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PLUMBING.INSPECTOR RECOFD
<br />APPROVALS DATE ID/SIG.COMMENTS I}lVNDR BUII-DT]R DI)-CARATION
<br />I h.rchy rfirnr trndcr l{ rlryofNrjrryrhr Ii cxcnrll lio thcCo rrl{n\ l,i..nsc La* lor rhc bllo* ! r.tsin rsr( Trtrl5
<br />lnr! trcs{ ilk] I'tlir\ior Codc) Any(iryor (i,uDry *hi.l, roqun\ r Nnnir ti.onsnr.r. ilrs. irtrov.. d.nxni\h,{ RIr',t Jn,
<br />k' rh. Dnvi\iotrr ol lh.Contr.tr'\l-iccn\c{llrw(Chrlrcr'r.Coxrctr.[gs]rhSc.rion7ol]roll)ii\i .1 .l rhcBu\nt.\sid']
<br />rflllnrnr r(trdltnnI suh]c.rs rhc rpplrrtrllo rciviltcrrlly.lnor nnrcrlL llv. hundrcd doll rl55(x))
<br />-I
<br />s ooM olrhc poFny. m oy .mploFs *hn *sg.! as thcn sh erpcnsalhn. *ill tlo dr sot &d lrt irEt@ t ml
<br />inrddcd or of,crcd for sh (Ss-?044. BBiEss Md PtDlcs1hre Codq Thc ConlMols LLrrs Lio docs nor rPrly !o !n owmr of
<br />theDDrEny wt hiius o, irp,o6 rlron...d who dc eh N* hinsclfo, hmlf or lhmud hh or lrr o*o.nplor@!.
<br />pmvided rhot sch impoetuiB e ml hrcnd.d o.otu for $lc.ll howr, tlt hilding d invmEftm is $B vftin one r{
<br />of.orpbli,tr {E Ovrc. Bu hr wil lEw $. hrh! ofpmvi.g tn€r lE or shc dn el blild or itr'por rlE Ftroly for rlE purlos of
<br />sL).
<br />-1,0sownerof
<br />rhe rmrcny, rnciclx*ilclyconkaciin! wirh li.c ncd .ontlcros ro snsltrl lhc pmrc.t (Sd.7(X4. Busross
<br />lnd hnt6\bn Cod.r Th. Co.ka.tols Li.cnrc Law des not apFly lo !n osncr ol pro,rdy wh. bnilds or inrFovcs lhcron-
<br />lnd wh. onrmcls aor slch pmrcch sirh ! conr@ro(s) liccnred NBuur brhcconraclols Licc.s. Lrw).
<br />--l u.r.npl u.dq Selion-, B. & P.c. for $ir rcen
<br />]TO8f,Ef,S:COMI!NIAIX}NpEclA8Atrll!
<br />I hcEby llfid undcr Dcelry of pdiuly orc ofrhc l6uoairu delmrioni:
<br />L'htr (-('dc la, rltr Nnomrncc oi rlr *q[ nn { hich rhc jrcrnrir n istr.J
<br />_l h.vc 6nd wiu tuinr.in workcrs comp.nrslion insurnrcc.6 rcquircd bySdion l?0oof E r2borC.dc. for lhc Pcrfotutueoftc s.k lor *ht h db p.mil is issr.d. My workss ohpctrstion in$@c .otr .d polty numb.r dc:
<br />-l
<br />ccdiiy lhal in lhc p forronce of lhc *ork lor which rhir pqmi is hsucd. I shall nol cq,loy any Pcsoo in uy @n.r
<br />sr N ro hcorc subirl ro rhc vod<ns cotrpcnsal ion laws of Clliforni!. Md tsm lhul it I rlDuld bccom slbjerl lo llt
<br />sorkc6' hffsn$tio. povisions of Setion 37fii of ih. tlbor Codc. I shall, lonhwilh .on{iy Pirh lhos pDvisions..
<br />WARNNG: F,ilurc to rcurc mrkcts' conqrnslrion c.vcmSc n unhufirl. and s *uhjccr M cnq,h,er to siminal Irtulri5 and
<br />c.mn nerion. drro8cs rs Fovidcd lot lhc.ivil fin$ up ro 6nc h!.dr.d ltroNand doll!* (Sl0o.mo), in addnion
<br />sc.rnrn 1076 ot rh. tf,bor cod., inr.Bt md atomy
<br />DIII,AMIIAN
<br />I ncebyntfirm tr crpcnalryurl)cjuryrhdr I nn li...st{ urdcr ltrovi\inof Ch{lcr 0 (&dmncins wnh sdbn 7uJ0) oi Division l
<br />of lhc Businc$ md Pmltssions Gdc- rnd rny licc { i\ in tull ror.c srxltffu.r.
<br />CA!$II1(UANII,!IJNTiJ!!;I'N(I
<br />is!u.d (Sc. rl)r)7. Civ C.)
<br />APIUI;ANLIIECIAAAII!]N
<br />I h.dry afiinn undcr !.nally oll)crjry o& ol lhc folbwin8 declslrions:
<br />Dcn!'liri(,n ,crmirl \br{oq NDrilic tutr lrcd.rrl Rcruldn,ns arnlc 10, P!n6)
<br />Rcquncd I-.tr.r or Ndifi .!rk,.
<br />-l
<br />.cnily thlt rhc fcdcrsl rcsuldions Egd.ding dsb.sros nmval {rc mI .0pliclblc ro thh tmicl
<br />IccnilyrhlrIhnkrcndthit.'I,ltrrionddstsrcrharrn.hovcinromElionhcotrcd.llserosnplyeirhr[CnrundCounly
<br />ordi.!m$ ud Srarc Lips EdinS lo buildin8 consrrucrion. .nd hcrcby lurhorir rcprcsnuivcs 6t rhh Cny a.d Cornty to cnlE lrioi rlr
<br />at-vc entiorcd pm!'cny for
<br />Aprli.anl o. A8enl Sian!turc|
<br />UNDER GROUND A
<br />Waste & Vent H71r W,VIA
<br />E"V+r6)fr$P PftJAEb
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent nLl) l<,4{.8d^/ us..-Y,.O
<br />Water Pipinq 1-Zs-tr x.W)A\
<br />Gas Piping T25-tr r.vlg
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL ,I-A1V k.\4.r0
<br />Notes, Remarks, Etc
<br />0otf ,^,?Y rrl,Yt tf )-tE- lr'
<br />Id 6aDhfe .t, u.-ceL
<br />PdrzrrV
<br />Water-Under f loor K17"tV
<br />Area/Storm Drain
<br />Gas Service
<br />t4dd r N.m'-
<br />ktrd.fs Addt!r!:
<br />-
<br />Pcmlte .rne (priol):__
<br />/u44( ^,.,r/,-zy'a
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