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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Waste & Vent \Lou
<br />Water-Under f loor l"l)\Lv >0'' (4i)
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq L-5- ro Jlls'k -.-\??)
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOLiSPA
<br />P{raplDrain Line
<br />Main Drain/Pool Pipinq
<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 Plumbinq
<br />Meter Release
<br />FINAL t t-l c--/g J),la Dr€4
<br />Notes, Remarks, Etc
<br />Oll,lTEF DUILDER DELCANATION
<br />I h.rcby affi.m uid$ ,xrslli ol p6!ry lhat t m.,.npl lmm ihc Conlrtou LicN L3v for rhc followii! rcdr (Sa.7oll.5
<br />Busines i.d Profc$t n Code)r Aiy Cny or County *hi.n fquircs a IEmn ro onsner. .ltB. iqmv.. dcn lbh or Epan e,
<br />suucturc, ,,ior lo ns issulm. aL. rcquiB llE ,ppli6r tor such ,Emir lo filc ! siSncd sllcmnt thal tE or rlE ii lianscn tuNsl
<br />ro U. pmvisions of dr Codr6crois Lienscn Liw (Chlptcr 9. Conmrcing snh S€rion 7000 of Division I of th. Busine$ .nd .
<br />Pofcssion, Codc) or rhlr lE o slE k cxempr theE&omdd rhr bsi-s fo. lhc alhg.i cx.mlrion. Aiyviollli.nofSccliorT03l.5brany
<br />lppli. l for r lEmir {biek th. aptli.mi lo , civil Fmlry of mt nEE lha. 6v. hlndrcd dollas ($5m).
<br />_1, as osrcr of rhc Foltny. o, By cnlplolEs {irh pig.i &s rhcn sb .oopctr{rion. *iI do ilE edt .rd tlE slrBle b mr
<br />intco&d or offeEd fd eL (Se.?04!. Busic$ ed Profcsio,s Codq Tnc CodEloar Lien* tiw ikEs nor qEly lo on owmr of
<br />iE poFr,y *ho btr'ld.i or i,pr.s trE6( .rd wh d6 sh w* hin$lf or lEelf or lherdt ti! or hr oM cDploy.*.
<br />,rcridcd rtar suc[ inprcEmds e hr int nd.d u ofiftrl for slc, lf. nosfti tlE t{itdii4 or in$mrmd is sld si{tin om Jat
<br />ot@np&liotr 0r OwM BoatL, will hlE llE bod6 otpoving th.r he o. ilE dil mr tdild or inp.oE thc A!,Ely t , $c Frpos ol
<br />l. a\ o*no ollhc |,6Fny. m crclusiwly contra.tinS wilh li.cnsd .ontmron lo oisldct ll'c roj.lt (Sd. ?OU, Busims
<br />{d ttrfNim Codc: Thc Conrrkror's Liccnsc Luw docs mr ryply ro e os.( oftoljcny *ho blildi or imtowr lherm,.
<br />and who.onrtursnrsuchnej(lswnhrContnto(glicen*dpuBumrolh.Co.lraclr'sLiccnsL,N).
<br />_l rm excnfl under S*r
<br />UABSEEa..CAIITBIAIIITN
<br />DECI.AIAIION
<br />I h.Ehy afatrn uld$ D.Mlly of D.riury om of th. followinr .lc.ldlhns:
<br />-l
<br />hrvc ard will minrain e CenifEarc oacotrsnr to Scl murc for rork6'coml'cni8lion. N nmvided for bySccrio.l7mofthc
<br />tih6r Codc for fie p*fdmnc. ol rlE wort for Bhi.n lh. ncmir h ir.ucd.
<br />I havc and qill tuinhin *orkcrs co'rFns,rn,. insun.c.. $ rcquncd by Setion :1700 of lhc t bor Codc, for rh. pdforuru ot
<br />rhc Rtrk tbr whhh rhis rcrnil is issu.d. My workdJ coq,.ndio. insurlncc caEicr ard plicy nlmbcr m:
<br />-l.cnify
<br />lh0r in rhc Derlo.n4c of th. *orL for whi.h rhi. F.ni is issNd.I snall nol employony peMn in lny mMnd
<br />so trs lo bcmm su6)d to lhr NorkcR'omFnsalion laws of Califomia. ud ued lhd ir I rhould b..onE slbFr lo rrE
<br />worid onp.nsalhn pmvkio,s ol Sdion lT0o ol fi( tibor Coac. l shull. fonh*nh onlny wnh $o$ Imvisio.s..
<br />WARNING: Faihrc b $.utu uorkcN cotrlF-nsdiur colcnlc tr unlrqful, rtrd bir' .f, cq,lorrr to sinJnll Ftulrics !.d
<br />civil li.c\ up t, onc hundr.d rlk)u$nd dolllrl lfi),ouD, n rdrl irr)rhc ion. drm8* I providcd for rh.
<br />S..rn'n -1076 of rh. tntr)r Colc. inrcrci
<br />rl rhr Btr\i'ir*rntll,ror.\\irtrtr(irl.. d rr" lc.n.. tr n tulltur( r (l.l1r.r
<br />I h.Eb, amrn undcr lEmlly of p.rjury lhll ttFrc is a
<br />hsucd (Scc, 1097- Civ. C.).
<br />fl.rion lc.dirB rScmy for lhc FrformrNc oa rhc work for which 6ii Fml i\
<br />APILICANTDICIAMTI}N
<br />I hfth, aiim lndcr p.nalry of pc,jury om of ttE lollo*ing &chnlionsl
<br />Dcmlirior Pdmits-tubcsros Nori,l.dion Fcndat Rc8uhions (Tirlc 40, Pan6)
<br />-Rcquircd
<br />Lcllcr of Notifi olion
<br />-l
<br />ccnitr rhar rhc f€dcral r.gularbor rc$rding x\bcslor rctu)val !,c oor appli.nhlc
<br />'o
<br />nris tmjer.
<br />I I hrkr. rhis {pl'.dn aid {rr.rhro i'rktrmrrnnr N.odrcr I aE e lo comlly wnh lllCilyand Counly
<br />srrro lr$\rLri'r3 k) htrj[lnt aulrtrin r.prcs.ntu'ivci.rlhis Cny rnd Counlyto cnlcr ul:on ltr
<br />^,, S)7'(9
<br />I
<br />UNDER GROUND
<br />l -[.n- '
<br />TOP OUT
<br />Fill Line/Back Flow
<br />Final Gas Test
<br />l)irr o$Nr
<br />W-.,
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