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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNER BUILDTtr DELCANATON <br />I hcEby.ftum undcr pcmlry of p.rjury rhar I m crcmpr fohln Conrlclo6 Lken* Ll* fo, rhe lollowing qsn (S(.7o11., <br />Burituss lrl Prof.srio, Codc): An, Cily or Cdnry ehth rloiti a Fmi ro otrnflEl, allci imp6!( &mlish or E En uy <br />sreuE lnio. ro ir! L$w..,ho Equircs lh rppltdr for such Fmir ro 6L a si8r.d starcm rnar h. or rh. ir lie8cd twrlll <br />ro rhc povtions oa th€ Conx&rd s Lkcoed Llw (Chapter 9. CoomctuinS wlh S.clion 7000 of DivisioD 3 ofthc Busine$ 8nd <br />Prcl.*iois Codc) or 0'.r hc or slE i! .rcmd dc.c6on ud rrE bo.is for rtu .lL8ed crcnprion An, liol.rion of S(lbn 7011.5 by a.y <br />opplicart for . Fmil subt{ls rlE applic. ro ! civil pcNhy of NI mrc rh.n fivc hu.dEd dollm (55001. <br />l, tr\ osnrr or rhc l,n,,tny. or nrr c rfk,ycc\ sirh wrgc\ r\ rlrninc.o lEn\rri(nr, willdo rtE sork ffilrhc slmrurci\ tror <br />ncndcd orollarrd nr*ft(SL{ 7Ul-{. Bu\inc$ r Prolt$i rsCdc Ihc(-ofrracu \ l-iccnr L's doc! nor rprlyh d.*ncrof <br />rhc propcdy qh. $!inh or i$pnN\ rhcron onl sho d{rs sh sorl hims.llor hcrrlror rhmu8h hn or hcr osn cmnloycc{. <br />L nsowrcrof$c lroFny, trncrclusivclyconkrcrinS wnh [cn*d contmcloB roconxrer rhc r'oj.cr {56,7O{:1, Blsmcs <br />Md PtDf6sion Codc: The Co.rBcrol\ Liccns. Law docs nor applyro &6sner oltror.rry who builds or inplows lher@n. <br />on'l who onrE ls a.r such !rcr.|s wirn a ConlEcro(s) licn$d pu^lur to rhc Conrd.rol. Li.crs t!w). <br />-ld.kmrr <br />!.dr Serion- B. & P.c. forlhh rcen. <br />D.l.:- <br />lIIBf,Ef,5:.cOMTEIAIl(A <br />DECI/IBAUAN <br />I hcrcby a6irh lndcr D€nalry of psjuy onc olrhc aollo{ing del{arionsl <br />-l <br />h.rc unqill minrain o Ccnifr cofcons ro Sclll.suc for aort6 oepcnelion. a\ Fovid.d for 6y S*tion l7m ofthc <br />Libor Codc. for lhc Frfolfue of llE hrt for *hich lhe lsnil is ised. <br />tuc, tor !h. pc ommc of <br />l.difyrhd in rh. p.rfonMmc.l lnc work for which lhk pcrnril is hsucd, I snoll"or ctrploy any n *nn i. any or!.ncr <br />s us ro becoft subjd ro rhc sorieB .omp.n\arion laas otcllifomia. i.d +rcc rhll irl should tEom subiEl lo Ihc <br />wortss comFnern,n Frvi\t.r orSdcrion lT0oorihc tihr Gdc,I shtrll r(mhwith conrrly wilh lhos lovhionr.. <br />WARNINC: ljnilurc b scuE *orkd6 co'npcnsrn .olcrasc t ril,wlul. rnd <br />rhotrsrnrl doua {Sl(x).(xD). i. nddirion ro <br />hr@{ orxl atomy\ fes <br />o <br />I hcrcbt aifirnr und.r lcn.lryofpcrjurylhll I am lienEn undcr ChJpr.r 9 (commncnr8 airh Sccrir'n TmorolDiv,\ion l <br />ol ihc Bu\nr!\nnd Pn,fc\\n,ns C.dc, md nry h.c \c is h ltlll,trci <br />C O ?a <br />/r'**" <br />I hcEb, linrn und., lrNhyolFrjury lhnl thN n a consrflcri'n <br />hslcn {se. 3097. civ. c.) <br />!8cncy for lhc pcrfomne ollhe work r.r vhi.h this Fnrn s <br />dIILII;AITD&CI,ABAIrcN <br />I rtrby nltm hdcr pcnnhyorpcrjuryonc.llhr lollowin8 dccl,rarions: <br />Dcmnirion Pcrmirs-Asticsros Norificurn,n F.{cral RcStrhrn,nr ('t irlc 40, Pda, <br />-Reqrtcd <br />l4rrcr ot NoriaKzrio! <br />-l <br />ccnif, rnar th. fcdcEl rc8llalions rcgoding &rl$ros rcmvd m nol 3prliclble ro rhl\ pEirl <br />-l <br />cc.riiyrhrr I have rc rfihoppltain,n <br />ordinurccs lnd Shlc ljws Bbriry ro bxildi <br />rhc slbrc infor@raoi i! coofti. I aBN I <br />or mDtiomd prcpeny for <br />Appli$nt o. Ag.nr sigmlo <br />a_J.- <br />o omply Birh all Cil' lnd Cnrnly <br />ths C y ord Cou!.y lo cnlcrtDon rh. <br />^,"a/b/ts <br />I <br />Waste & Vent /26fi6 9.zl' <br />Water-Under floor 7 <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent 7 <br />Water Piping ) <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Test <br />Rough 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 />Gas Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />FINAL W//tll>/Y1 tin-/ tNotes, Remarks, Etc.'u (\J <br />V <br />ID/SIG. <br />UNDEB GHOUND <br />POOL/SPA <br />Water Service <br />Meter Release <br />wP <br />qhkh rhnFmir is isucd.i,surmc trir atid lolty nun$.r a: <br />Lxndcis AddB.: <br />- <br />I <br />= <br />=