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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcEby artrn uds pcnalry of Frjury thsr I m .x.npr lfrn $c Crd@ron Lk nc tiw for tlE follo*ing r@sn (5...7011.5 <br />Busin$s n.d PDfc*ion Codc)r Any Cny or Co! l *tich rcquircs o lEmil lo snstdcl. !lid. iqrrcvc. demlGh or EIr€n rny <br />slrlctuc, Fio. r. irs bsumc. 3ls rcquiE. rh. .rplicdt tor such ttmil lo 6L a sigmd ndcm $at L or slE i lk.n*d pwad <br />to thc povilirm ol rlE Conh.rois Lien*d Lav (Cnlprcr 9. C.amrcilg wirh Seiion ,000 of Divisio. I oa llE Businc$ lod <br />PDfcssions Co&) or rhrt tE o, shc is ercnfl ths€frcm and th. bch for rhc atlc8cd crcmption. Aryviolerio.ofSccrionr03l.5bysy <br />.Plli$ for a !.rmil subj.rls ln lrpli.el loa.itilpcmltyofrot doEth.nfirc nundrcd dollus (5500). <br />-1, <br />&q owM oirhc ttuleny. or oy cnplo)es eirh *agcs s rhcir slc .o,pcnsrion, will do ttu wsl !d 0r stnrrm is mr <br />inlcidcd tr 6tLEd f6 elc (Sa.?044, Busimsi 6d Ptuf.sions Cod.: TIE ContBdor'i Lt.np Lle &rs nor Arly ro an ow*r of <br />rlE pioFny who h{ilds or intrcB th.mr &d wh. &{.Eh s* hin..lf o. h.Elto. $Dugh his @ he. own.nphres. <br />povtcd lhat such inl,mrcmnls m mt i.l.n&d oroEcE<l for sl.. If. howr. the h.ildins or inplMm is sh withr onc Frofonphhn. dE OwM BuiLL. will htr 0r hnrhn oflDving tlur lf, or slE dA ml bild m iqmw rtf, FrtEiy rtr dE pl.FE ol <br />_1. $ ownc. ol rh. tmp.ny, d .xclusirl, .oorEdins sitt liensd contmroN ro mnstrucr tlE l,Dtct (Sc. 7144- 8utircs <br />lnd Pldisibn Codc Th€ Conrmktr's Licctrsc Lrw des ml epply ro an orn.r of p,opcny wlo boildr or iFphres rh...on. <br />lnd who onlEcIs for suchpmj.cls wi'h a Cooracbns) li*nscd phu ro rhe ConlBdo! s Liccns k*). <br />-l <br />m .r.ry,I und$ Sccrion- B, & P,C. fo. lhi\ rcason <br />l) rr <br />UAf,f,Ef,.tljQMPJNSAIION <br />DDS,T&TIION <br />I ficehy ofiirmund( p.nllry of lsjury orc o{ rhc followinB dLrlarslbns: <br />_l h& ed uill tuinr&in a C€rrifrcr. olcnnsnt ro Sclfi.@ fn eql6 @Doctrdioo. &i prcvkled for by Sclion 3700 of lhc <br />kbor Cod.. for lh. pcrfolrlrc of lh. wort for whbh rhc Dcmii is nsud. <br />_l hav. !d *ill mintlin porkcF com!,cns.rion insur.ke. f,s rcluircd by ser b, l70o oa rhc tibor C.dc, fo. rtu pdfomr ot <br />lhc work for whi.h thh F.nil is irsu.rl. M, workcB ompcnslion insurMcc caricr r.d polty Nmbcr tr.: <br />_l ccnili thll i. thc penormmc of rhc wort for which thh prmi a! issu.d, I shall nor cnploy do, pcson in any num,s e\ to bccotu subjel to lhe $ortol ohpcnelbn l,*s ofcalitom,a rd .3r di,l if I should b.{om subjat lo th. <br />vorkoc..hpcnstionpmtisionsofSalionl?00ofth.t$orGldc.lrh,ll.fonh*ilnomllyeithlhospovtions.. <br />\4ARNING: Fiilurc !r Ecurc sorkc!( conrNn{i(rr .ovcrn unlaw6rl. and sh.ll suhj.rr 6 mplotcr ro sinin0l pcMtrax .nd <br />. il linci !p to om hundrc! llhusnd dollss (Sloodr). in <br />sccriol 10T6orrhc btor Codr. nrcrrr ond srlorrcy s f!r: <br />hn lo lnc osr of.onp.Mrior, <br />I hcEhy 0flnmund$ p.nallyorn rjury rhll I am liccnqi undcr ofCh4rrd 9(.onmncinp wnh Sdion 7000) olDirhion l <br />of rh. Bliincss aftl hofcsions Codc. and my liccnsc is h full rors orn.nccl <br />I h.Eby affrm wd$ Fnalry of pcrjury lhrl rhce h s onsrMr <br />hsucd (S€c.3097. Ci!. C.). <br />!8crcy for lhe pcraolmx. or lh. mrt for shth lht IEftn n <br />ATIIICANfDECLIIAIIO! <br />I hcftrhy lnim u.dr pcnslry or p.rjrry onc.lrh. aollowins dccl.rsln,ns <br />Dct{lirn'n Pcrmil}AslEslos Norifi.oliotr ljcdcr!l RcEuhlions (Tirl.ir0, Pd6) <br />-Rcquncrl <br />Lrrrcr oi Norificarion <br />l.cnitrrhll thc ttdcEl esulurions Esedins a{bc$os rcnrv0l dc mi.pplkabl ro this pmj.t. <br />_l ccnify rhd I havc rcad $is,pplicnrion ald { c ihor rhc ornvc infouio. ix corar. I os.s ro comply *nh 0ll Ciryand Colnr} <br />odin!rccs and Srrl. ti*s Ehline ro <br />sbov. mntioftd prorEdy fo. imDc.' <br />.oosrructk'n. rrd hcrcb,lurhorizc rqres ariv.s oarhis Cilyand Co!trryro entcr upo. rhc <br />Appli.ant or AEen( SiEn.lu <br />tml <br />f\l <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Water Piping <br />Gas Pi ping <br />Roof Drain <br />Tub/Shower Test <br />Roqgh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />lvlain Drain/Pool Pipino <br />Fill Line/Back Flow <br />Pool HeateriGas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Eough Plumbing q flgn ^AA,\FAJFinal Gas Test U' <br />Meter Release <br />FINAL IP tbltt -l\t*-tr'te,,-rt <br />Notes Remarks Etc <br />t ndr'sAddic(r <br />P. llen.me(pnnr): <br />UNDER GROUND <br />Waste & Vent <br />Miscellaneous