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PLUMBING.INSPECTOR RECORD
<br />ID/SIG.COMMENTS qWNER BUTLDEtr DELCAIAIION
<br />I tcrcby rlttrm und.r pcml'y of pcrjury rh4r I m.rehpt tDh th. C,nracto^ LicM t s fo, rhe foUoei.e lmo (S<.7031.t
<br />Bu.inesr lnd Profcssiofl Codc): Any Cily or Coun(y shich Etrircs a pom to onslrucl. alrq. inpruE. &mlnh or rcdd $ysrel@, l)rhr lo ils hsud. lle r.iuirc. rh. .pplkd fnr $ch lEmt $ aih a rigrcd srd.m thar lr or shc t lien${ pumo.t
<br />lo llE I'rcvisioN ollh. Conhdofs Licc.rd kw (Claprd 9. ConmcminS wirn Sccrion ?(n0 orDivision:l ofrhc Busiocsi aId
<br />Pmlcssiors Cod€) or lfiar h€ or she n excmpr lh.Efmn md rh. baris lo, $c rthgcd .rcn$ion. Atry violariofl ofs.dk n ?031.5 by any
<br />appli$nl for a rEmn subjek 'h. rprli.m lo a civil Dc6lt, of mt mrc lhln fivc hundrcd dolldr ($500).
<br />l.J\osnc.otlhcnnp.nr.ornrJcmnk)rccsqnhsr!c\a\rh.ns,hconp.n\dion.silldorhcNorkaftlrhlsrB-ru4i\n,r
<br />iNctrdcd oroflircJ f{trsrlclSE 704J- !u\inc$ !trd Pr.fcslotrsC( cThcCi tu.t \l.icctr{Lr*d.c\trorrpllyr,Mosncroi
<br />rlf, rnlury llt boild( or inrrn*ts rl*Enr. rxl who dmr \u.h *.,1hnns.lior herrllor rhioush his or hcr o(tr cnrtloFc!.
<br />pnrvdcdrhlrruchnnpx^rrtur\tnori.trJ.d.rolllrcdtur!rlc.lt,howcv$.rhrhrildi'rroriqmlcmfrisqnd*irhrn,c)cr
<br />ol.utrtl)Lron. rhcO$ncr Buiucr sillharr rh! tunlcn oi F)rirB rhd h. Ish.dittrurhuitd I i'rtro\r rhc ptrrldy tu rt* puqi,y ot'
<br />-1.
<br />$ ownf ofrh. pep{iy. !o.x.hsiElycontrctins wirh licctrsd controclon ro consrru.l lh. phiNl (Scc rur4, ausrcs
<br />&d Eoission Codc: Thc Conlretols Liccn* Lrs des Nt rItl, to doencr of lropcny *no btilds or imFmEs thc,mn.lnd *ho conln.k tbr iuch pmr€rs wirh a Contmcro(9 licon*d pursunr ro rtu C.nkacbls Lic.n$ Lnwr.
<br />lo'n.r.nnn tridcr \..
<br />lllaf,!8s:roMtEdsar&N
<br />IECI.AAAIION
<br />I heeb, afftrm undd Fnrlty of tE jury om of rlE nrbwine dc.larathN:
<br />-l
<br />hrvd rxl *ill nhintnin a (tn iaf,rrc .f Cons. r lo SclflNurc tu $ or*cr( snDcnsdnrn. !s DR'vidcd f$ I'y SNt ion l7m ol rh.
<br />tihtr C,xl.. for r hc ntrloflMncc oi rfu wo.k l'or which ihc p.rnrn i( i$ucd
<br />_l havc and will nrinrain work tr com!..iorion in\uancc. as rcquircd by Scd n,n 1700 of rnc bbor Codc. ior lh! pcrfonErcc of
<br />is ns.n. My e.rkea .lnpcnerion inslrlrc.!dcr &d polty nlmhcr m:
<br />s
<br />\.\ -\zr
<br />l.cnify rhar in lic,,crformnc. oflhe *orl for which lhis Fr6n is irsu.d,l shall ml cmpLynny pc&n in rny manicr
<br />s as to h..oE sub.iEr ro rh4 wrloa @nFnnrion bws ot C.lifomio. and agrc. rhd il I sholld beam subjst ro tlE
<br />rorkEl omp.ns0rion pDvirions ot Sdrio. l70O.r lllc ljlnr Codc. I shlll. forthsitt @mply eith lhos ,rmvhions..
<br />WARNINGT Fsilu.. xr sltc {orkcG coqrnsllion mvcnBc is unltrwtul. md sh0ll suhirl M cmpk,ycr io dimiMl tEMhics and
<br />civil fin.r xp b nrc hundrcd lhou\and dollls (SI(I0.OO0),
<br />scction 3076 ofrhc ti&r codc, ior..ci od drorrcy s,Ns
<br />in Mdirion lo rhc co{ of.orrycndbn.
<br />*" ]ll}l l1 ^
<br />!]!L]=!x.{t(A
<br />I hcBhy lilnn ukl.r l.nilrroirrjury rh.r I am lien*d udd.. pnvisi,,n.rChrprrr I (.o'nL-ncins eirh sccrbo 7Oo0) orDivnion.l
<br />ol rhc autnr$rid Pn,rc\s.i\Cudd, ard nry liccn\u is i'r tullri)r.c drleli.cr
<br />,-"-*."* 3. ,"""""*,,.*, tooal6r-
<br />*.-JUN 1 1 2018.-,*"., Fat',o,r.
<br />CONflAIICUqNIENI'IUC.AGINII
<br />I ltEby afiim u.dcr,Enllly of pcriu.y $al lhdc is a ondocrioo hndi.! dgcncy for rh. pofolr1@c of tbc wo* f6r whth rnir Fmrl n
<br />hsucd (Ss 3097.Civ. C ).
<br />AIELICANI.IIES,AAA.IION
<br />I lLr.l,, allmr !"dcr lcnolry oi ,'crJury om of lhc followi.8 d*lmrions:
<br />Dcmlition P$mih-Asbc(os Noli6.atio. F.dc.rl Rrgahb.s (Tillc 40. Pan6)
<br />-Rcquncd
<br />Ldlcr ol Noriff,olbn
<br />-l
<br />ccdiry fid th. fcd.r.l rcSrhliom Eg0di.8 rlbcnos .cmvd dc nol appli.lhlc 16 |hi. per..t.
<br />,1 .!d ily rh0r I h,!c rcad rhis ,l)pli.ariun ond sdrc $nr rhe lbyc infomrion n cotrsl. I asrs t omnl, wilh all Cny rnd Counry
<br />odnrrccs.nd Srtrrc tjes (hrin8 lo building con{ru.rion, afll hcr.hy auhornx rcprcscnuivcs ofthh Cir, md Colntytocnrcr upon rlE
<br />!hov. mnlioftd popcny ror irspe.rion
<br />Applicut o. As.nl SigEroE 1
<br />,llt 1 " -,,
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Bu ilding Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pi prng
<br />Tub/Shower Test
<br />Rou h 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 />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />R ough Plumbing 0//L//x ) n6A
<br />Final Gas Test
<br />Meter Release
<br />FINAL ?/lt/tt
<br />'.Af.,1{Notes Remarks, Etc.
<br />APPROVALS DATE
<br />Roof Drain
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