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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hmby.ffun trndcr lEnnlry ol pciury rhar I n.r.nq tmm $. C! r&rc Licr* L!* for rlE follo{h8 rasn (se.m3,,5 <br />Busin.ss urd PDf.ssion Cod.): Any Cny or Cou.ry *ni.h Equis c tEni ro 6nsML !116. iriprcvc, &mlish o. rcpqn lry <br />irtuct!rc, I'ior to ils issuft.. lho Eqlies rlE +plkaot for ch pcmir lo fiL ! si$Ed statcMr rhll ,r or slE i' ltcnsd pulsJur <br />h th. prcvbions of 0E Conlmlqt Li..o$d kw (Chaptcr 9. Co.lmdng wilh S.clion 1000 of Dilision I ot rhc Budre$ and <br />Pmf.siors Codc) or rhar lE or shc k .rcmpr rh.Efreh aid lh. bosh for the alLBcd crcn rion. Any viohrio. otsetim ,031 .5 by fiy <br />lmlkdr for o pcmi! subjel3 rhc appli@ lo ! civil Dcnrlry of ml mrc rhe fin huidrcd dolldr ($5m). <br />-1. <br />ar ownc, of lh. nmr.ny, m ex.llsiwly .ont{cting with liccosd conhclou lo .onslru.l lh. pmjel (S(. ?04-{. Dusitudr <br />!d hoftssbn Codc: Thc Contr&rois Li.ens. Llw dds not apply ro e 6*tur of pbrcny Bho bnilds or improv.s lhcrmr. <br />ind who ontGcrs {or s!.h nmiir. walh 3 ConrB.ro(r) tiensl lt6ud' lo tn C.nrrurols Licn$ t:v} <br />-l <br />{ncxcdpr lndcr Serion- B. & P.C. forrhisMen, <br />Orner:- . .-. _ <br />]TOA6EA I!)MTENSAIIO! <br />DECI.AIAIIAX <br />I hcrcby afltdhdc, prnalryorn riu'r_.n. orrhc rollo*in! deld)rion\: <br />l.ihtrC'(1..li)rrhctr]lirnnD(..l rN*n k,whichrhcl{mlr i\n{'.,1 <br />-l hlw lnd *ill @int.in qo,k.r! conFns,ioo insuEmc. $ Equircd by Ssl iofl 3700 of lhc Llbor tu , for lh. l,6fomee .f <br />$c worl lor which ftL |)emir is hs.d. My workEs .oDpcnsarion insurmc c{rhr ud policy runb.r dc: <br />-l <br />ccnifyrhrl in lhc Frformmc oi lhc wort for whichlhis Frmil is tsu.n. I snal nor cnqloy at, pc6oo in a.y m,nncr <br />sasrobccomsubjftrrothewortc'.on{rnsadonlawsofcalifomi!.Md!!rcth.titlshouldb..omslbieltolhe <br />sortcn coqrcnstion Imvisions of Serion 1700 of rhc Llbar Codc, I sh!I. lonhwilh conply wnh $oc l,Drisions.. <br />WARNINGT Failnr ro su6 mrtc* orlPrnsrlion .ovcngc k unlavtul. .nd shlll subjccr !n cnpl.ttr b ajnnal Fslrix and <br />civil lincs uI ro onc hundr.d rho!,rnd dollus ($l0o.0d)). i. addilion ro rhc cosr ofconpcndion, damg.s 0s proridcd lor Ihc <br />S..rion 1076 of rhc tihor inrcrcn and arlorrcyf lccs <br />Dsrcl ^ppx-.,X1 ]>fu- -tr Aa,)EJ4 <br />LICENSED-LQNIAACIQA <br />t Ect AEA.rlon <br />I hcnb, dt!'irn und$,.6 y of !.rjury dd I 0n lic{.an undcr pn'vi\ion of ChEncr 9 (.nm'mrcin8 eirh Seri,. 7m0} ol Division l <br />of Ihc Busincssand Pmlcsions Cele. dd <br />'ny <br />ltc"se i in tull ttrcc dnd.fier <br />totozg/ <br />I IB c-r-"r""x i)6- 'T-. AJe"?Yer.+ rery <br />g}NSIBUCU9NIEIDINC.ACINII <br />Ihrrcby irnxnd.r Fn ryotr.rjurylturhcrcna.onsrrudionlcndirgo8lnyiorlhcpcrionnanccoarhcw..kftnwhi.hlhkFnnni3 <br />tsld (Ss.3(a7. Civ. C.) <br />AIILICANLIJ'IIABAITON <br />I nrd'ydttmhdcrncnllryorpcrjrry.nc orrhr r.ll.sir8dc.hr,iiors: <br />lxDFlirio. Pcrmirs Asbc{os Norilic ion r{dcrrl Rc3ulnrio.s (-l'irlc 40. Pd6) <br />,{cqutcd krrcr ot Norifi cari0n <br />-l <br />enify $r1 lhc ledcr.l (guhiotr Egldin8 .sh.sros Emval dc nol lppltlbh lo lhis pmitr <br />l.cnify thor I havc rc0d rhis trprlicorion ond shrc rh0t rhc otnrc inrbrmarion iscotur.l ucxe loooplywirhsll Cilyand Counly <br />ordiMrc.s md shr kwr rcbrina ro buildinS Ckt dd counry ro cnra ulbn ttr <br />rh.v. mniioE{ I'opcny lq hstEtkrn pEposi <br />ADDlLul or Aiar skotunr X <br />) <br />,." '(,rl /B <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Areaistorm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Water Piping <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Test <br />Bouqh Water Heater <br />P{rap/Drain Line <br />Main Draini 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 |9,ldn T,w n -)Z-,) <br />Final Gas Test .l <br />Meter Release <br />FINAL $!"1161'tG n*d.D) <br />Notes, Remarks, Etc.\!t <br />_+ <br />Waste & Vent <br />POOL/SPA <br />_1. as o{M of rlE pmFfly. or ny.nphy.* wirh @rss as rh.t slc con cnsdion. *i[ do dE sqi .!d rlE slrEtE is Nr <br />i.rcid€d or olIeE<l fo. eL (Se.7044. Buiicrs ud Protu iom Co<L: Tnc Coni@lols Lirr* ljw do.s nol qpl, lo e o*ftt oa <br />rh. rDpcrry who hilds d inpms lnc@n. a whoddskh@ nituclfor lEBlfor rhDugll hi. tr hd own.nq,lor.s. <br />Irrovi.lcd rhar such itqmrmnlrc rcl inic.dcrt orofi.rcd lorele.ll, hosEr, dE b'rildin8 r in{mwft h $ld wlhin orc ra <br />ofonpLrio( rlE OvBr A! is *ill IEE tlr t{rd.n oa poving thlr lE tr aE dil er hild o, anlerc dE Flraty lor t! F4.e oa <br />L.ndcrs Addrcs. <br />- <br />r"-,'--*rpa"r;K FFE- -- FlirJ <br />-------T------ <br />=