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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underf loor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pi prng
<br />Roof Drain
<br />Tub/Shower Test 0-22-lv
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pi ping
<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 />A
<br />Bough Plumbing i-Zz-lY
<br />Final Gas Test
<br />Meter Release
<br />FINAL -Nrq\rS
<br />Notes, Bemarks , Etc.
<br />OTVNI]R BUILI)ER DEI,CARATION
<br />, hcrcby illnn undcr Ntriry ol pcrjrr rhir I cr.'ntr ft,drhcGn ru.tn Li.cd\. L,w ror rh. fdli,wi'r! rcrv,n (s( 70.115
<br />Ilo\i'rcs\ nl Pdirsion Codc): Any Cily or Cou.ry ahich r$un $ Fnnir ro .onifl.'. rlrd. nr[ovc, dlnFlhn or rcI)jn liy
<br />{fl.trrc, prirn' ir\ ir\rocc. !l\6 rcquirc\ rhc lPrrlicanr lnr such,tlnnirnr lilca stncd (ircnEnr Ihr hcorshc i\ li(c.scd n!6unN
<br />h rhc nmvnions ol lhc (onlr0crtr s t,iccnscd l-0$ (Chqlc. 9. C.nnncn.irs sirh Sc.rion 7u)0 or Dilis'on I of rhc Busincss and
<br />PRnt\\ionlcddcrorrhrrh.orshc i\cr.npr rficrcfroormi rhc hisis f.trrhc!llcscd.xcmorioo AnyynnarionotscctioiT0.ll5htaiy
<br />upnli.a nrr pcnn[ subjc.r\ rhc nptlr.trrl(, r.ivilptrrllyorno! nx,rorhm fivc hundrcd dolld\ ts5m).
<br />Ll. s otrn( ofrtu prcrny, {tr myriltk,yN! {irh sllsc\ !\ rhct vnc.orn,rrerur. $rrrdo rhc $olk ud rh. xrnil@ b htr
<br />idcnJcd or oflircd lor n'lc (S( Tll44. Busircs rn hold\\i(,n\Codc'IhcCo kactr'sl-i...sctjwdoc\norlnplyroano*ncrol '
<br />rhc pmpcnv wtt tuild\ or iroDvcs dcmn. rnd !,h. dr{s \uch $!* han\cli or hcrcll or r hrotr8h hir or h.r own cnrllo}ccs,
<br />nnrv i cd rhd {rh i F)vc rtrh m i.r ificelcd or olltrcd l',r ulc ll ho*rw. rhc huihlin! or inpmvcurd t snld wirhn, .n. $dod.ri.rh.OwtrcrBurlhlwillhi\crlr${rdciofpr,lingrhr1ror{h.diltrorhirdorinDr,(rhc|hD(nylffrtf,purpo{oI
<br />-1.
<br />Govnoof rhc Dftp.ny, ln.r.l8iwlyconr@riig sirh li.cnEd co rdna r. @nsmd rlE imj<r (Ss 7Ol4. Alsdss
<br />ond A.fshn Cod.: TlrD ConlEctols Liccns Low doca ml crply lo u owrcr ofro!.ny who buil& or impovcs llrcr&..
<br />od pno .onhds fr such pmlErs wnh r ContBd.(.) lkincd plrr@r ro thc Conr&ld s Lien* L.w).
<br />&clion-- 8
<br />. qr+r(,r*r- X
<br />IECI.AEAITON
<br />I h.rcby lffirm und.r p.nahy of Fjury onc of ltlc followin! dc.lanlioBi
<br />Ihaeclnd*illruinrm!CcnificdcorCnnsdtoSclllnsur.rorrorkc6..nrp.ns ion,0( ptuvidcd for hySc.lio..l7(I) oflhc
<br />ljhor Cqlc. lor thc rcn'ormncc ollhc work for whi.h rhc 0cmrir ir irsucd
<br />_! hlre ond {ill nrintoin wo*en cohp€ndion instramc, as r.qun n by Sslion l?00 of lhc hbor Codc, for lftc p.rfomie of
<br />rhe wDrk for which rhh psmir is iislcd. My *orlc6 omp.nslion insurotrcc fficr dn ,DIcy numbd N:
<br />PokvNunr!.! jDirce'
<br />lll c.niry rhll i. rh. Frform,c or rhc qo'k for shicn rhis Fmi is nsucd. I shall nor .mploy any pcno. in a.y mmM
<br />s! os ro ltom s.6je' ro rhc eltdi onqE.srion l.m of California. ud !3m rlar if I stbuld bciom slb,c{r ro rlr
<br />sorl6 Ntrll*asllio.,,mrisionrolsetion 1700 oflhc kbor Codc.I shall, fonhwilh mmdy wilh lho* tmvisions,
<br />WARNINC: Fnilurc lo surc rcrkes' ompcn$lion cov.n8. is !6la*tu1. aM shall subj.cl d cnplorer to siminal Fmltt, lnd
<br />civil fincs up lo on. hundr.d thousrnd dollan l$10o.0o0), in lddilion k, rhc.os ry.nsolion. damgcs as lrovidd n,lhc
<br />Setiotr 30?6 of tlE Lrbor Coda inlmsl and unomy s rcs
<br />lppricnnr: *
<br />DECLAEAUONIhcNh!nlfinnuid{rr.nrhtofl.rruryrharI rl'..n{dufld.rrRrvni{'nolChrpr.r9l.o rmkin! qirh S.cri{'n?txm) riDivi\irr l
<br />ol rhc llu\iic\\od ltolcs\ioi\ Codc. a ,yliccn\c is in tulltnrcnndclli{r
<br />Licctrsc Chsr Li.cn!. Nun$.r
<br />CoNSTRUCTX}N t FNDIN(; A(iENCY
<br />I hctby rllthudcr p.nllry.ipcrjury lhlr rhcre n a connr.tinr lcnditrA lrcmr lo' rhc trfonuncc orrhc sork ror which rhi\ l.mlil i\
<br />i$ucd (SN. 1097. Civ. C )
<br />AITIICANIDECI,IBAIION
<br />I h.Ebyanimrundcr l'cml!, ol pcrju,y onc olthc rbllosin8 dccl didrs
<br />DLRnitior Pcnnn$Asb({.s Nori,l.rriotr Fdlcrrl R.euhn,n\ (Thl. 10, Pd6)
<br />-RRturrcd
<br />la $.f Notificminr
<br />1..'rll,v rltrrhclcd.r!lrcgulxri{)n\ rcgrrtli'rgx\6.no\'.N,vilrt norxptrli.]hl. t) rhn nn)t.r
<br />LI rrnil.vrhrr Ih c r. rhi\ rrpLrrrnn,rnd (rrr rllrrhcrhrk innntruri,)n is.or..r Irrr..b.sndywirhrll(iry.tu1C.unry
<br />ordi.a@s sd Shtc kei rchrins ro hiildirB .omhcrio!!i2c rcprc*n',rivcs .f thii Ciry a.d Connry lt .nlcr urhn rlE
<br />lhovc nEnrn,rcd pml'.ny lbr ins,ccrion
<br />x-
<br />x
<br />fl,',',^
<br />-(,(t t(
<br />I
<br />Waste & Vent
<br />o"", . Llt I rL
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