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PLUMBING.INSPECTOR RECOBD
<br />APPROVALS DATE COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder Iloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area,/Storm Drain
<br />I nterceptor/ Clarif ier
<br />Waste & Vent
<br />Iater Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trapi Drain Line
<br />It/ain 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 Plumbing
<br />Meter Release
<br />Notes Remarks, Etc
<br />FINAL
<br />I
<br />OWNI'R AUII,DFJR DFJI,(]ARATIoN
<br />I hcrchy rtfinn undcr pcnrlry ol r{rjury rhd I r cxcnr tnnn rhc Cotrtr.hn- t.icctr\c lj\ rnr rhc lnllowins rc,vrn {Sc..7{r.ll.5
<br />Ax{i'rc\\ aid Pn,rcs\nr C(xl!J: An, Ciry or Cotrtrry Nhi.h r.quncs a Frnir k,.on!tucr. rlrcr. nnp'i'vc, dcm,li$ r ftnJr rny
<br />srnr.rurc. p.i(tr h n rrurtrcc. rl\r rqurcs rhc l|)driN nn sud l*hrirk,lilcd rigncd { .nrtrr lhtrrhcor Jr s lrcnscd tursurnrl. nr IRrvi{i(,n\.1 rhc Contr.ktr r l-ic.n\cd Lr* rClhD(cr t). Con,mcncirg wirh Sccrnnr TOlx) of I)ivi\iiD .l oi rh. B \nr$ 3nd
<br />Pm,cssir \ Codc)orrhar h.or\hc is.rc fr rhcrcrionlrnJ rlt hi\i\ turrhcrltug.dcrcn,rrio. ty!ii)hrnrofSccri.n70.ll5hy].y
<br />ap!lic(nrl.r I |xmirnrhr.cNrh. rttl(itrrb n.ivil|tDrlryol orniorcrhln,lv. hu drcddolldn(!5(X))
<br />-1.
<br />* owEr of rh4 pop.ny. o. ny cnploter wirh erecs a rh.n sb con!.n.odon. *ill do 0E wk ltxl tlE i.Ene ii mr
<br />intqxH or ofidd tor elc (Se.rol4. Busircss .Dd Proacasbm Cod.: TtF Co dols Liene L.w do6 ml lpply lo e owmr of
<br />$.pmFnt wtht ins or in{rcB $.8(.ri who dN Mh mrt hins.lf or hcelf or t}mugh hir d h.r ovn cf,ploy..s.
<br />piovidcd rhar such inprct@ir. e mr irrcidert or oftc,ld lor sb. lt tDk6. dF tdiHi.g o, inpDwenr h $ld whhin oN yle
<br />of€or{ihlior rlt OeM BuiBc. *i[ lEr lh. b{dd of pEving th.r lE or dr did iol b'iild or iryrcE th€ polEry for llE puros of
<br />-l.0sowncroilhcImpeny.lnrcxchsivelyco
<br />rncl i.8 wnh li.cnscd conlr.clos lo .onslEct thc pmj.{l (Scc. ?044. Buiiftrr
<br />ond l\t.Bqbn Codc: Thc Conha.ror's Li.co* Llw d6cs nor lpply lo !n own$ ol propcny sho buildr or imtrows lh..mn,
<br />and who o Ers for sEh FmFts wirh a C, Edo(, liccnscd llumulr rorlEContEcrtr's Liccnsc L!v).
<br />-l
<br />dciemfl underSetion- B. & P.C. aor rhis rason.
<br />]TOAf,E8IT-IOMTENIAIION
<br />DECIASAION
<br />I h.rcby ,fiim undc, lcnah, oa Frjury om of rhc follovins d.rhratioB:
<br />-l
<br />tuvc andwill rui ainaCcnificarco,ConsnrloSclf.hrurcnrworkcrrcompc.sllion.a\ Frvided for b, Sccrh. 17(n of fic
<br />L.$or Corlc. for lhc t).rfonmncc ol thc B.rk ior whi.h rhc Frnrir i\ issucd
<br />_l h!rc and will moinlain worleF co'npcnsarion insurancc- as rcquned hy Sccrion .l'7(X) of lhc bnor Codc. for rh. pc,folmE€ oa
<br />rhc worlfo,*hichrh pcrnir i\ i{nad. My *ortcF coqrnul ion insunncc uMicr and F,licy nlhbcr e:
<br />-l
<br />ccdily lhd in tlE paloro1m. or rlx vork io. whtn $B p(ni i. hs.d. I shdl not cnploy .ny p.M. in Mt lllm.r
<br />$ * ro b..om slbrcl ro llE !nth'omrcnsdion kws of Califomia. .rd rgN th3r if I should tr.oE subJc.r ro rlr
<br />Mrrc6 onpenidio. polirionr of S<rion lT00 of rh. Labor Codc, l slEll. fonh*irh 6nDly wirh rnoc pDvLiotrc .
<br />'?tru;4}"1
<br />lV]\RNlN(; Friltrrc t, {corc (orkcrs (,mpcnsdi,,n cokflEc i\ unhsful. and shrll \ul,r..r an cniplorcr b aintinrl Fnrlri.s nnd
<br />.'v'l tinc{ uf !o orc hundcd rhnusnrl doll6 r$1m.0001 drmgc! or p/.vlbd for ft
<br />I hcrc6ylrtrm und.r F6,lrrofp.rjury dI
<br />ol rhc Bu{ift$rnJ Pmf.isiotrs CD.h 3^l
<br />r f,luerftrrrrnrttrn \l
<br />DELI AR\TI('N \Iri.lr.',{JdnJ n1rrn,n,'r.hr|vr,',,{'incn.,r*$hSc!rtr1,'rrtu',,r1,'!'.tr{',
<br />nrr liccNc i\ h fullrarcnndcflccr
<br />coNf,rxllll&x1lNDl[li-&cENtr
<br />issuri lsr. .r(r)7, Civ C )
<br />AITUIANLIIEII.A8A.IIAN
<br />I h.r*'t aalf,n undcr pn,l'y or pc.jury or* ol rhc rolk,wing d(hrnr ioos:
<br />Dcn,liion Pcrmir\ Asbc$ror Norificlli.,a FcdcBl Rcsohlions (Tnt 4.0- P!n6)
<br />RLlut d L.trcrof Mnificlrioo
<br />_l ccnify rhlr I h!rc rcad rhis !i,t isrion rd srarc rhrr tn .hoK iotomErion is mror. I alre lo omtly enh sll Ciry dod Couiry
<br />.rdinrnes lnd sbrc La*s Ehritr3 ro builii aullsrir rcrcrnrurivcs otrhn C yand
<br />ahovc mnl ioncd lmpcny for
<br />.{r,Dlicanl or A8enl SismluE:1
<br />L.idci. Nam:
<br />-
<br />G ,tfl'\ AJ,ln..
<br />l.cnilith r rhcfcd&rlr!AUlrri,)nsBgni(linE i\h. o\rc'R,rrlrrc nor lPpli.abk b rhi\ po.icd.
<br />ID/SIG.
<br />TOP OUT
<br />Final Gas Test
<br />w//r ftl&.//rz.--
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