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APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area./Storm Drain
<br />lnterceplor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service Lt,t-zo ** lo,
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbinq 7- -11-t
<br />Final Gas Test \-j
<br />Meter Release
<br />FINAL 7-. ti-?o ,
<br />Notes, Remarks, Etc
<br />owNER lrulI-oIr D!]l,c^RA'rIoN
<br />Ih.rchydlli n ulldcr t'cnrly(n r,-.riry rh l cxcnntonrrhcConra.kril-ic.ns.h\rrdrh.folloqirrsrcnu(Sc.rlr:ll5
<br />Btr\iNi( r Prntsion C{xld: Anr" Ciry nr C,,u ! {hi.h rcqdnrs r tf,nnn k,.oD(rud. ilrcr. imrovc. dcnn,li\h nr rcnrn r')
<br />h rlr Uori\i,$ ol rhc Conrrcttr\ l-i..n\r l]N (Chrprcr L Contr ci.in! wirh Sccri.n TlXx) ol l)iririon :l ol rhc llo\i',c\s md
<br />Itotc(\n)trr(idrr.rrhrr lr ( \h. s crnrN rhcrclirmrnd rhc hrsh lor rhc lllcscd cc'nprn,n Anyvn,hrn,norSc.ridrT0ll.5hr_ tt
<br />t!1i.r tur r |xr nrir {:lrlcdr rh. rlpli.ror n' u.iviln.nrlryoinor nnrcrhrd fi$ hutrdrL{dollirs (S50o)
<br />-1.
<br />,s oqBr 6f lhc p.oFny. o, ny .nploFs wht *sges I llxir sk m'npen$tion, *ill &' lh6 *ott dd tlE smir@ i Dr
<br />im.Bln or ofi.&d lor sL lSR.7Ot4. Blsimss and PmfEsio.s Codd Thc Crnm.loat Licne kw dod nol .rply lo M.encr of
<br />rrE |n,Fny wt$t lrs or nq,oEs llrer !d who &B sh w* him$lf or h*lror $orgn his or h.r ow. crmloyc..
<br />porilcd rh,t iuch irp.oEmds e mt in'.d.d d ofi.En fm sl.- lL hv.q. tlE hiltins or ir+rotftd n $E wnhin orc )dr
<br />ofonphrir. rlf, O*M Bui}:kt {iU hlr rlE bodcn o(rrovi.t tlEr ,r o, dE did mt hild r irpDw dE pmFtt for tlE lor!4* of
<br />-1.
<br />!s osrcr of thc ,,mt'cny. am cxclosivcly c6.rrx.rins lirh lkcnsd .ont cror !o onsrruct IlE rmF.t (56. 7044. Busircs
<br />{nd Pn,fNia Cqler Ih. Conracrols Lic.n.. Low do.s mr rpply lo m.wncr ol rmpcrlr eho buildr or idptov.s rh...o..
<br />trfld who onrB.rs lbr Fuct rmj.{rs *irh sCotrtEro(n [cssd r!l\@r roth.Conhcior's Licns. tr*].
<br />-l
<br />amcicnfl u&. serhn- a. & P.C. aor lhi! raso..
<br />D.r.: o*E
<br />IIT8trEBL TMIEISAIIAN
<br />DECI.ASAIION
<br />I hocby ,mrn u.d$ Fnllrt of tEjury on. or rh. aolhwinS d..6rdioN
<br />-l
<br />haw ud *itl tuinhin a Crniarst. of Con$fl ro S.lf-ltrsur for s.t6 on{EBlion. a! Fnvid.d for by Sslion l?00 of Inc
<br />tatff dc. ftr rhe p..fomBc of th. lort lor *hich ltt pcrnil b ks!.n.
<br />AhoE and will mainhin worlc. compcnslri.n inruraec. a\ cqrifti hy sdtion 3rm of rhc Labor Codc. for thc rE l'o,mncc of
<br />work for whi.h rhn 0cmn i. ir*d My work.B onpcnsori.n i.surucc carf,r arrd policy trunhcr m:Lrbeq-?b',r5 bEbi tolD to-/-tu^
<br />_l.rnifyOar in rhc Frforrunct ofrhc *!* ror which rhir lc rnit is nsucd,I sh0ll nol cmploy on, llc*on inrny @n@!
<br />$ N ro h.com suhid lo lh. woltss omI)cnsri.n lass ofcllirornia, and arrce fi if I rhould t c.@ subj.ct b lh.
<br />sod{sr'conFnsslionlmvirn,trsofScdionlTmofrhcLihorCodc,lrhall.fonhwirh6mplyenhthoetovhions..
<br />WARNING: a{ilurc lo s.urc workc( conrFosstnrn mvcrosc is utrltrwful, $d shall sxhjsr an cdploFr ro oimiMl lrMhbs ond
<br />ctuil n cs up lo onc hundred lhoustrd dollaF (sltro.odJl. in addition h rh.
<br />Smlnrn 10?6 ofrhc t$or Ci'dc. i.rcnst rnd rormy\ les.
<br />i^a-7.ao
<br />I hcrch, d,hD trtrdd $rrltyofp<rjrylhrr I lnr lEnrn undcr !o!nn'n olChaprcr 9 (con1nrcrcing wirh Sc.ridr T0l{)) orDivishr:l
<br />or rhc Bu\i'rrsrtrnd Pn,f.\ri(,nr Cnd.. fil nrr li.${ t h rxllf(tr.rtrdcli .r.
<br />c-to)czq(3a 65077-k-ao *".x
<br />I hcrchy!rnm ndcr pcnrhrotp.rj!ry rhnrihce is tr.on{tucri,n hhdin8 rg.tr.y r(,lhc lrrforron.c orr
<br />issucrl (S.c..lrrgr, Civ. C )
<br />sork for vhich rhis F,nil is
<br />AITLICANI.IUCIABAIIQN
<br />I hc..t t rrm unilcr p.nnh y ol pcrjury onc of
<br />'hc
<br />a.llo* in8 d.tlmrion\
<br />D.mnii.o P.roirs Arh(or Norifi.di FcdcBl R.gullrmns (Tnba0, Prn6)
<br />-R.qrtcd
<br />Lcrr(.t Norirrdrir
<br />-l
<br />ccrrify lhtrr thc fcncEl rc8llorionr Eeo^lin8 Bstf,sxx rcnnvol arc mr at)Pliclblc ro rhir prui.l
<br />$Hllllr,I hsvc ud r hi\ rmli.lrion {nd srdc rhd rlt at rc innrmsrioo is .otr d I oSrN ro sryly wirh all Cny and C.ury
<br />rrc I a*\ rcldi'r! ro huiklinS rcprcpnrltivc, oartk Cny $d Colnry ro em6 u|i)n fi.
<br />Appli0nl or Ag.nl sigmlu 1 - d7-/2
<br />I
<br />PLUMBING-INSPECTOR RECORD
<br />TOP OUT
<br />Back Flow Device
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