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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE tD/slG.COMMENTS OWNER BUILDER DELCAIIATION <br />I h.Ety lrtrm udq p.nalry .( Frrxry rhd I m .r.opl fDm llE ConlB.lN Lttrs h* lot thc lolloviry rcasn (56.7031 5 <br />Buiincis art Prcf6sion Cod.): Any Cily or Counry which rcqotcs a l.rnn ro sNrDd. dld, inPmt d.mlhii o q4t oy <br />smblu.. ptur ro ils issu.mc. lts Eqrircs rhc qJrli.lir for ru.h Fmi lo nh ! rigi.d slar.ft lhd h. or slE is lic.sn puunt <br />ro rhc lmvi(ions ot rhc Conm.|or'i Lhc.$d tlw (Cnnphr 9. ConffiEins wnh Sc.tiD 7000 ol Diviriof, I of llE Blrincs lnd <br />Potcrsioos Codc) or rhi & or shc is cxcnpt 1h.rc6!n and th. bost for ihc ilhgcd crcnplion. Any viohlhnofsdbn 70:l L5 by My <br />q,plicrnl for . Frmil slblrls rhc rrplicld $ a civil pcn.lr, ol @l mE thu fiv. hudtd doll&s {tt00), <br />-1. <br />&{ dwner of lhc pmlEny. or my cmnk rrcs wnn waScs e llEn sk onpcnslion, will .lo tlE *orl od ltE smrlle i! rcl <br />inrcd.d or otu for sk (Se.7044. A$iE$ and Prof.isions Codq Thc Conlracld s Lic.n* Laq doci nol alply ro u ovrcr of <br />rhc pmp.ny wtE hdild! or ilproB ln mn. sld wlE des sh kd( himlf or lEBellor rhbu8,l his or tEr o*n cnplores. <br />pmvid.d rhal such imPmrrcftnl! 6 rcl in.nLd orofrcr.t 61 3d.. tl hoEE, dr toiuing or iqloEftnt i! 5ll withi! om )Er <br />ol@nphrbn. rlE OwE &rild.r *i[ hlw tt hnhn ofFovins rh tEorCrdndbildtri,ptuwdf poFly aor llE Flrosof <br />-1, <br />as osmr of rlE nmp.ny, m ci.lurivcly .o.rB.ri48 *irh lic.n{d contstoF lo onslocr rL Ptr'j*r (se. 1}44, ausms <br />,d Eure\*i{ Cod.: Tnc Conltrlols Liccnrc tiv dms nol a!,'ly ro an 6wmr of prop.ny who builds or intmt. rhq€o( <br />and {ho mntEcrs for $ch pbj.crq wirh a Conhdo(n lkcn*d puBMl lo lhe Conrachls Ltcnsc tzw). <br />I m.r.mol urd.r SNlion .B & Pc.lorLh"Elsn. <br />uoB(!8tr-cl)r4PiltarlaN <br />DEIT.AMIUN <br />I hcrcby afirm und& p.Mlr, ol Fjury om of thc followins dehturionsi <br />-l <br />har ard eill milloi. . Ccnifral. ofcoMrl lo S.lf-lNurc for srt6 onp.Deli.n. rs Fllidcd for by !€lio. 1700 ofdE <br />L5hor Cod.. fd lnc pdtortlam or llE so* lor whict tlE pcmil ir istucrl <br />-l <br />harc .nd will @iblri. vorkcB compcnsatiotr insumflcc. ss rcquncd by sdrion 3?0o of lhc Llt or Codc. lo, tk pcnoru. of <br />rh. work ao, which lhis pcmil h issi.d. My comrc.slrhn i.su@ c tr srrd lDlicy numb.r el <br />WARNING: FailuE b surc *orkes en{Ensalidn @vcdec n unh*tu1. tnd shlu $bFrl 3n cmnhtlr ro @minll lf,Mlas and <br />civil fine ul) t6 om hudrcd ihousnd dollm ($100.000). in addirio. to lh. 6st of conPcnstion dlmgcs as prcvid.d for ihe <br />S.crion -107a, ofrhc uh, ('(xL. inrcrc{ lnd <br />I hcrchy lififlnundcr pcndryotlf,ijtryrhdr I unddr povhion ofChD/( I (conmncin8 *irh Scclion 7000) ofDivni.n l <br />of rhc Busiros und Pm{c{sions Cod€. and o, li..ns h in tull rbN aftltltKt <br />I hcrcbtlffirmhd.r pcndlry.rl(rjury lh lnm naonsrruclion bndingl8.kt for rh. P.rfornBrcc orrhcw6tk [Mqhi.hrhn Fcrmn n <br />isncd (Scc 109?, Civ C ) <br />AIILfEANLOI'IIABAIION <br />I lmhydlnnrunJer nctrllly ofpcrjury otrc.frh. followin! dNlnrlrion\: <br />Dcnn'lir,on Pcrnrir$Asttslor Norilicrrion F.dcral R.auli ion\ (Iirlc ,(). P0nO <br />Rcqutcd L.tlcr olNorillcdi{,n <br />-l <br />edify rh,r <br />'hc <br />tcd(ij rcFlntiotrs ESadiflB sstxslos rcmval arc ml .pplkabk b lnh Pmi$t. <br />-l.difyrh$ <br />I htrv. ud thh apnlicalio. aln slgr. th rhc lhow anformrion i,c(ret.l ase lo.omdy wi'h.U Cny and Coonl, <br />odininc.s drd Sralc tjm Ehr in8 ro buildi.! .oo{rucrion, a,rl h.rcby oulhoria Eprcstlarivcs of $i. Ciiy and Counll to .nld uton llt <br />ah,vc rc n,n d pft,lr y fo nsp€r <br />Appli(rnr d *enl Skmltr <br />UNDER GROUND <br />Waste & Vent l-h.-tb -,)>$tbt ry <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent > t -lt4 t-& <br />Water Piping l(uu-io f, <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Test <br />Rouqh 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 />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL il-i-G \D.ralza /r) <br />Notes, Remarks, Etc. <br />-l <br />ccniry rh in lhc Frfortun.t of rhc wort fo, which rhk p.rmn i$ kslcd, I shlll not cmrloy an, FBon in sy mn.cr <br />so &\ ro b€oft slbiccr ro rrE mltdc omFnsliof, loqs of Culiaonia. ud artc rhd if I should h.com sobj*l lo rh. <br />wol(sl .omFn\ari.n ntuvirhnsoiS.dion 3700 oflhc litnr Codc,I sndl fonhwaln drmply wilh lho* lmlisiom.. <br />Nurbq <br />- <br />P€mile mme rprinl), <br />*,",67t/tt <br />I