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DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under Iloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Vl&lter Piping <br />Gas Piping <br />Rool Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />It/ain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Water Service <br />Lawn S prinkler <br />Sanitary Sewer/Cap <br />Rough Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL q-204D.4fl2D <br />Notqs, Reparks, Etc. <br />?,oe <br />I <br />u U)c^'In 45 lta-7-b f lpro <br />olvNEIi BUII-DIiR DDLCARAAION <br />I hcrchy rrilnn uM$ t. hy .r Frjrry ihrr I rn c{cnrpi tn)nr rhc An rrcloN Lhnsc lj* fitr th. iollowiflB rc!$n (scc.70ll.5 <br />Busincr{ ml Prot$bn C.Jc) Atry Cny or C.u ry $nich rcquircs a Fnni' b consrD.r- allcr, nnprolc. d.nDlhh or rclaiE my <br />(tucrnrr, pr& ro il\ h{!rncc. rlro rcquircsrhc {IlicaDr lttr $ch,ri,nir h lilcr siSncd N{ctrrnr rhrrh.or dr is li.cr$d l)tr\uunr <br />ro thc pruisbn\ ol rtr Conhdois Liccnscd hw lchspr.! 9. C.mtuncin-! wirh S.crion ?rx)O or l)ili\ion I of rhc Bu\inc$ r.d <br />PnlcsioN Codc ) or rhrt hcor sh. i\crcmpr rh.(rronald rhc hrsi\ rq rhcJlclcdcicrprirr, Any!hlaliin'ols.cri(nr TOll5 hynny <br />lrplie li'rr ncmn lubj(h rhc rppli.rtrr k, r.irilpcnrlryofnor nntrc rhln liv. huntli.d dol!!r( ( S5m). I <br />-1. <br />!s owmr of th. pmlEny, or my cntloF{. eirh w.sei ai rhen sk ompcnrlridn. will do rtE qdt !n rhc sntr@ h mr <br />i c!'.Ld or ollced for slc iS6.7Ol4. Blsincs ud Ptofcsrionr Codc Th. Conrn rols Liccn$ Llw drEs nor spply ro an owftr oi <br />Itc pmrEny wlF hild. tr inpmEs tENn. lrd who dG sh wl{ himcll or h.Mlf or rhDuah his tr hr own.mrloyds. <br />pmvid.d rhal $ch irpoEftnt m mr i.ldld€d 6r6fictr! for $h. lf. hoscEr. tlE lrildm8 or iryx@tun h eU sithin o( tr& <br />oaonrPlrhn. rn Opmr Blilds will hlvc lh. ludcn o( poving lnd h. ar shc did mi tuiLi or inprtrrc lrE p@tsiy lor lh. lurpos of <br />L.sowncr.trhcpmpeny.amcrclusivelycontracringvilhlic.n€dco racton lo onslrucl llE ,,or(r (Scc. 70,14. BB'ms <br />and trofssirn Cod.: Th. co.'Ecroai Liccnsc liw docs n6r.tply ro anowocr ofpbp.ny who buildi or ihpovcs rhcr.on. <br />"nd qho @ turs for s!.h rbi{ls,nh a Conhclorlo licen*d Fu6uanr ro rhc Conrrlcrols Li.ens L.*). <br />l. tckntpr undcr Scdn,B & PC. forlhis reson. <br />IO8f,EIS:IOUTT,ASAIION <br />DECI.AIAIION <br />I h.r.by amrftund.r Fnalr, ofFrJury nnc olrhe followitrs delmrioDs: <br />IJt{tr Cotl..lnrihc |{nnr,roN,: olrh. \ork ruhr.hrlt,lcnnn Ni\{rd <br />I havc and will moinrdin woikeB c.nrcnsarion inruraicc. !s rcqln.n by Sarion.]700 olrhc L.bor Codc, for th€ pcrfortumc of <br />lhc work for which rhis ponir ii isud. Myworkds omDcnerion inslmnce clEtl rd nolicy nudhcr e: <br />PolEvNunb.rJrDiEs <br />-l <br />ccnily lh0l io llE Frfo.mmc oflh. work for which rhis F.mir is irsucd. I shrl .or c.plo, lo xMn in rny o.nflte os b lEcom slt er lo $c snLer' otrW.surion h*s of Califohh, ond .Ercc rhlr if I should b..om subjccr ro tlE <br />sollns srtnrr ioo povisioB of SNrion 3700 or rhc L.bor C.dc. I stull, fontwirt omply qnh tlb$ pmvisions . <br />WARNINC lirilu( n, \dcuru trorlcF ion ovm8c is unlavful. and sMll suhjcl en mtloltr to ainiml lrcMits and <br />civil 6nes uI, lo onc hlndrd rhousand dolles loo,Om), itr lddilioo lo lne cosl ot.oml'c.stion, dlmBcs .s ,rovidcd for lhc <br />S.cri6n 11076 ofrh.lrhn Cdlt inrcrcd <br />I l( l:NsIaI) c()i\ rR,lclota <br />UE(II.BJIIQT <br />I hcEb, alfirm udo p.mxy of pcriury und6 Fovisaon of ChaDro 9 (onancinA wirh Sdhn 7000) of Division l <br />or rhc ABincsi rnd Pmrc$t,ns Cod., o nryliccn{ is in tullntrrc md clfs! <br />c36 ?7t vj 1 <br />-ty <br />I hcEby amhr und$ FMlly ol p.rjury lhar Ls r conao.li,. bodi.-! rgcfty ror rh. |xrro|IM.c of rh. eor* for shi.h rhh Fmir i! <br />hsucd (sd.109?, civ c ) <br />AITLICANLDEII.ABAIION <br />I hcrct'y !frim undn pctrolry orFcrrryoR ofrhc followih! dftlddrn,n\: <br />Dcnblirn,n Prmirr Aih.{os Norafi.nrio. FcdcrrlRcluhrions (Tirlc 40. P!n6) <br />Rstuird kncr otNori'narion <br />I .cdify Od rhr fcdcrul rcguhrn'n\ ftS,.dios {rbci$ rcnurlil sc nol upplic.blc to rhh prcj.cl <br />PLUMBING-INSPECTOR RECORD <br />APPHOVALS <br />Gas Service <br />Back Flow Device <br />-0q nl <br />""",M:,4 l)'(r <br />'6-t> <br />rid Counryt) cird r[)n rhc <br />7- />-l12