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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under Iloor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />Waste & Vent \tQ . c-$s / <br />Water Pipinq '1-lt't0"fi01 <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Bough Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL 6-ls'tb .-Aa*}-to '9 <br />Notes, Remarks , Etc. <br />OWNEIR BUILDER DELCARATION <br />I hcrby anird lndcr FMlry of pc4ury rhr I d cxempr 6om rlE ConhcIoB Ltcne Law for rnc folh*i.g @en (S.t?011.5 <br />Businc$ dl Protcsri.n Codc): Any Ciry oi Co!.ry which rcquies a Frnir lo con$ocl, a[6. inprcve. rhrc,ish or Ep.ir ey <br />slruduE prior ro ils issurm.. d$ r.qut*lh. aldtd lor suct Fmit io 6L ! si8md sl.lcmnl lhrl tf, or sh. is lk.ncd plmalll <br />m fic prcvhions offt. Conu&rols Liccnscd Lrw (Chlprd 9, Conmming *i6 Secion 70m 6f Divisioo I oflh. Busir.s ed <br />Pof.ssionr Codc) or rh{ lE or slE is erc"lpt ll*r.tomod ltc bdsis for llE rllc8cn excfrllioD. Any violrtio.ofSelbn ?031.5 by sny <br />aprlicanl for o n ndl subJ.rls lhc lpDlkant b e civil !.mlty of not mE lhu fivc hund(d dolles ($5m). <br />I. $ owncr ol rh. lx)tcn). o! nrr cnUlorrs wirh qnScs Ds rh.ir vnconl0.tr\rrion. silldo lhc trork nd lnc\lBlm is En <br />irrc cd or ofltBl ror slc ( Sa 7Iu. Bu\inc\{ ord [,lott(io.s Codc -l'ic Conh.roa s l-iccn* ljw docs nor amly t, ,tr osn r ol <br />rlr fm|rty wh) builds or irroR)vcs th!a'n..nd *lx, de\ {rh w'lk hnn\ellor hcrsellor rhmugn hi\ or hcr own c'npk,yccl. <br />prcviJ.drlri su(h i'nprr!'m m ftn i.tnd .r onbrud for $k ll. howclrr. rh( t{ikiin! .r in mvcmd h arld wilhitr orc frxr <br />ofconrtncrhn. rh. O*n r Buildcrwillh.vc EhurdctrolrrcvinBrhdh,or\hcdid!dhildoriNprovcrhcpmlcn,rorrhcpurrnEol <br />-1, <br />s o*M of rlE !op.ny. .m cxc,uiav.l, co.n&rin* airh licosd .onl.ero6 b o.crud tlr p,ljd (Se. ?O44. ABim*r <br />ad hdc$b. Cod.: The Contrmroa s LiccNc lj* do.s nor spply ro u o*n.r of prop.ny aho buildi or inporc. $ercon. <br />ed qho @ n ls fo. su.h prcila wilh a Contndo(s) lixtr$d pursua lo thc Codndtr'r Liens bw} <br />-l <br />lmci.npr tndd Saion- B. & P.C. forrhk Eeson. <br />]TOAAEBS:IIJMEEIIA.IION <br />IECI,AMIXTN <br />I heEby affrm und.r p.nalry otne.jury om of rh. followins dehdriom: <br />Irtitr(ixi.. rd rfu plr,oflun.colrhc $orl ntr Nhich rhc rnnii i\ i\\u.d <br />,l hi$ 0nd will minlain worl.N' co,penslion insnmc, B Equir.d by Selion 3700 of lh. Ldbr C.<lt. flr Uc p..Io.rl@c ol <br />lhc wolt lor wnkh fiir Dcmil is i.${d. My *o c @mplnsalion inruluc cyicr sd Iblicy nlmbcr G: <br />-l <br />cenify rh in th. pdformrcc of fic qork tor sta.h rhh n rmn i! i$ucd. I shall not cnploy .ny ptEo, in a.y ,Mns <br />$ is ro b.or subF lo lhc srts omlEn$lion hws of C.lifomix. r.d {gN that if I sholld bccom $biBl lo tlt <br />wo.t$ orlxn$ri.n prcvl\iois ol Srlion 3r0o or rh. kbor @c. l dull. fonhwirh comply vith rno$ pmvisions.. <br />IVARNINC: Failum lo scurc Rortcrs conpcnslion covcmec is unlawtul. lnd shrll subj€d an cnploy., ro qininul pc'ukrs &d <br />civil fifts u! <br />'o <br />oE hundrcd ll$usrnd doll&s ()(l,ofi]), in Mdiii,n b rhc co\r ofcomlxnerion. da.EE$ aq lmrid.d fur rh. <br />Sc.rio. 10?6of rhc lii-rCo<lc inr.nd <br />L nvb"**,.. b-)x-l{L <br />I hcruhvrrlirmu .rJ^- rlrt.rt{lurrrhrr I li(nwl undcr |,ro\ (t,n ol Clqiid 9 (dDtxtc rtr ! [h SLrtlr 7(xx rr oi l )n ni{m .r <br />ol' (h.llu!iN\\n l'(n.$nnnCoJc. M.i uvli.ctr{ is ir tnllln.cc rid.lfucr <br />B t\t ty7 <br />r//,- <br />I hcr.by rllimu .r nlnrlr!of pcrj!ryrhrr rh.'ri\ 3.on{ <br />i\srd(S.. :r(,7,( iv. C.) <br />i6n hndins aecn y f.r lh. pcrrorlMc. of ll* work tor $hkh lhh lrmil is <br />APPLI{;INTDETJI.AXAIIO! <br />I tf,rhy a0in, unds pcnrlry ol p.rjury onc ofrhe followins dccluuln'nsr <br />Dcablirion Pcimik Asbcstos Norificalion Fcdcrul Rcr!larions (Tirlc40. P!n6) <br />_Req! ncd I.r rcr.a Noriardrio. <br />Egtrldions mg..di.g Nb.sros 6fr,!!l d. nor q,plic lc to rhis pmtd <br />rcld rhh erplicarion rd srarc rhor rtc ftovc i.fonndirn n cotrsr.I dsB roco6pl, wirhall Ciryrnd count, <br />L.rs rcldtins ro buiklir8 connrcrion. ut hcr.byaulfiori^ Ep*senrarilcs oarhh Cn, und Cou.ryro.nrr uF)n rtr <br />b-s-/t <br />I <br />TOP OUT <br />Fill Line/Back Flow <br />D.l.- Om.i_ <br />_1_ <br />Lendd\ AddEs: <br />- <br />/w:/.* <br />=-------T------