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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />UNDEB GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Boof Drain
<br />Bouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbing
<br />Final Gas Test
<br />Meter Release //^
<br />Notes Remarks Etc
<br />OWNEI BULDM DELCARAIION
<br />I h.aby a(iro under penaly ot p..iuy lh,r I u crcopl tom llE Co ret6 Lt.rE La* for ln€ fotloeins Men (Se.7031,5
<br />Bxbes ard Pofdsion Codc): Any Ciry or Cou y which EquiEr ! Fmh lo mnslMl. rllcr, imoDrc. d.mlhh ot rcpair u,
<br />srru.rurc. Fin ro irs isuM.. dso Equircs rhc appticlnr for ffh Fmir h rrk a ii8icd st rcmfl th.r lr o. slE is iiftnrd lursdl
<br />ro ih. ptbvirioN ol rh. Conrra.iols LiftiEd lrw (Ctuprf 9. ComrcinS with Scdion 7000 of Division 3 of lhe Buiirc* a.d
<br />Pmf.srions Codc) tr rnll lE or snc Ls .xcq,r rhcEfiom lnd rlE b&ris ror rhc ,llcged .xcnDtion. A.y violrliof, of Sdbn 70rl.t br rny
<br />appliclnt for . Fmn sbjdli rlE appli@nt 16 6 civil p.@lty of ml rcE th$ ,iv. hutr<lnd doll&s (1500).
<br />-1,
<br />a\ .wner of rlE FotEfly. or h,.nl,lorcs wirh sagd a rlE sh onlt).nerion, willdo th. mrt snd tE irEt@ is ml
<br />inrcn<Iad orofrcrcd 16r sh (Se.7O14. Bu.iB! md Pibidrio.sCod.: fhcC.nlBclor's Licn* t e dca tor .Pply lo m owrcr of
<br />rh.lmpsry wlht itls m insrlrs trd .td wth {tBsn E* him*lto. r**l,ot lhsu3h his or hd o*ncoployd..
<br />prcvided rhar skh nrpbEE s fl mr i .ndn oro,YcEd lor sh. li h*!*, r,E taiEing or an{,ore ii$Bwnlin@tru
<br />of strpbrion. tlE Owtur Blihd will hlr rlE hr&n ol foeing thll lr or shc did ml hild o, nlPr.E lhc pmFny for lhc Pnpos of
<br />I. ar own.r oarh. tmlEdy. !n.rclusivcl, conhcring qilh lienrd onracroG ro.o.sh.r rtE proj(t (Sc 7044. Blsincrs
<br />ad ftofschn Codc: Thc Co.lrldofr Laccnrc ti* do.i n6r.pplyro Mo*.r olpropcnt uho builds or nnpover ihcrcoo.
<br />a.d wh. .o 6.rs lor s.h prcjdr wnh ! ConrEdo(9 lic.n*d puBlutrr ro thc Conrh.toar Licn* trw).
<br />I im.rcmp' undcrSdio A & f.C. rb.rhis,.r$r
<br />]((lf,f,!f,lloM[rNsArl0]s
<br />DECL/IaAIIAN
<br />I hcrcby offirn uMcr pcmlry of pdjury otu of lhc follo*in8 dechtutions:
<br />t]l\tr(-, c. ntr rhc pcrli,nnrkc ol rhc N.rk li)r which rlr Frnril i\ i\\u.d
<br />-,
<br />irk and $ill minl,in qorkc^ .oq)cnsarion i.snr.ftc. ar rcquircd by Selion l?(l() of lhe ljhor Co{ic, for rh. t dlo.mnc ol^B;h4-.
<br />K-;o
<br />-I.enify
<br />rh i.rh. p.rl6fu. orlhc *ork 16r whichrhirp.rmit is tsu.n.l shull nol cmploy any pcrtun inonymtnncr
<br />s ato b..om subiri ro tic *orkdc.onpcndion b*s of Califoni.. and agN rhd af I should tE om subj.rl lo rhc
<br />ktrtd' sfrpcnsllion povisio.s of Sclion 3700 o, lhc Lihor C,odc. I .tull, lodhwnh sn{,ly wnh lhos Imvisioos,.
<br />WARNING: Flilurc i6 suic Mrk n .omp.nialtun covcEE. ir unlawful. lnd shlll subjccr o. dplorfi ro cihinal FmhL\ snd
<br />civil fiEs u, h .nc hr.drcd rhou\dnd dollrs (slm,fin), in rJdki r, rlE co{ of conrPc du@g.s rs ,,rovilcd for lh.
<br />Sccri,,n l!076 oa(hc trtxrC.dr, inl.r.$ rnd !trunEy s fLr!.
<br />I orrr*,t
<br />IEqAAAIION
<br />I fuEby.flirnrundcr pcnllryor pcrjury rhar I nm lienqt lndcr Dft,lisn n orchud 9(commncinS wilh Sccriotr 7fix)) orDivisn,n l
<br />ol rlr Busi'rcsl Md Pnttsions 6dc. and ry licctrsc h in tul hrcc andcflccr.
<br />c-76 /{ryL3
<br />coNfrx.!,lsr0lrDNDllrci!.ENtl
<br />I lwchy rrfD u.dcr lrniltyolpcduryrhrr lhcrc i\ r.on(ocrion Lidin8 dg.d.y tr rlr Nrfinrmncc ol'rhc $ork lor which rhil rmir is
<br />nsucd (Scr 101)7. Cir C ).
<br />ATPIICAILDIiILAEAIIIJN
<br />I h.i.by ,finn uMc. p.nalt, ol Frjry .rc of rhc folbwnrg dcclMr ii,n\l
<br />Dcnrol nr Pcnnn$Adf,sros Nolificrrion lc&rol Rc8lllliofls (Inb 10- Pan6)
<br />Rcquncd rxtd ol N.rifi .arion
<br />-l
<br />ccnily rh rhc lcdcnl rcsohrions rsdi.s ^t {o\ e@vd,r.or rrplkablc to rhis pmj.rl
<br />tin ard sr,r th0i thc ahovr informrbn is mrer. I asrE lo en ty wirh all Cily ond County:#/z:
<br />Dvztot-;e ft
<br />L
<br />TOP OUT
<br />Tub/Shower Test
<br />Gas Service
<br />FINAL
<br />\.*,*,*, /)//z,c*ceia L
<br />trn.h, .4,t,h.*
<br />", "tp"",t &le6 E
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