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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE COMMENTS ON'NER DUILDEX DELCARATION <br />I lEcby aflirm !.d.r Fnolry of !c+ry Er I d.r.m!l fmn rlE Conrlcrd'Lidn* L!* for rlt follo*int Ee$n (S.c7011,5 <br />Businc$ ard Eolcs.ion Codc): Aly Cily o. Colnr, which rcqlircr . ltmit to co.nod. alro. in'9rew, dcrclnh or Epoi. sny <br />3tEcrw, prio. io Xs issua@, lbo Eqnircs the .I)plicor for sh Fmit o lih { .iged sr.Lrcnr rlt r he o. slE is liccnsd punuel <br />to rlr provhioni of dE Coortutoas Lien$n k* (Ch.pb 9, Commfti.B {irh Se on 7000 of Division 3 of $. Bu.inci! and <br />Pofcssiori Cortc) or ln,r lEdslE ii cxcnot ,Erion alrl E hash toi rhc llhgcd cx.nl,tio.. Aiy violflio. of Sdlbi '1031.5 by aiy <br />arplisnr fo. aFmrir rubieN ih. rppli.sr ro i.ivil perdry of mr mE rha livc huidEd dolles (t50o). <br />_1. es own( of thc ,rcFny. or my cnphrt s wnh *dsca ds Eir $L onpcnerion. will do th. wrk erd iE smd@ i! rct <br />inlc .d oof,.r.n for sl156.7014. ausircit md Pblc$io.s Cod.: thc Co.lraclols LiccN tts.lod ml spplylo u owrcrof <br />llE porEry wlE tdilds tr in+,o$ rhE@r ard sno dc trh wort hift*lfor hcMlaor Uonsh hn o, h( own coplor4.. <br />|,oviL<l lhar skh inprDmc m mr inLn Ld $of.,rd lor elc. IL l[rcE.lh trihhS or i,rpoEmd is sB *nfiin w rw <br />ol@nphrb.t tlE OqM arihr wil hw tlE hirdcn of !o!hg rhn l* or shc did ml hriu or inp&r rhc pDpdy h. rlE FrpoE of <br />-1. <br />ar owmr ol fi. pmlEny. am crclusiv.ly ontrdin8 with li.c.ed .onturon lo consrucr tlE po.ier (Se. 'to44. Burirccs <br />drd Eatu$ion Codc: Tne Coorreror\ Lkcnsc Las dG nor apply ro !n o*rcr ol pr.p.rry wh6 build.6r impmvc. th&.o.. <br />lnd vto .onimls for suh piDj.ds vnn 3 Contmcro(s) li$n€d lurMr ro rh. C4nim.tols Lisne t{w). <br />_l an cxcnv,t u dcrSeinr <br />ltr(IRKERS' C(IMPFNSATION <br />DECLAAATQN <br />I hcEby aftum und.r pcnllty of Frjury of,c of lh. aollowirS d(lu.lionr: <br />-l <br />nrvc 0nd will mintain r C.nific.t ofcons ro Scr-ln.uE for workEd ohFnsllion. c provi&d for by Sc.tion l7m of rh. <br />t bor Code. for lh. Ffolllm. of lnc ao* for {hkh rh. p6nir is issucd. <br />I h.vc rnd sill mannain work*' .omp.islrn,n insrrancc. as rcqrncd hrScrrion.lTot)olrhc lihor Codc. for thc l]clform.cc of <br />smpcisrioi io@cc cMtr {tn F.[.y ouE$.r m <br />-01--0 <br />in rhc,)crformlnccofrhc wo ttr whichlhhI'c mn h hsuc{- I shall nor cdrloyaorF6on inanydmtui <br />md aEM lld if I should tIcom su$irl lo thc <br />slBll, aonhwilh onply wilh thos pmvisionr.. <br />suhiccl ro lh. workc( corn .nsarion l.vs.lCaliforni., <br />workel comlcnsorion provirions of Setion 3700 ol lh. tjbo, Codc. I <br />WARNINC: FailuE ro we wortln' omlcnslriotr ovcESc is unhwtuL and 3hall rlbirl 3n cnploJd 16 dioi@l trM[ics iid <br />.ivil fincs !n ro otu hlidcd rhousdnd dollss (1100,000), itr lddirion ro iE coir oa .ompcnsrion. .hmge. a, lmvidcd fo. thc <br />Sccrion -1076 otrhc lihor Codc. io'cEn and !tromv' <br />"",.,t- \3- [X <br />^,,,-",, <br />Dl:CldlBAL&N <br />ol rhc Inr\i'r$ rdd ltoltsi{m\ (inld, rxl niyli.ci\c i\ in fullli,rcc {l.ffccr <br />{3 5 o <br />u- 13- K c <br />C!)IIIBUCIIANIENIINCIGENSI <br />I hcrcby urtrn undn pcmhy ol p.rjury rtu <br />'hcrc <br />it ! sNtudion Lnding o8.Ry lor rhc p.rforomc ol thc *ork ror ehich lhk frmir is <br />hslcd lse.1097, civ. c ) <br />AII].I(ANI.UiITATAIIII! <br />I lm$y rfliiin otolrr p.ndlry.fp.rlxrt otu ofrhc rbll.wi'rg dcclurrrnns <br />Dcnnnirn,! Pcmir\ A\tEslos Norificulion rfllcrol Rquhriotrs (lilb.r0. PfiO <br />Rcquncd hrr.rof Notifrdiun <br />I.cdilylharrhc fc&rrl rcplari(,.s rcrding r\h.no\ rcfr)rul orc nor lppli.$lc t. rhis fmi.r <br />-l <br />ccniryrhot I havc rcad rhh 0ppli.ariofl Md shrc lMl rh. atbvc inlomlion k corccl l.BrccrocomplywirhallCiry!trdCounry <br />odin$c.s {d Sr{r! tiws rblin8 lo blildin8 .o.(rucr,on, md h.r.by ourhornc EpEsc lliv.s of lnis Cit, ond Counry ro cnlf upon llE <br />.bov. 'Enrioftd !ml.n) ror inlFylion <br />Applk.nt r. Ag$l SiAmrorc -lj-/ <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Bu ilding Sewer <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipino <br />Tub/Shower Test <br />Rouoh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Draini Pool Pipino <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />R ough Plumbing <br />Final Gas Test <br />Meter Release A <br />FINAL 1-Zo-l Y <br />)kWlr\ <br />Notes, Remarks, Etc V <br />ID/SIG. <br />Area/Storm Drain <br />Roof Drain <br />Miscellaneous <br />L.ndo r AddBrf------T------