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APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under lloor <br />Building Sewer <br />Area,iStorm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Rool Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line q\\q\\u .^u44(1 <br />It/ain Drain/Pool Pipino 7z--'-''b'/'/q aa <br />Pool Heater/Gas Line P*A.r-7//ltlrl q(6 <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Bouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc. <br />OWNT'R BTJILDI'II DELCARA'IION <br />I hcrcby nfinn und.r ltnalry ol p.rtury thar I im crcnDr imr thc A,nlnctna l,icen\. Ij$ r(tr rhc rolkr*in8 rc,$n (sc.70ll 5 <br />Busincs\ and P,otc\rnrn Codc): An! Cir, or Connry *nicn r.quncs r F.mir b .onio.r. rlrcr. nnlrovc. d.trhlhh "r rcwir dtry <br />ntu.ror., trirb n\ i\\uanc.. rl$ rcqrncs rhcinlli.rtrr ntr su.h Fnn[ lo l]lc, siencn srlrcm lnd hcor lhc i\ li.cnscd tu^ua <br />r,, rh. ptrivntnr\ ol'rhc Conklc(r \ l.ir.n\dd lr* (Ch,fl$ 9, Co'ntun.$g rnh Sc.rion Tuxl of Dilhion .1 ol lhc llusincs\ lnd <br />Pn,fcsn,is(i c)orrhrrh.orsh.i\cx.inflrh.r.lionrMthchrsislorrherllc8.dcrcnrnlion.AnyvioldionotScrrkn?0.ll5l,yri, <br />{pli.rnr rorr rcnnir suhlchrhc rpnlicnnl baciviltcni[yolnol nmrcrhrn nve hhdtd dollm (S5(n) <br />_1. as osn ! of rhc prop.n y. ,n ny cnll lottc! tr irh $r!.\ rs Ihsii q,lc .o rFn\rl irtrr. sill Jo rh( *o* .nd llrc slruhrc i\ <br />idcnd.{ ordll.rcrlfor srlc (sc 1011, Busirc$ od Pi'tu$nnN Ctrlc I hc Cnnrlcntr s t,ien\. U* do.\ ioi lntly tu m o*.c. of <br />rhcptriFny who 6uikl\o' i'npn)vcs ihcr$n. s sho d(r\\u.hM)* hnnscllor hcr{lf.r rhrru8h hi\ or hcr o*n cnuIoy.r\ <br />fr.vii.t rh su(h nnpntrTnrnrs e mr inc ct .r oftcrn hr !,1c. ll l.i'sc\ cr rh. hliklinB .. iqnorBnt h $ld wirhin nc )rr <br />of.otrDlcrirr. rl'( Owtrd Burkld trillh[r rhc budcn ol pnlvhS rhlt h( or +hc dil r! huiu or inwovc llN rolf,nt for rhc purjxrc ol <br />-,. <br />.s owrcr of thc FoFny. an crcllsivcly conrrscr ins wnh [ccnsd conrdclG ro ..nsMr llf, pDrcd (Scc. ?o44, Bu\ifts <br />.rd hDfslbn Cod.r Th. Conrm.rors Lic.mc tiw des.or.!olyro atrowncr oftroFny who builds or improws thed,n. <br />rtrd wno conttucrs for such pmFrs sirh a Contrscro(s) liccnscd pursuur ro rhe Conu-acror'r Liftnr L!s) <br />-l <br />amcxcnDl undcr Sation-, a. & P C. lor rhn Ea$n <br />D8re: Orne <br />Itaxf,Eis:cl)urENtArlllN <br />DECLASAITqN <br />I herb, dlfird !.dcr lJcnrlry of rojury .nc ollhc followint deldaiions: <br />-l <br />lE!. rn will minroin ! C.rrif.areof Codc roSclilNefdtrrk6 @nFisrion. rs Fovncd for 6y Sdlion 3700 oftk <br />Llbor Codc. for thc psfor,rm. of lh. mrl for whth llE osnl is nslcd, <br />_l hlve and will mainrah pork.s compcos.lion iNur0Bc. .s ..quted hy Sd ior 1700 of lhe Labor Codc. tui rhc Polorromc of <br />rhc qorl lor shich fiil p.mn as h$.d My work6 ompcn$lio insftre cMi.r rn policy .un$cr d: <br />_l ccniiy ihlr in thc plnhrinancc olrhc wo'k fitr whi.h rhi\ pcnnir t i\\ucd. I shnll mi nn! pcron in any nrn.r <br />$ as ro tE 5m rublrt k, rhc work s .omlEns.rion laws ol C.lifomi.. and <br />{odr.i d,npen{tnri ln)ytions ofsc.rion 1700 ofrh. tlt rCodc.l <br />j.cl un cnrployq lo rihinal Fmhics md <br />ion- datuEG ar pn,vid.d fn rhc <br />ncin8 wilh Satbn ?000) of Diti\ion l <br />ol rh. htrinr\\ x d Pn,l.l!o Codc. !d my li.cne ir in tull loEc ud <br />I h.Eby !,Iro uod.r ncn.lry ol Fqu.y rhd rlm h ! connddio. lcndine aBcfty for lhc tlcrfomrc or rh. sort ao. whkh rhis Imt h <br />hsu.n (Sa. 109?. Ci!. C. ). <br />l-BfLlCAIiLDEllAtrrlIl0N <br />I tRty nmund.rl.nrlryrf tlrjuryoitr of rhc inlhqiredccl nii(rr: <br />Dtnn'liriqr l,crnils A\txdo\ Norili.rr!,,n Frdrrrl R.grhrnnr\ I I'irld 40. Pan6) <br />-l{equn <br />(l Idrcrol Norillcrri{m <br />l!rc tror Jppliclhlc t, rhi\ nhl..r <br />abvc int imrion is comct I agN lo ompl, wifi all r. <br />,rd hcEby .u'h.rir rclrcsnl.livcs of rtis City 6nd <br />Pemir@I\( <br />6 2 <br />PLUMBING-INSPECTOR RECORD <br />Gas-Underlloor <br />Fill Line/Back Flow <br />q*5 <br />Foalryofpruury rhlt I am liccnsl uRh, povtn)n <br />tf,nd.i" Addc$'- <br />I <br />_l