|
APPROVALS DATE ID/SIG.COMMET{TS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underf loor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Boof Drain
<br />Bough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ivlain Drain/Pool Pipino
<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 />Rough Plumbing l'l/tt/ir 5\61
<br />Final Gas Test
<br />Meter Release
<br />FINAL zltz//q <uv1rk '/n---
<br />Notes, Remarks, Etc.
<br />I
<br />PLUMBING-INSPECTOR RECORD
<br />OWNER BUILDER DELCARATiON
<br />I hdby lfatrm undcr p..ally of !.iury lha' I m .rcry 6Dn lh. ConlEcloF Lioc Li* fo, llE fouoehg @bn (Se.'oll.t
<br />Bosincss lnd Pmfcasion Cd.): Any Cny or Co!.ry {hth rioirs , lpmt ro onsft.( dr6, impmv.. d.mlisn or eFn any.
<br />sEu.ur. r/ior to iri L$wc. il(o nquircs rlE ipplicer for $.h FmI rc fib a sigEd $atcmd lh,l hl m slE n [enscd pN&n
<br />ro rh. pmvisions of th. Co Ecrols Lkensd Llw (Ctapr.r 9. ConmrinS wnh Sdrhn Il00 ot Division 3 of E Busims rnd
<br />PDfcsrionr Codc) or rhlr lr or ihc i. crcnp $.rcton an<l lhc tEsh fo, rhe alLg.d .rcoptio.. Any vioblion ofse.lioi 7031 .5 by any
<br />rtplic&l for. Fmil slbjeB lh. alpliclnr to. civil Fnlhyofml mrc lhln 6t hlndrcd doll&s (S5m).
<br />a
<br />-1.
<br />&\ owr nf rhe tmltny, or my cnDlorG. sirh wagcs as lhcn eb conF$rrioo. wi! do 0E wck ud tlE dBt@ ii hl
<br />i.rcid.d o. ofIcEi fd eh (Se.7Bl4. Busircss md Profc$ioE Cod.: Th. Cona.cbls Liatrs Li* dcs nol q,ply lo m owm, of
<br />lh. pmFny wtb huikls o, inpmrB lh.En. .nd who d..s wh wrl hihscllor lrcelf or lhmuSn his or hd own cnlt)lo,tcr.
<br />provided rhrl s!.h im0hrmnr. @ m inlcdlcd or or@ for sh, lt tDwcEr, rh. btrilding or irpmw@ is $U wirhin orc Fa
<br />ot coottcrbc rhc ol,M AuM., wiu l8w t E htr Ln 6f lotins Ost lr or da dit mr bdld o. i,rp@w 0E Fopdry for dE porpo$ oa
<br />-I.
<br />N ovncr of th. prur.ny. {m crclusiv.ly conrm.rinE wirh li4nsn onlmcroF lo construcr rhc prcJcr (S*. 7044. Burimrs
<br />ud hDli\snn Codc: Thc Co.rr&rol3 Lkcnic La* der not appty ro un 6*ncr 6l p6F.y who build. or impmvcs th.mn.
<br />rnd who onrBrsror such pmic.rs sirntr co n ro(s) li.cnsd l)usu.nr rorh.C,nrrcrois Liens kv).
<br />I d .x.nrpr und.r Seri.
<br />lt!8f,8f,S:r0Mfe$ArXlN
<br />PECL/iBAIP!
<br />I hcrcby dfim !nd.r pcn.lry of pcriry .rc ol fi. tollowin8 d(lrnioos:
<br />-l
<br />navc &d will mi.trh ! C.nifMr. of Co.rcnr lo Sclf-lnsuE for eorl6 6ir.nerion, I filvidcd for by Serion 1700 6l fi.
<br />&bor Cod., for thc p.rfolmm of $. qort fc *hich lhe p6nil i, nsucd.
<br />_l har and will dsinrsin *ortc6 compc.sarion inslr!rcc. *r eqlircd by Selion 1700 of fi. Llbor C'odc. for lhc rdfolrr@c of
<br />rhc smt tu *tich tl s lEmir is h{.n My w.rk6i @ftp.nstion ir\!ll@ .aoicr d poliy nomh.r ml
<br />_l ceniti rhil in rhc p.rfo.mtrc of lhc wort fM whhh fik pdmil ir hsucd. I shall nol cnPloy any pc6on in any Met
<br />e ss ro tEsm subicct ro thc *0116 cohpcflslrion laws ofcilifomia. md lBdc rhlr ia I should b..om subiFt lo llr
<br />trol*sl comlEnsrion lmvisions of Scrlion ]700 of rte L3t r Codq I .lEll fonhwith 6oply wnh Oos povisiof,s..
<br />WARNING: Failorc ro su6 worllns smDcn\0rhn $vcngc ir unhwtuL 0nd shall sutjccl an cmlloy€r ro siminal F&xix dd
<br />civil lincs xp ro otu hundrcd rhou$nd doumq ($lm.ffx)). i. addirion ro thc con olcomtcnsllion. .lams.s as lroridcd for th.
<br />\\4 +
<br />I hcEby alitrd rdcr pcNlry of pcrnry fid I rn Ueied ufttd Fovision .f Cbaprf 9 (@@i.a wilh Sc.lbn 71100) of Division l
<br />ol lh. Eu.imss and Pmfc$ions Codc, .rd my liccns h in 6ill foN ud e,Icl.
<br />1 ,!l
<br />I hrruby rflnn,uid.r IxMlr, ott)crjrry rhnr rhfc i\ r.o {d(ioi lr di'rg recNy lor lhc Nrlonuncc olrhc Bork nn thi(6 rhi\ Ifnnir i\
<br />i\{ucd1Scc.ll)9?, Civ. ( )
<br />AP]LICAXI-DECIdBA:IION
<br />I Hry afm unds pcmlly of F+ry otu ol rhc followifls dGhralionsl
<br />Dcmolilioo Pfmils-Ash.slos Norific.tiotr Fcdcrol R.rul.lions (Tillc40, Pan6)
<br />-Rcqut
<br />dt llcrof Notifrdnnr
<br />I .cn ify rhdr rh. rcd.i,l 68nlriio.s mBtrding 0sh.sros rcnDvrl ff. nor amlicrblc to I his l)roJccl.
<br />I ccrliay rh0r Ih cE0drhisnlpticationnrd(otclh dc abor informdion h codccr I lsic ro c!,npl, wirh all Cny atrd County
<br />odin0Rcsa.d sl,l. tjws rhlitrS ro l,u ilditrg consldclion. !d hcrcby lnorizf, rcprcscnrarilcs olrht Ciry dd Cou
<br />ati,r. n{nri{,rd pFpcdy atr
<br />,\ppli$nt or ,\A.nl SiAnul,'-[?-r.- o-r.-Js\,o,,,,r ?.-z I
<br />TOP OUT
<br />Tub/Shower Test
<br />')
<br />Nun$cr
<br />-
<br />\ls
<br />----=
|