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PLUMBING.INSPECTOR BECORD <br />APPROVALS DATE ID/SIG.OWNER AUILDER DELCARATION <br />I tEmby aftrn undcr lcralry of p.rj!ry rhar I u cxenDl tiom Uc C.oreloR LiIn$ tis lor lh. following Msn (Se.?011.5 <br />B8incs a Prcfc$ion Codc): Any City or Connly wtich rcquirB . psmil lo onsltucl. slrs, impoE.'dctulish oqE?ln uy <br />stnd!r.. |rhr ro ils Lssoaftc. al$ Equics lhc.pt'licanr for such p.rmir ro fih a si8ncd slalctuit lhar lr or shc n [ft.si t,umdr <br />lo lhc pmviions of ltE Conlr0ctols Li.cnsd t B (Chafl.r 9. Commn ine wiih S.clion 7000 of Diviion 3 of llrc Busincss .nd <br />PDlbssions Cdc) or thal tr or slE is ercnpr rhmfrom sfld lhc berh fo! rh. lllcEcd crehflion- Any lhhriotr of Sdbn 7011.5 by ony <br />rpdicant fo. 6 p.mn sobjdrs rlE $plicdrr ro a cilil DcMhy of ior mrc rhan fivc h!.dEd dolhi ($500). <br />-1. <br />os owtur of lhc pmrEny. or my cnplo)t{s *ilt e!8e as th€ir sh @mrcniadon. qiu {,o llE wlk dd th. sEr&,lm b tuli cid or of.r.d for sl. (Sd 7044. Busims ed PrcLslbns Codc Tll conlEtor's Licne L.w des ml ltply lo rn owftr of <br />rlE DmrEry slE h,ildr 6r nqm6 rlteo. d who d@. sh sB hiN.lr or heMlr or thmugi tb or hcr ow .nplorcs. <br />porikth3l such inlrsEmnls arc ml htcdcd orotu for sk. l( trn@r.llE blilding or inlmEr is$ld whhinotu )ta <br />ofsd{rldiorL 0E Owm. Buatkr *ill hM 0E hldo of psling thl hc n shc dkj ml brild d inplw Oc pFpdly fo, llE pu{Dr ol <br />-1. <br />rs own6 ofrhc ropeny. !m cx.lurivcly conrturine wirh li..ns<l .o.rr.hn ro sBmd rh. Ir.Irr (s(. 7044, Busimsi <br />ad PDfsih Codc: Tn. Cofllncrol s Liccnsc bv docs nol ontly to an owncr ol po!.ny who,6uilds or imrrcEr lhcron, <br />aid vho co'nmls for Mh PrDj(rs *irh a Conmdo(s) licen*d plNu ro rhe Conhdor'r Lic.ns Llw). <br />-l <br />m .xchfl ondcr Sedoi . B. & P.C. for rhh @on. <br />Ort.: o*mr <br />!!}8f,!XS:IjAMI!NSAIION <br />lECt6lAION <br />I hcrcby arrn un&r lctulry of tqpry ort of rlE ,bllowin8 deLErioN: <br />-l <br />h!!e and will mainrain o Ccfliarab or Concn! to Sclf-lnsurc for erlc( smp.nidin.. os AoliLrl tor by SGlion l7m of lhc <br />Lltor Codc. lor ttc pcrfo,rlwc of ltc wort for which In Fmit ic issucd. <br />#s will minllinvorkcs comlEns.rio. in$ramc.,s ftquied byScdiotr 3700oflh.L.borCodc. for lhc I'.rfomlncc ot <br />ompcnsdnrn insuroncc cmi.r <br />\ <br />-l <br />ccnily rn.l in thc pcrlormnce ot tic *o.k for which rhis lqmil is ied. I slEll nor celllo, lny pctron in !,y m,nncr <br />e as lo tr.o.r slbj.ct ro th. workc6' .ompcns.lion l&*r ofcalifomia. rnd tgc rhll if I .thuld lxcom suhj.rt to rlr <br />w.lks compc.eta.n Dovlrion! of ScLlion lT00 of rhc Labr tu., l shall. lodhwnh.onply whn rhoc prcvilions . <br />WARNINC ljlilurc ro €rtrr. sorkrn conr|xn{rion co i\ !nla*tu|- ad \hall iubFr rn .npLrrr ro nimind Fmltics lod <br />addirtun ro rhc.o( or.6n{rnqri.n. d.m8cs os providc{ lor ficciril fincs ut ro oft ho <br />I h.rcby ainrn undf p.n!!ty of pcrjury lhd t an licnr{ undn pn,viciM of Ch.tlq_l {com'Etrcin8 eilt Scclbn 70m) ot Dieirion IrriCodc, tuld my li.cnsc is in ltll fore Md.ffccr qq\r6 <br />c0NfrBllcll!)Nr[ND.lltilcllc1 <br />I ncrcl'yufiflnrndcrt'ctrlltyolp.,ju,yrhor lhcrc haonslrucriotr hndnrsascnc, fqrhe n rlomuxc orrhc work lor whi.hrhi( Jri! ^isucrl (s( 1097. civ c r. <br />AITTICANLDECLAaIIION <br />lhot{'yoltlDundcr pctrrhy ol lcrjury.nc ollhc lbllowin8 dLtLtrations: <br />DcDrlirion P.rnirs^sb.(os Nolificalio. F.dc.rl R.Bx ldionr (TiiL ,lO. P!d6) <br />-Rcquirod <br />t nct ol Norifrdion <br />I c.nifyrh,i rhc lidcrd rcgll,ions rgarding r$.no\ rcnn,ydarc i.t rfnli..hlc ro thN pmjcd <br />f-t *niry rmr t m*.ua rm uppt <br />orlinaks and slar. L!*s rchrii8 to <br />ion !n slarc rhlt ibc ahovc inlbrmrion h corer. ! 4xe ro oqrly rirh ,ll Cny a.d Coutrly <br />B consrructt'n, lnd ncrcbyouthorirc rcF.snl]rirls ofrhh Cny ar"l <br />ohovc mn'iokd pmp.ny a.r <br />UNDER GROUND <br />Waste & Vent {sl<5D6t <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarilier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Bough Water Heater <br />POOL/SPA <br />P{raplDrain Line <br />tvlain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Water Service s/to/t%<b<( <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing 1/2rt n s :Nrf6 <br />Final Gas Test h/z(/rc 5N8X <br />Meter Release <br />FINAL l -2, z-W,Cto> <br />Notes Remarks, Etc. <br />COMMENTS <br />Gas Service <br />ttr1'Jr '. <br />^J,la.\ <br />U 7r