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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area./Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<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
<br />FINAL r//ttu 7t\*s
<br />Notes, Remarks, Etc.
<br />OIVNER B(JII-DT:R I)I),(ARA'I'IoN
<br />I h.rchy i nnr undcr r--trrlry oi Nrjury rhir I m cxcnru ltun lhc coma.rtrJ Lice.sc tiq fo rhc n bwir8 r.r*rr ls..l0ll5
<br />Bu\n'ds snil holc\snn, C,ic) Atry Cn, or Counl)_ shich rcquiE\ r t--flnir ro .on\rru.r. lhct. tnrnn.. dcnBni\h ,tr r.r,n ,tr'y
<br />vr!.rurc. |ri(tr k, [\ '\{ro.c. aln) r.qunc\rhc npt]liunr tnr \u.h p.nnirh lill i signcd {dcdc rhJr h.or \lr i\ l(cr*d tlnr\urnr
<br />h rh. pnrvi\i{'n\ ollh. C.nrncln \ Liccnscd Lrw lclurlcr e. (innnNrcine wirh Scdio. 7({)O ol Divhi.o I .l lhc Burincl\ lnd
<br />Pdcssn)n\ Cod!)orrhrrhco'\hc i\ crcmlr rhcrcfrcm md rhc hi\is I{rrhcrlLcEcJ.rctrDIi{'n AiJ !i{nrrt'nufSr.rirn70.ll tbyiiy
<br />rppli.utrr itr r pcnnir suhtccls rhc lpnli.lnl h ncivnncmhyol tur nxnc rh.r livc huklrcdttrllnm ls5(x).
<br />-1.
<br />as owrcr of rhc toFny. or my cinlorr.s wirh wd!c$ &\ rhct $lc .omrcnsuraon, will do rhc w6h ad rhc rr.Er@ k mr
<br />inlc.d.d dofcrcd for $1. (Se.?0{4. BusiBs ed PrDlcsrionsC6dcr Th. Conh.lols Ltc.F t w.tE.ol.IJply lo s owr of
<br />ilE poFn, who buith or inqhh tlb6n, !d wlF &a sct si( hinsclt o! hcRla or rlmlsh hh or h€r o*n emdoye*.
<br />pmlidcd lhal such im!,mwmnls@ ml intcndcn trorlcEd for eL li howd6. rh. t{ildinS or irpbrcE Lr$ldwithinomyt
<br />ofsnpLtbr llE owmr Built r will tuw itf, hd.n or pmving rhd hc or dE dn mr bild or inpow 6e lopcly lor tlE pulns of
<br />-1.!sowncrofrhctmpcny,amcrclusilclycontroclirrgwirhlic4cdconlBcloNlosnidcllhcpmi\1(Sc.7O&.8liircsdid &bfesbn Codci Thc Conrturof . Liccnrc L.a d@. nor altly ro an owrd of lrop.ny who blild! or iFnotcs rhcrco6.
<br />and who onlfdls for sNnpmjers wnh. Conrtrtorlt li<nen lunuil b thc ConrB.lols LicctrE L3*).
<br />I m .rchd unds Selion . B. & P.C. fd UN Eon
<br />SAatrEEa'.CAMTENSAII(A
<br />DECIAXAIION
<br />I ll.rchy afiirn undcr FMlly of psjury om of ll* lollowing .t .hnrions
<br />L'hor airlc. l,r rhc ,[rl.nMncc olrhc $ork lnr \[i.hrh. ncnnir i\ i\\urn
<br />_l h!rc ord eill mrinlaitr *olkc6 cotr{*nsalion insmmq ,. Equrd by Serion 3?m of lhc bSor Codc. ibr lhc psfomrc of
<br />llE hrk fd whict lth pcmil is issEn. My wor*cF om!,cnsotion insurm drhr rn polty numbs rc:
<br />-l
<br />ccnil'ylhul in Ihu performncc of thc woIk for whi.h tht pfin n i$u.i.l shallnol cmployanypcNo. i..nr oann(s asl(,bciom bjNr rd rhc qortcr .onl,tnsation law\ ofcllifomia. rnd Urc.lhd ill rhould LE om suhF.r rorlrqo*6..opcn! ionpovhionrofSdion1700ofrhcIlborCode.I\hnll.ft'nhwnhcomdywiihrhoeprovisiotrs..
<br />IVARNIN(i: l.xilrtrd ri s..u'c rorltd rnl shnll subJr.r 3n cn'floys ro dini' l Fdrhic\ r J
<br />h onc hundrcd rh.u\rnd dolh^ro rhc cosr ol.6mr.nun,n, drtuEc\ r! ti.vidd rd rhc
<br />Sc.rnr :1076 ofrhc utrr
<br />o^,.N-2/-ao
<br />I hcrchy ffiirn undcr ,.n,xy of p.rjury udc. roviqion or ch,flr 9 (co,tmBinS wiln sc.l ion 700) of Division 3
<br />ol 0r tl \n.\snndl,ml.\\i,trr(intc.r nrvli..n\d i\ i,ltrl!lnr.. rrlrlldrr
<br />c3z f
<br />on", 9- a t -3,ot
<br />I h.nhy afii.n und.r F.,li, or Frjury r
<br />hsu.d (s(. 3097. civ. c ).
<br />b.din8 .gcncy ft,
<br />'h. Ifrrorrucc ol dc wort for $hicn rhh ,mil is
<br />AITUCAII.DECITIAAIIIIN
<br />I hRby adif,n undc, IE.aky of p.rjury oN or rh. ftrloRins ddle ions
<br />Dcn,lirion Pcrmih Asbcsros Norificrrt, Fcdcrul Rcslhrnrtrs (lirlc40. Pan6)
<br />-Rcquncd
<br />Lcllcr.f Mnifi orion
<br />os rcnn,rrlarc nor r!fli.rhlt t,rhispii,i.r
<br />l fic ahov. inlorrolion h cotrcl llsalosq'ry*nhaUCnyindConnry
<br />ion.ond h.mhr.ullxrnc rctrRnlltircs olthis Ciryand Colnly to cnt( upoi l,t
<br />fapaotf,
<br />Tub/Shower Test
<br />Fill Line/Back Flow
<br />3"ro,* €1*
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