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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNOER GROUND
<br />Waste & Vent ft)c\tu\tV AV 1LI er)* f-,,a
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptori Clarif ier
<br />TOP OUT
<br />Waste & Vent '7lt4l,a -rN?9
<br />Water Pi ptng 1ln'tfi.rilD
<br />Gas Piping
<br />Roof Drain
<br />Tubi Shower Test 1l.alfl 1rtu )
<br />Ro ugh Water Heater
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Servrce
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL VJ;it /rtr -,,? )
<br />Notes, Remarks Etc.
<br />OWNER EUILDER DELCARATION
<br />I h.r.b, rfirm und.r Fnally of pcrj'ry l,t!l I m crcdlpl fdn rh. Co ktoB Liccn* k{ lor lnc follo*ine @sn (S€.?031.J
<br />Busincss lnd Pmfcssion Cod.): Any City or Counly vnkn rqlunB r Fni, lo snrtucl, altn, inpr6v., dcmlish o llIir my
<br />,tocluc, t ior ro nt ietue.. alro rguias rhc amuca' for such lEmit ro fik s sisnd sr.rce rhrr lE or slE is liensd pulsut ,
<br />ro rh. tDvisiris of d. Conlmctuls Liftnsd L3* (Chlpt r 9. Con@rine wilh S.clion ?000 ol Division 3 of llE Blsims .rd
<br />Pmfcssio.s Cod.) or thal lE or sh. ir.renq lnercfem dd lh. b6ie for rhc elhscd cicn$ion, Any viol.rbn of Setio.70l1.5 by any
<br />.lplicail for a psmit subFls ll'€ applicanl lo ! civil p.uhy of ml mrc rhlr 6vc hlndEd d.llar ($m).
<br />-1,
<br />&r ovmr of lh. ptup.ny. or my cmplors3 sirh w,gcs &c Ocir $L oiqEnsarior. wiU do ttE r@t ,!d ,E nn.rE ii Dr
<br />inrei&d or oocn! for $L (Se.7Ol4. Blsircss 8nd Ptsf.sbm Cod.: TIE Conrfttols Lic.s Llw dos mt rpply ro e owmr of
<br />lhc poFny wio boilll d iq,mrcs llEmn. dd wtb dc Mh s& nimrclf or h.slf or rh6tr8rr hL d h.r 6*n .npl,or.s.
<br />p.ovllcd rhrr sch iqftvm.h @ mr hrdd.d orotu fm sL. lf, hokE rlE tDiUi,S or itrprowmnr ie $ld *nhin om )Ed
<br />olonphtiotr llE OwB Buil&r sin hrt iir hldd otltrotiig rlEr li or slf, dil ml hlild o. iqerc Oc po ny fo. $c purpo$ ot
<br />-1,.sowncrofln
<br />pmpcny, smcxclusirly.onlreli.S wath li.d$d.oor.&to^t oriulcr rhc Ireifl (Sr,7Ol4. aunms
<br />,nd PDf$sim Code: Thc Conrt.|or's Liccnsc ljw docs ml.mly to an owncr ofprcpcnyvho builds or impmvcs thsmr.
<br />and *ho .onlE ts for sucn pmjds wirh r Coihlo(O ltcnsd p!6unr ro rhc ConrEcroir Lk .s La*).
<br />-l
<br />uncxcnU undcrscdio. .B.
<br />,",", 06^ft2-llg
<br />I hcrcby offtrm und.r p.mlty of pdrury orc of lnc lollowing ddl@ri.!s:
<br />-l
<br />hlvc eld f,ill minldn ! Ccnifadc of Con*.t lo Scll-lnrurc ror *orlns .on{Ens.rion. ri FDvidcd lor by Seclion 3700 of lh.
<br />L,&tr Cod.. for th. F.folr@e of lh. w6rk ror thhh lhc }ortit h hswd.
<br />_l hlw and will fr.inhin eorkcB comle.sllion insur!rc.. 3s Fquircd by Seiior l70O of lhc t b.r Cod., for $. Frformmc of
<br />rh. 8.* lo, shich lhh !.m is hn&d My krksl ompcnelion insuEm€ cmi.r $d plty numbcr m:
<br />PolicvNumb.r:JtDiEs
<br />-l
<br />enify ltll in rlE r.rformrc oflh. worl for which rhis pcrmn ir Lisu.J, I sh,ll no' .ry,loy any F(on i. any mnn.r
<br />s s !o h..Dm subier ro thc worl6 on4eneri6n laei of Califonia. and artc rhar if I should t coft slbirI ro tlr
<br />wo cs' (nFnsarion lmviioB of sdion l70o ol lhc L$or Codc, I rlEll. fonhwirh @opry wnh lh.c p&risioG..
<br />WARNINC: FliluE lo surc workc( comp.ns,iion oKne. i3 unbwtul. Nd sh0ll subj$l ofl cmoloFr lo aininal Fmllics &d
<br />.ivil lincsulrlooml ndred lhols.d dollss ($10o.00o). in addhhn b llE cosl olcom!..$lion, dadgcs as povidcd fo. th.
<br />Sdion 1076 ofrhe Ld,r cldc. itrtcrc( ond ltlormy s
<br />Dtlrllltllr)N
<br />of rlr Ilrrirc\\ ni Pn'lc\\i(trr C.dc, rid n,yli..tr\. i\ ir lillinrru irrlcll..r
<br />Corhdoi_
<br />CONSTRUCTIoN LFNI)II!(; A(;DNCV
<br />I h.tb! anir r utrdcr ri lr!orp.rjurrrhrrIhc.cisaconsrru.riotrbrdinsa[cncyr.rrtcpcliolnuNcoirhc\orkaor$hichrhnpcoiri\
<br />i\sucd ISL{ l0r)7 Civ Cl
<br />A.EEIIIANLDECLAf,AIIO!
<br />I ttrb, !fin! utulcr p.nrh, of p..jur, orc oarhc rirllowin8 dcclanliflrs:
<br />nctrnirbn PcrnrirsAsbc osNorificaln,n ledcrul RcEul,rions('Iirh,r0. lM6)
<br />-Rcqutcd
<br />lxrlcr of Norifi clrion
<br />l.cniIrhni rhcf.d$dlrcUuhrt)ns rclarding a\lrnol rcnrivrl 3rc norr!f]icfilc (' rlrisr'otcrr
<br />-l
<br />ccnify rhd I h8v. rcd rhn 8,'Dlkalion dd slir rhor rh. uthlc infonurion h .6m.r I lclc io comply wirh all Ciry 0nd Cou.ry
<br />onliMnas,fld Stl. hws EhlinS lo buildins.oD(rucrion, ard h..cb, althbrizc rcpEs.fl,riv.! ofrhis Cny 6nd C.uorylo omd nroo rtf,
<br />atxrc mtrricncd phr.ny for
<br />Alpllc"nl or A8ent Sirn"lu oqzl lr
<br />ffil
<br />POOL/SPA
<br />Gas Service
<br />",,, oe l?-ltg
<br />*."u'*--",0n", -tl4lA/
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