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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII-DER DI.JLCAR I'ION
<br />I hcrchy riinn undcr pci,lry (n Nrlurv lnll : 0'n cxc.rB for lhc Conlrtrcro^ l.iltn€ Ijw ln rhc fdlowirB rcov'n (S.c 70:11s
<br />Ilu\inc\\ rfti Pnrfc$n'n Cdlc): Any Ciry o. County qhish rcquircs ! pcrmir b.otr{ru.t. llrcr. ia]Prolc. dcm,li\fi rrcNnnny
<br />{tu.rurc, prn, tu irs is\utrncc. al$ rcqutc\ ih. {rlicrn' ror s&h rnnir h rilcr srsn d slal.nEnt rhar heorshc Lr lic.n{d ,xr\umr
<br />h rlr rtr'lirnnr or rlr C.trrrctors l-i.cn*d Lrp (Chrnlcr L Connncncinr wirh s..rn,n 70(n ol Divi\i :l otrhc llu\inc\\ !tr{l
<br />Irhfcsiotrs (intr ) or rh.t h. dr shc i\ cxcmpr rhcrcaron and ft berk tu rlt dlLgud cxcnuriotr. Any viohri(,n ol Serbn ?0:l l 5 hy Mt
<br />lprlicrnr fUr F-.nir \uhjccBih. {,tli.rdr r. !.ivilrcnrlryotnor ntrcthrn fird hundrrddollrn (S50O
<br />-1.
<br />!s os rr ol rhc lrl,r(ny, rtr
<br />'ny
<br />..d.ycc\ s fh wrEcs us l[cn dc conDcn\ tD. will do rhc sork rltslnrluci\nor
<br />i'n.ftlNl or olltrcd fr {k (S( ?(}l-1. Busims\ rnd Proicsi.r\ Galc: l'hc A,nhckn-\ Ltun{.ljw docs nol a,tPl, b aio*icr ol
<br />rhc pmljcnt wh. huilis or inlpmvcs rh.n,n, mn $b dr\ tkh $1)rk him\cll or h.^cli ot Ihx)LEh hk or hcr osn .'nplorccs.
<br />pn)vnlcdrhrrsuchi'npn^umnrr&noridcnrlBldo,lcrcdir!,Lllhowcv.r.rh.6oildir-!ori'n|m)!cn. il $kl wirhi'r onc )utr
<br />olqnrylctidl rhrOwncr lluitln willlrlc rhc huidcn of |r)vr n! rh.r hc or \hc dtl nor taiu or ii{nnt rhc pmNny tu thc Putlr{oI
<br />-1.
<br />0s owmr of lhc ,opdr- !mciclusirlycon[erins wirh licdn*d .ontdo* l. snsldd llt pmjed (Se,7044, Busrrc$
<br />n.d Ptr,fBsin, Co{tc Thc Conlmlols Liccnsc Laq dos nor rnply to an owncr ofriopmywho builds or im!'roles rhcreon.
<br />lnd sho ontncrsfor such poFcrs wifi a contm.ion 0 li.cnsd luNunr to lnc conrrelols Liccn$ taw).
<br />I amcrcmnl und.r Sfflion , B. & P.C. fo, rhr Erson.
<br />IIOS6DBS:.CI]DIIENIAIION
<br />DECLABABTN
<br />I hcrcby afirrm unde. Fnally of Frj!ry onc oflhc follosinS dc.l[itioosl
<br />-l
<br />h.w !d will mirui, . Clnilic,t of CoN.t lo Sclfln@ for *ot@ 6,r{lNlkJ4 6 Fllided tor by Serion 3rO0 oa rlE
<br />knor Codc. for fi. p.,fo,it1.re of $. tu* for *hict lh. pdnil i, Lslcn.
<br />I hdw and will mn rin workcF conrpcrsal iqr inslratuc. o\ rcqxiEd by Scd ion 1700 of rhc lihor Gdc. for th. PcnnnMr-.c ol
<br />pcrmil n iiqd. My *Drke\' cohpcNrri{,n insur.ftc cMicr rd Poliy nuntcr @
<br />-l
<br />ccnify rhrr in rhc p(lonnanc. oflh. vork lor which thn lcrmil h hsocd, I shnll nor.frplo, an, pcson in an, nMncr
<br />s N lo b.sm subjel lo lhc wltcB'rotFosario. laws of Califomia. tnd 08ec lhol ia l should bc.om subr.d ro llE
<br />wort6' compcnsiion ,,m*ions of Sdion ,1700 ot lh. trbor C.d.. I shlll. fonh*ilh coq)ly wirh inos pmtisions.
<br />WARNINC: [silue r{, su.. workcA'compensDlion colcmsc is unlawtul. dd shdll subiccl on coplortt ro qinir.l Fmlris md
<br />civil fitus !D ro oft hudicd ihouslod doll-s (SI0O.0O0), 0ddnion to rhe cosl of.on4.n
<br />Ssrion 3076 of rh€ bbor Codc. inrce{ ..d olbrEy s f@s.
<br />D^r", ')'t!
<br />Ilrrhydrf Ud.rncnrlrtolpcluryrhllI!nli.cnrdulr{lcrprovi\i(notChnfrcrq(.rnnxNinA*irhS|crin70(X))nll)i!i{i.r.l
<br />ol rhc llu\inc\r trd Prnc$i{'n\ Coilc. md ry licrns
<br />^
<br />ir tulllar.c xlcllt.l
<br />I t2z2?? .i51.
<br />Yo,l"''rz*
<br />q)NiIB.IJEIIANIINDINIJTiINCI
<br />i\\ucdlscc.l(l)7.Cr C)
<br />I cdify rhrt rhc rcdcrsl rcEllarions asddan! !.lEsros rctu)vdl trc nor rlplkablc Io lnh por..!
<br />L, l.cnifvrhd lhn\c rctrd rlrim-*.-"-rs-",,*.*hii,pplicn'ion md slordhtrl rhc svc inforror
<br />d Cou.iyro cnrcr upon ll8hri.g ro bui[in8 constru.rion. !d
<br />.bove mnlbncd tmpcny frtr iNp.dion ,,url,ss.
<br />Appli.anl or Ag..t Signuture u,," 1-a'/ o,.t
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<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 />Rough Plumbinq ?/t+/'t )h t</
<br />Meter Release
<br />FINAL 6(t(rftX i\6b
<br />Notes, Remarks, Etc.
<br />1.\.\',t.
<br />o.u 1. l, l Ql c."'*"".-
<br />l4nder \ Ad.lrc.<
<br />-
<br />AITLICAII-DEIIdAAII}N
<br />I hllby ldirn undcr l.n.h y of pcrjury onc ofthc lollo{ins dccl$alions
<br />Dcnrlilion Pcrmirs-Asl{slos Nori,l.urn'n Fedcrul RcSullrions ('rib 40. Pan6)
<br />_Rcqxircd L.rr.r of Ndificalio.
<br />E+
<br />Waste & Vent
<br />Waste & Vent
<br />Miscellaneous
<br />Final Gas Test
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