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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE rD/stG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <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 />Meter Release <br />il,'t*rr{pdFINALatltAt4 lt @ <br />Note$, Remarks, Etc.u\ <br />?aft. tllqln ec.ot;er cc"trYr€t rl].nl a'fV-n',r-*t6) <br />tI I tt u I <br />o o <br />OWNER BTItI,DER DILC RATION <br />I h.reby ofliirn under ncnally of pcrjury rh l am .x.mnl iom the Conta.ro6' Lic.nse I dw lit rlt firlowms r.d$n (scc 70lll 5 <br />Brnnc$ ond trof.ssion C{ni.) Aiy Crly or cor y Rh'.h r.quRs . I.nnil ro c.nnrud. all... imrn,vc, d.mlish or Eprn dny <br />{rucrur., prior tu rs issrhm.. rho rcqunes rhc.nplrcad lor such p.rmir to nb . si-gNd sr.r.mnr rhor h.or.h. ir licenscd pursont <br />k, rhr tmrisions otrh. Conrraclor s Liccnsed Law lchnprer 9, con.kn.xrg wirh Sedim 7000 olDivhion I oflh. Br$n.sr nnd <br />t^rcslonq Codc) or rlrr lLo.,h. is ercnn rlElcfmm.ftl rlt h.srs forrheallcscdcxcmprion. A.rlidarionofs..ri,n70 15bytny <br />$rlicanr lin. r,emrir subj(k rhc amlicanr r..cllrlpcnakyolnot mrcrl$ fiv. hundr.d dollam (55001 <br />_1, os own.r ofrh. ,,mrEny' or my .mrloy!.s wirh wags N rh.i sl. omnds.ta6l\ will & rh. wnt od t. itudE ! mt <br />i md.d oroE nd aor slc (56.?014, Blrin.ria.d Pmf.$ion3Code'l h. ConlEclols Ltm* t w(h.smltrpplyloanowft.of <br />th. poFiy who buildr or r{mlB tk6n md wts (IE Mh s.t hiN.lf or h.mltor llwush hie.r hd om cnloloys. <br />pmvil.d thd such irpm@.rs e mt iil.rd.d o. oftEn forBk.lt tsw.c. tk buiBins or inDreEmnl ir sU wnho o* <br />'wofoqrkriol! (h. own r Buitlrr will hlr 0. lr!&n ofnmtns th.r lE or . did nt fDild or irpEE 6. pmFry for E purFE of <br />_1. as.wn( olrh. Ilopdly. d exclusivcly conrBctiq wnh lic.ns.n conkcl.F lo @mltucl rh. nmj.cr (S.c ?o44, Buins <br />dnd Pofr{in aon. Th. Coatncloi s t ic.re. tiw .loca not arply to .n o*n( ofnflJr.ny who I'u ilds o. imr.orts lhcror <br />lnd vh. contmcl3 fo och pn'jcctr wirh a c(,nrmro(9 ltctrsed luma ro r h. Conlr.doir Lic.nk L.q). <br />-l "m.x.nfl undd s{t <br />woiKi:ns' colllPENsATIoll <br />PECIA8AI,IA! <br />I h@by .mm u.dd p€B[y olp.rFry om olth. lolk winS d{LrtioB: <br />-l <br />h.vendlrrll mrinriin ic.nr,ic coi(ons.nrro s.lllNUru lir *orke6' onrpcnsrion, os nnvtlcd linbys(.on1700 olrlt <br />l-ahor Cnde, tulhc penbnnancc orlh.lot* ri,r sh(h rhe permrr h trsued <br />_l hrw dd will mai a,n wolk.B comp.nslion iNumrc., .i Equircd by Sdion 3700 oflh. Labor Cod., fo! lh. p(fomN. ot <br />lhc mrt for $nich fii! p.mn i! is$.d. My vorks! omptuion in$6m. tri( un lolic, nudbd e: <br />-l.cnify <br />rhar in rh. p.rh.frar..lrh. work lor whahrhis r.rnn L i!flcd. I sh.ll ml mploy ony r.mn in any oonrcr <br />$ ss lo lx,ft rubj.rl t. th. wortd' mmp.ns.rion hws oac.liaornia snd ssE Ih8r if I il..uld h.{om. otJ.ci lo lh. <br />mrt.R' 6mr..etion ,mvkions ofscdion 1700 of lh. Labor aod., I ilEll. fonhwnh mnrly {ilh to€ pmvirions. <br />WARNINO: fsiluE ro sfuc qo*.6 @ordslio. 6!.8r. i. uohwtul and sh3ll stjer an .mplorr. to nimitul ll.mlli.r ind <br />civil ,in.! !n t. onc hundr.d lh.lsnd <br />S..l6n 1076 ofrh. Llbor Cod.. inl6.n <br />0n, damr.s $ providcd lor lh. <br />lrt(l"u .II(a <br />I h.ct'y 6ffm ridd p.dlly of idjury rhar I m liced uodB ,evirion olchrptg 9 (6n:lffiiD8 wnh Sdion 7000) of Divilioo l <br />of tn BuiB Bid Pof.sioro Codq ad my licd. i in tull f.re ad.fIel. <br />7/Z2a/ <br />I h.Ehy.mrmundcr Ffl.hyof Frjuryrhar r <br />k rcd(sN.1097, Civ. C ) <br />s tr q'tr{tucrion l.dd'ns slcncy lorrh. pcrfomrmc olthewo* for which tis Fmi is <br />-l <br />c.rrily thot $. f.d@l r.grilarioB Egl,rdine ish.srG rmEl rr. .or dr'llicabL lo lhh rmjel <br />ionaBlsrarerhdtheit v€ inaonniri.n is.or€r lslrd(.complyw hallCiryrndCounry <br />n, E d tcEhy dtnrir. Epre .riv.s oalhrs cny ad cou.ty lo.nl6 upon th. <br />furz- <br />Water-Under floor <br />AIIIICANIJIICIABAIIOB <br />I lEhy amm uftLr p.mllyofp.rjuyoe olrh.Iollowros d6laErions <br />Dcmhion Pamn$Asb.{or Notilication ljedml Relold ioN ('l ir le 40, Pbn6) <br />-Rcquircd <br />t.tte. otNolifistion <br />I <br />37tu7-A <br />-------r----- <br />f------T------ <br />i-