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PLUMBING-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS oWNDX Bt]ILDER DEI,CARA'TX )N <br />I hcrchy rrrrN uMcr Fnrky of pcrjury rhd I rNcxcnFr lis'n rh. C.ntmron-Licctr* liw n)r Ihc hlhwin8 rci$n (Scc70lll.5 <br />llu\inc$ a Plnic$ion Cqlcrr Aoy Cily or Counly wli.h rcluircs r pcnnir ro c.nsrrucr- llrcr imnDvc. dcnrli\h 'tr rrntrn Jy <br />{tocrur. prnn h ir\ i\ ancc. al{' rcq!i.\ rhc lPpliconr f{tr such Fnnir ro lilcn rigndl {trrc'rnr rh h.or shc i( lic.tr{d pu6urnt <br />ro rhc I'olirnnN ol rhc Conrtu ktr s Li.cnsd L.tr (Chercr 9, crnnncn nr8 rirn Sccrnnr ?000 ol Divniu ] olrhc Bu\inc\\ !trd <br />Pmlcsi,'ns Oxlc ) or lhnl hcor !h. ncrcnDl rhcrclronand lhc bris r'or lhD rllcscd c{c uli,ro Any!iol!li,nrorsccri{,r70:ll thyi jl <br />,Orli.rirli,rar.iinir\ulrccr\rhr U,rlicrtrr o tr.irilJrialrrolnornorcrhM livc hrndrcd dollr (S5fi)) <br />_1. ar owmi of thc po,rlry. o. m, cmplorc€s wirh e.gcs a rlcn sb @npcns{ion. wiu do iE s6k !r!d rlE sbEt@ ir ml <br />i cdcd or ofcen 6r sL (Se.?O14. BusiRss ud Pmf 3ioB Cone: Ttc Conlrdols Li6ne Lip dGt nol arply ro owffi or <br />$. trepeny qho tuikL or idp&Es tlr@tr and who dB trh hn hinscllor lEBlf or lnmuSn ht o.lB orn.nlloyeci <br />providcd rhrt such i,qmw s m ml hrcndcn u oficEd for sL. lf. hoqlw. dE L{ilding or iqrlrm n $B withio oE }s. <br />olcorrhtiotr lh. Oemr Auilt( will tBw tlE td(bn olpmvire $al lr or she dil nor hiu or inDreE 0E prordty for df, plrFoE of <br />-1. <br />$ oerc. ol rhc tlolErly. e .rchsiwly conr..crilg sarh li(!*d contracroN ro consru.l rl* pmicEl (SB. ?044. 8!sinc$ <br />ond Eolcsbn Cod.: Thc Conrrmrols Licen$ Lar dGs mr rpplyro !no*rcr ofprclcrry uhn builds or imDrcvci $crenn, <br />lnd oho onrErs lor slch roj.dr snh a Con!&torls) licckd p!B@t 16 rlECont6.rtr s Licene I-3*). <br />I mcxcnd undo S6rion .B &P.C.folrhisu$r <br />lr,lr (r*r.r <br />MtSX!:AS:1l]nlfEtl,tIl)Nut;cl .Bilr.lor <br />I hc(.htrl&nrr (lr.nctrJlrtoit)urr!otrrotlhciflh{ri'rE ..hBri,ri\ <br />l hlw lnd u ill Einrain r Ccnific(lc olconsm ro sclrlnsuft r.r workctr corrr.nsar io., os tmvtcd for by Ssri.n ST00 6f rhc <br />bb.r C.dc. fr rhc p.rtomnft ofrtu solk 16r whhh rhc t)ermh is iqsucd <br />_l hovc and willminl.in wort.s' compcnsatiofl insu as rciltcd by Scction 3700 ofrhe Laho, Codc, fo. rhc !.rrormncc ol <br />t h*n. Mysorlc6 o insurlne c!dc. and policy nlmbct @: <br />-l <br />c.nify rhll in rh. DcrformG of 0* w6rt lor hih rhis pcml h iss!.d. I shnll nor cmployany pcrson in uy manmr <br />s s ro h..om sub.iccr b ln woltEl onFnsar io; l.ws of Califomi., nnd a8G rhat if I should lrtoft subicr r. rhc <br />w.rkd$ dnp.nlarion pDvilioN of Scction 3?00 of lnc ktur C.d.. I srDll. fonhwilh m'nply uirh lhos povisions <br />WAnNINC: Irihrc ro slr *ork ri.oolcnslrion co!c,!ac is urhwfll. x.d shdl sxbje' an cntlotcr to aiminrl Fultics ond <br />civil lnrc\ up l. oE huMrcd rhous!.d do <br />Scc!idr.ll)76 ofrhc Lrtxtr CoJc. nlrr.{ trnd <br />in ddirion ro rhc c6d .f .orp.nsrrion. d,roBcs ns [ovidrd lor rhc <br />+lttln <br />DECI,IIIAIION <br />I hcrcby.,Itrm undcr pcnalry ol F july th.r I !m lictns.d umlcr provnion ofChnplq 9 (commncins *irh Scdbn 7O0o) ofDivisio.l <br />of $. Arshd* rnd Pr.fcsn,.r Codc. nyli.cn{hinlullrucdsndcff..r.9 'lslulttli <br />,,,, zfi/rt .."^"c O\ -r€ <br />cax$f,llEltotrlJiltDlN(i-acE!(I <br />I hcrubyrinnru er pctrulryolpcrrury rhrr rhcrc n r con\lru.rn'n [ndina !!ch--y ln rhc pcrr!!tun.. orrh. *ork ror f,hichrhis pcrmn n <br />isucd (Scc. 3l)97,Civ C.). <br />AIIIIgAIIDECLAaAION <br />I h@!y ofrn undcr Fnllry ol lcriury orc of rhe follosing deherionsl <br />Dcmlirion Pcmirs-Asbcsros Norirerion Fcdc6l Rcguldn,ns (Tirlc 40, Pur6) <br />-Rcquircd <br />Lxrrdnf Norifrarbn <br />I ccniry rhoi rh. tcdcral rcguhtions E8,di.8 <br />"(h.sos <br />rcmv,l dc nor $pltrbk 'o <br />lnh pmrcct <br />-l <br />an ify thrr I hovc Eld rhh application &d stule rhll rhc abvc inl'omtion is corEl. I s8re lo o'n ly wnh lll Ciry and Counry <br />ordinanccs rfrl Srulc tiws rc o huildin8 coNruction, tu*i hcr.by 6urhorir. rcrrc*nralivcs ofrhh Ciryrnd Cou"rylo circr lpoo rlf <br />rb\e nrnrnnrcd nnpcny lor i <br />/J-ae z<l^I <br />UNDER GROUND <br />Waste & Vent -7-lqqy <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Areer,/Storm Drain <br />I nterceptor/ Clarif ier <br />Waste & Vent -), <br />Water Pipinq t) <br />Gas Piping t- <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main 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 Plumbinq vM-k <br />7-11-tg <br />Meter Release <br />FINAL (-E-tv vw\c, <br />Notes, Remarks, Etc.v <br />APPROVALS <br />v.\2/x) <br />TOP OUT <br />\.Vrtu\.-7- <br />Final Gas Test )a <br />= <br />= <br />I <br />I <br />I <br />=