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PLUMBING.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER BUILDEN DELCAR TION
<br />I hcrcby affirm hdcr Fnahy oa !.riury rhd I m excml 6!m thc Conr&roF Lt.N Lrs fo, the fouowi.S rc.$n 1Se.?031.5
<br />Busarcs ajd Prcfcr.ion Codc)i Any Ciry or Coufly *hich rcluircs . Fmit to .onslncl, !lld, improw, &tulnh or tl,Ininy
<br />stldm. Fi,r ro iis i3suft.. also Etuircs rhc +plicrnt fo. .Eh p.mir ro lil€ a sisrsi $arcftfl rh,r lx or stE i! lkcnrd l,unu.j
<br />ro th. rrevbiors ofir Conkrciq\ Licnsd tlw (Ch4ir 9. ComBEing wilh S.ction 7000 of Division 3 of lhc Busincsr and
<br />PmfcssioN Codc) or thlr lE or sh. k cxcmlr rhcrcfiom dnd lh. basis aor lne alL8.{ cxctr{,tioi. Any eiolarion ofsethn 7031,5 by rny
<br />lmli.anr for ! r,cmir subjalr rh. lpplk.nt lo a civil p.nlltt of not mr $d tiv. hundlti dollds ($500).
<br />-1.
<br />6 own.r of lhc lmFny. q oy cmplo)@s wnh qagri &c rl*t elc ompcMlion. wil .lo lhc fr,l ed 0* stE1m h ml
<br />inr.ndcd tr oficEd ftr sk (561044. Blsimss and EDfcsions Cod.: Thc Cofi!.rn s Lt.k Lrw does rcr !t!ly lo s oetur of
<br />lh.t op.ny who hilds o. inp6B dE6r ord eho.lo.s sh mrk him*lf or hcr*laor thelgh hL or hcr ow..q,loyss.
<br />lmvided rhlt sh irymEcifte6li endcd qotu hr sh.lf. hoEE, dE hoildinS tr inprlwEnl b 6t within nt t@
<br />ofonpklbG dE OwE Bui|dr wil tuw tlE b'mh. of pmving $d tF or dE {iid mr toild or itrprck 0E poFry for tlE purpoc of
<br />-!.
<br />No*nerolrtE pf,lt dy, .m cxclusilcly.onrEcrir8 wnh Iensd conrrmro^ ro.onsrod rt pmF.r (Sd.7044. BuriKs
<br />,nd hofBsion Codci The Conrdctol s l"imnsc Lrw d@s nor aprly ro an owncr ofpropcnywno builds or impmvcs ltcreo..
<br />{trd vho conhcl3 for such lmif,rs wirh ! C,.rmro(, liNiscd luBum ro rhc Co .a.roCs Lie.e tlw),
<br />I rncrcnmr undcr Sccr B. & P.C. turnis rcus,i
<br />II}B6E8S:TIITIIENIA.IIAN
<br />DECI,/If,AIION
<br />I hocby{mrnund$ r..rlryorpcrjuryom of lhc followi.gdccLrali.nsl
<br />l;ihitr (itrlc.l,tr rh. ps lnnm cc ofrhc $ork fo' \h ch rtu n&ni il n\u.tl
<br />lh,vcrndwillnrnnli.w.rk.tscorycnslrionnsu0n.u.13nquircdbyScclbtrlTlOolthcLlborCode.{irrh.pcrtor.un.cof
<br />{hc $ork lnrshichrhi\ pfn,ir i\ is\hd Mf a.ikc( c,iotr inrurmc cdi.r ! policy numbcr e
<br />-l
<br />ccdilyrh,r in ih. p.rLrrorcc of thc wo.k for whi:h lhis !.rmil n ksucn.l sh,llnol c,itlo, dny rc^od in a.y n0nrcr
<br />v, N to h.corx subrc.t ro rhc wo*cr' cooFn\dion lawr of Califooi!, ,nd ,8N fid I I rnout hccom subirl ro llt
<br />worlc* Nnpensarion p.olhions of Serion :1700 of rhc lrto Codc, I shull. todhwnh $mply wirh tbo* prcvisions.
<br />14ARNING: lnilurc Io sw *o,kc6 ompcnsdion svcnsc is lnla*ful. !4d rhall rubicr r .oDLyer ro fti rin.l IEmLis lnd
<br />civil fincs up to onc hudrcd lhousuod dollas (!100.001)). in nion lo rhc cos of .onwBstion, dsm8cr !s lrovidcd aor fic
<br />Ser ion :l07tt of rh. I it-r C.dc ihrc'cd and nnom
<br />Drl€:-
<br />!IrL!-8t!r.L
<br />I lrehy ilirm undn Fnalty ol Fduly ttrl I m lien$d uld.r P,lvLion of Cnlpl6 9 (ottmtrin8 *nh S.tlk . 7000) of Diviim 3
<br />of rlE Blsics ud P,ofcsnoni Codc. ard 6y ltc.s ii in tull fod .!n .'Icli
<br />Bl o t"ttloqrl
<br />?ro o. , l;<
<br />rl)!$x.uclrcIiuiNDlNc-ta[|icr
<br />I hcrhy rr',l.rn u cr pcn0lryol pcrjury rh( rhclc i\ xconsrrucri,n b in!a8cncyitr(h.Frhnnin.cofrlrcwor[hrshi.hrhi\t^-nniri\
<br />i\ru.d rSc. :ltJ97. Cir C.l
<br />A.EELIIAITI.IIECI,IM.TION
<br />I hcdy dlm lndcr pcnolr, otFrjury.tr..rrhc tolk win8 drldrarn,nr:
<br />Dcnolnion Pcrmil! shcsos Nolificalio! Fcdcral Rcsularions (Tirlc 40. Pan6)
<br />-R.!uned
<br />t.rlq of Nolifi calion
<br />-l
<br />edify rhar rhc fcdehl Egubri.nr ngudi.8 Bh. os Emv,l o. nor applicobh lo lnh ,oj€1.
<br />l.dify rhd I h,vc rcod rhis allltarionad sllrc rld th. !tov. infomthtr is cond. I asra 16 con{iy onh aI Cny rnd Cou.ly
<br />ordimn.cs md Sratc Liws rcl,il!building consrdcrior md ncrcby.uihrizc rcprcsc atilcsofrhisCiryandCondyrocnr.ruponlh.
<br />$ovc m bDcd lmpcny for
<br />Apt li.nnl o. AAenl Siemhr
<br />\-<
<br />*,. ? lr ltt
<br />UNDER GROUND
<br />Waste & Vent 7-11-t?k.vlJ(
<br />WaterUnder floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent 7-7
<br />Water Pipino
<br />Gas Piping L
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lVIain 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 A
<br />Rouqh Plumbinq 747-lk k"t4-1t \,.I"I{l)l
<br />J
<br />Meter Release
<br />FINAL {'-t9"1t v,\v4(
<br />Notes, Remarks, Etc.T'\/
<br />DATE
<br />A.\4)de
<br />Final Gas Test x t ndci"
<br />^ddrs\
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