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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE tD/srG.COMMENTS OWNEN BU&DER DELCARATION <br />I hf.t, .mrn !trdcr p.Mlr, of rcrrury rhar I d cxcdpr iion rhc Coir&roc Lie.e trw forthc lollowin8 Een (S.r.?03,.5 <br />Burinc$ d P,of.ssion C.dc): Any Cily or County which Equircs . p6mil lo snntod. rlt6. ir9rcvt. d.mliih or qair ey <br />slrlclE.. ,rir lo ils issakc. ako Eqund rh. alplicer for such pcmir to filc d sigmd itorcMr th t! or $c b lie.cd puNd <br />ro th. pmvisionr of ilx Conrturm's Lisnsd Llw (Cnlprcr 9. ComrcinS sith Sdrion 70m of Di*iotr I of rlE Busims! and <br />Prcfcsions Cod.) or thar h. G $c is.r.n{rr thcrcfrcn and thc b$is for rtE dtlcgrd cx.dpdon Any violaio. ols.dion 7031.5 by dy <br />rmli.anr for a pcmn slb.i.rrs rl* arllicafl ro e .ivil pcnalry of mr mrc fiar filc hundFd dollds (5500). <br />-1. <br />os o*ncr oi tt. pmpcny, or my cmploF$ silh rngcs as lhcn sh conlEnsalion. qill do tlE eort &n 0E snarh b ml <br />i.rol(kd or onb.cd for elc (36 '7(X4. B$incs rnd Ptbrc*ionr Co<lc Th. Codtu ls Lienr liw .krs nol rpply lo u owmr of <br />lh. roFny who h.idr or [lp,!B llEmn, sd who {ttr sh wl* nins.lf or hcMlf or lhmlgh hh or hd oq eqtloyccs. <br />providcd lttrl such imrmEm.ls N mt inlcd.d orofrcEn forsle.ll tsw.E, dE t{ilding or nr{,mvcmnr heB*nhinoft }r, <br />ofcoftpLrion. th. Owrcr BuikL. win hlE rlE td(,.n ofFovin! rtd he orsh. did mr t ild or arulm rh. lxrFly Lr df,,urpoc oa <br />-1. <br />os oemr ofth. pmFny. !mcrcllsivclyonrEcring wirh liccnEd snrmroR ro con{rud rhc,rbi(l (56,704!.8usfts <br />dnd Er&*sih Codc: Thc Conuebas Lic.n.c tle docc n.r applr ro &ovncr ortmDcny eho builds or inlrorcs lhscoi, <br />ond who sntGcls for such Fmrc.k *irt a CoflrErmG) li(trsd pursulnr ro rtc Contrrctols Licn!. Liv), <br />-l <br />amercmrt u.der Ssr <br />^,Dz/ tz-/ r€-k'''''''cz-I2rrr,!_8!lt1)! <br />I hcEby oftrrn udu p€nalry ot rciury onc of rhc folh*ing &ilalr n N: <br />-l <br />hrvc i will Ninrrin rCcnifictrl.ofConsctrlr, Sclf.rnsurc lo! soiksi $,npcnerion. !s ps,lidcd rot by scchotr:1700 orrh. <br />tntxtr Codc. for rhc p.rllflrrtrN ofrhc *ork lor which rhc p&nir i{ kucd. <br />_l tavc lnd *ill m inuin vorkc^' compcos.rn,n iosmnce. rcqlircd hy sccrion l70o or rhc hbor C.dc. aor thc perfomrcc of <br />$c work aor $hi.h rtis ,cmir is isrd My qorkcs .ompcn$rion in$rmc .mtr lld policy numh.r u. <br />I cMily U{t i! rhc pcrlbr@ft. ofrhc wor[ for whih lhk Fmil k issu.d, I shall oot cmploy lnr lcBon in any mdncr <br />sr is lo bcsm subjLrr ro thc {trksl ompcn*tion h*s of C{lifoinia. 8nd .ge. rhrr il I slnuld bc.onE subirl lo lfu <br />so.tc6.otr{nslionlovisions.fSccri]n1700ofrhcLllt,rCodc.Ishxll.ionh]irh.omplywilhlhospmvisions <br />rVAININC: Foilnrc ro sm wdk R' omFn$rion cov.age h unh*ful .nd shlll subj.d M ctrploycr to <br />civil 6nB ut! lo on hundEd tho$snd dollaB ($l(i. dddirnr. b rhc cost olonlnensrir,tr, datusc:::Hru)Y; <br />lr.( I \lr \ I lr)\ <br />I ltrrchyallirm utr&r Fnllry ott{rjlrylhal !n liansn hds tmlision ofChaprcr 9 (d,nftncnrg wirh scdbn 7000)otDivision 3 <br />of thc Buriress a.d Pofersions Code, .rn my lt.nsc h in tull fom srt cfiBt. <br />c0NsIxIJcrIoNlEtDllc_&Gl;IilI <br />I hcrchy rlltmundur pcnrlryolrrjury lhll rhcrc n ! con\lflcrbn bndiiE ![cicy tur lhc Pcrtunmncc ofrhc *o.k tu qnich ihis pcrmn ir <br />r\\ucd (S.. .1097, Civ C.) <br />AEILICAII.DDCLABAIION <br />I lEdry ffim !.dc. lcn.Xy ot pcrrlr, oe o( rhc tollowing d(lddionll <br />Dcmlilior Pcrnnk-Arbcslos Noliar.ation FcdcEl Rcpulations (Tillc.l0. Prn6) <br />-RquiRal <br />Lcrt$ of Norificattun <br />l.difv rtnr I tutc r.d rhis licrrion lnd rtflrc rh rne nw inrbrrErhn h ..nd I deN ro $mply wirh rll Cny olld Counly <br />odinuccs and Sxrre L,w!rlari,-s buiHing @n$rucrio.. aid h.rny auhdri4 cprcrc.larivcs of lhis Cny sd Counly b cils !!on llt <br />!lx'!e mnliorcn pmtcny for <br />ADDli.rnr or A,t$l siAnrlu <br />'--t'-'I Lt zlt <br />-7,tO-tb Yl,lO,gU- -fi .+i4.( <br />WaterUnder Iloor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Ciarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh 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 />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing 9lFltf Taa,fy4a J&9) <br />Final Gas Test tl I <br />Meter Release <br />FINAL plblal'l',ivqaL ,6D <br />Notes, Remarks, Etc I TV <br />UNDER GROUND <br />Waste & Vent <br />Gas Service <br />_l *niii th,r rhc acdchl mgulariom Egading ,sbcslos ans!31 arc nor lmlic.bk lo rhis pmj6l. <br />o-r' " /tr