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PLUMBING-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BUILI}I]R DELCARATION
<br />I hcrchy llltm undcr pcnrlry ol pcdury lh l u, cxcmpl from thc Conh.r. Li.cnsc Liw lnr rhc rbllowios r.rsoi (scc 70.11 5
<br />Bu\in.\\ rtrd Prunsi,rn Codc): A y Cny oi Counr! whi.h r.qutrcs a pcrn to consrruct. olrcr. imJrmvc. dcnoli\h 'tr rrf,'ir Jny
<br />{fl.rur.. nrior'o irs h\urcc. rho rcquncs rh.oDplic l lor ru.i pcrmir ro filc r \isnM { .mnr Ihr! r*or shc is liccn{d pu^urnl
<br />Ir rnc Frvnion\ of rlt Contrcktr s Li.cnsd Law (Chaprcr 9, Connnctuins wirh Scclion 700(r tDilhn,n.l.flhc llnsirc$..d
<br />Pior.sn,n\ C.dd) or rhr h. or !l[ is cx.n{'r rhcalror and rhc blsis tu rhc llL8lyt cxcnpiion Anyvid,ri,,nolSc.tion 7011.5 hy any
<br />!fl'li.rN tur r Fnnir .uhicch rhc iprlicant lo a.ivilpctrllryoiror mor.rhan nrc huidaddolkus (S5m).
<br />-1.
<br />rs .w.o or rh. ,rol.ny. (tr my emtlorcs wnh wrgcs .s rhcn bb compcnsrn,n. vill do rhc work 4d rh( inf,lurc is nn
<br />in.ndcd .r on.rcd ,.r Rlc (S(.7(l4,r. 8lrircss lnd |\olcsi.ns Cods Thc Conrrcktr s Li..nt Laq doct ool npply k' owmt nf
<br />rhc pR,txny whr builds or itryro!.s rtuNn. dnd who dtr\ $ch Bolk hnnscll o. hcrcll or rnrourh his or hcr ow c.[hy.cs,
<br />[orid.( r har su.i irrp(,rctrrtrk dc frn idcndcd or oflcrcd fttr *J. lt tuwcvci rlr t{ik|in8 or irlpDrcnror is $ld sirhin onc yca
<br />or.onllrLrirn rhc osrcr auiu.rwillh0rcll..budctroitmrins lhal nco,shc did.or t iU or i'npntrc $c pnrrdy for th( puqnc of
<br />-1.
<br />a\ ovncr o, rhc pmpcdy. d crclurirly .onra.rinS wirh li.cnsd .ontrdos ro onslrucl lhc pDJEI (56 7Or4, 8u\ift{s
<br />ad P,oi.sb. Codcr Th. Conlrscrols Lianrc Lrw dc mr lrDly ro d owncr ofDhr.ny who builds or imrmrcs thcr.on,
<br />and sho cor rers for luch pDitrs wnh d C6nhcro(\) lk.nsd tuBu lo lh. ContEclm\ Liansc Las).
<br />I mcrcmDr un,lcr SNrion .8.&PC nr rh\ '.r\on
<br />$ra$!$LcoMtExsArloN
<br />DEIIdBAII(A
<br />I lEEbysftrnund( pcdlryof F juryomof t€ tollosing dc.hr.lioml
<br />-l
<br />h.w !d vill mirlrin a Ccniferc of CiN ro Sdf.ltum to. srt6' @npcns{rion. s Fldd.d for by S.dbn 3700 of tlE
<br />t bc C.dc. lor 0E F.fo.ttmc of lhc *ort aor *l'th thc Fmil b istucd.
<br />-l
<br />hrvc sod sill mintli. s6rkc^ co,ipcnrari6n i.luancc, os Equircd by Scclion l?0o ot lh. kio. Cod.. l6t rhc Fdolrmc of
<br />My vo.ts onp..srio. i.smm cutr &d poliy nuob.r dc
<br />-l
<br />ccnafy rhar in rhc l*rf.nunc offi. worl for whkh rhk pcrmil k isslc.L I shrll.or cnplo, a., Fron in any nErcr
<br />s N ro tE om subrcrl lo rh. wfim @nrEnsdi.n lawi of C.lilomia. and a8rcc lh.l if I druld hrom sobjEr ro rtE
<br />wrt.tr .onrlEnsaln n pmrnions of S€rlion 1700 of lhc bt{r Gdc. I rlEll fonhwith 6mply w n lhos lmyisionr..
<br />WARNING: ltiluE ro *e *orkc^ otrqEnsdion .ovcdgc is ulrwtul. {nd shlll sbFl atr cnltrlorr lo dimi.al Flulra $d
<br />civil fincs up lo om hundrcd lhousnd doUaB (51 addirh. ro rh. cosr of compcnsrion. d.rBs.s ai lmvdcd 161 0E
<br />t)t,( I \lr \ llr )\
<br />I hcEby afrrm ud.r ,crrlry or p..jory tM I d [sNd tdd FlvLhi or Cr!8i 9 (@t!EGiD8 with Serbn 7000) of Divtion ]
<br />of rhc Brsiftsi .rd Ptutcsiom tu . ald oy lic.o* is i. tuU fo@ .,n cfiel.
<br />5
<br />r:(rNs tRlt('fl ()N l-t:NI,N(i ,\(iut\c\'
<br />I hcrchy rllrrn uid.r l*h,hlolpciury rh.l rhcrc is r coflsrru.rion hndins lscnct ttr rhc Frr.rturt olrhc work i'r snich rnis p.nni n
<br />hsucdls$ l{)97.civ c )
<br />AIELICANL!&CIAMIIO!
<br />Itmhy rninnulldcr I,cnuh y of pcrjlr, ond ofrhe r.lhwing d.clddnrns:
<br />Dctrrlirio. Pcrmils.Ashcsros Nolificariotr ltdcralRcBrlarions (Tirl.40, Pdn6)
<br />-Rcquncd
<br />btrcrof Noli,icdFn
<br />ogardine asbcalos .c,mral aE rml appliclblc lo rhh thj..r
<br />inform{tionncon(l. Ilsrc16..nrly{nhtrllCily0,Counl,
<br />uhvc Nnli,)ncd Dropcny fot tAnplic. orAre Sisno(u -'f,lt[
<br />UNDEB GROUND
<br />Waste & Vent 6/zt/r[ -Wvr)
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh 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 />Waler Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release .,G I
<br />FINAL {/r;2/,'f, .*ft',()
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Fill LineiBack Flow
<br />OrnB
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