?
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