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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Waste & Vent z 1 I LlQh,r r\r,U
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent (4\)
<br />warer Pipins I*r)
<br />Gas Pipino
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release /,\
<br />FINAL 1-11 ),W!0
<br />Notes, Remarks, Etc \J
<br />(69 fr('t-ar'tra& a^L -,\ol ,o J " hr+{U Pr'lth.
<br />U
<br />OWNER BUILDER DELCARATION
<br />I h.eby afarn udcr Fnahy of Fdsy rhar I m.reqr 6om rlc Contrerou Liens t w for tlE touoeins Er$n (S.c.?011.5
<br />Blsi.cs and Protcsrion Code)r Any Ciry or County whi.h Equirc. r Fmn ro snctrl. allci inq,mE. &tuli.\h or Epst d,
<br />(tuctw. prior ro its isffiq sls Equircr rlE apl,lilnr aor sch Fmn ro fiL a sagncd rd.m ihri lE or slE i lic.sd puN.nl
<br />ro rls Imvisions of ttE C.ntrerols LiNn*d L.* (Ch!I)rs 9. Collmrcirg *irh Ssrion 7000 of Dirision I ot rlr Businc$ dd
<br />Pmfcssions Codc) or rhlr lEorstE ir€rcq,r rhcEfion! th.hlsn for rlE allc8ld.r.i'rrio.. Any riolarhn ot Serhn 7011.5 by ary
<br />llllica.t for a p.mr subjers rtc aprlicrfi ro ! civil Fmlryof tut tue fi.n nr hun.rcd dolla ($500).
<br />-l.r\.$ncrollhc|no|Eny,(rnrycDDloyc.s*ir[*i!c\!srhcns'b.oDrpcn\rri,)n.Nilldorh.warkridrhcdddutonturic,xt(t or.fiar.dhr$lc(SL\.70,1.l.BtrstrcssdndP(,tusnnNCd.'lhc(inffu.nr'sl-ic.n\cLtrwrlocstror{!lyro oqncrut
<br />thcpmnlny Nho builds or npn,vcs rhcron. r whodocssuchNolthi'nscllorncr\clrrrrhfl,u8hhi\orhcrown.mDkDtcs,
<br />Dhvidcd r h{ such nnpolcnrms rm n r i, cndcd or otTcNt n, {L. It ho*cv.r. rlr lNiklirl8 or iDprncm is$Llsirhinon.)r,tr
<br />olcoaplurion. rh(O*!cr Auiklcr {illhivc ihcl,unlciol pnniryrl hc or \h. tlil tror huild .r nnproit $c tmFry turrh:Ntrrol
<br />-1.
<br />el os*r of rhc pDrcnr. m cx.lu.iwly conr6rirg with lkcnEd co.rEcloa ro oBirtrd rhc [mj$t (S(. 7044. Bu,iftas
<br />lnd Eof6sim Codc: Th. ConlEclol s Lic.ns L.w dfts mr .pply lo 3n owncr of ,:rcFrly *ho blilds or improv.s rh.r6r
<br />anil {h6 onrels fd such pr6j.rh wnh ! co @ro(s) ltdsd tlIMor ro 0E conrrach . Lt..* k*).
<br />-l
<br />m.r.mpl u!d.. Setbn--. 8, & PC. fo.6n t!e!
<br />ll)f,f,EBglllMfENta.rlQN
<br />DECI,ASAUQN
<br />I hcrcb, affi r und.r r..rnyorlEjuryonc of th. folbwhg dc.leations:
<br />Ihrvcod*illnui ii.rCcniii.nrcolCotrrctrrhSclllNurchrworkorconrFn\dion.i\ prolid.d larhySccrnrn lT{X)ofrhc
<br />hhtr (i .. lnrrhct rfonrB..c.f rh. $o&,nr*hi.hrhc n rnrir i\ is{rd
<br />-l
<br />h,vc lnd will mihr.i. work$s compcNalirn insumncc, as Equircd by Sdlion 3700 of llE Llbor Codc. fot lne prfomft. of
<br />lhc work for whi.h thi, Fmil h ileicd. My vort6 onqENlio. i.suEna ortr arn l,olky numbcr 6cl
<br />J.Tfi],e Pufut)l- l-20l ,1
<br />-l
<br />ccnifrrhrr in lte Frrorroncc of rhc BorI fot wnichlhisperfti n iisucJ,I sh,ll nor .nrllity .ny ,cson in,ny'nunncr
<br />$ a io b.&@ subicd ro rhc wolkc( conpcnsalion liws ol Califtn.in, and ngrcc ln ifI should iccom slbjcct rorlr
<br />woil.rJ conp.nsarbn pmlnioB ol Sc.'n,n 17(x) ol ttu tibor Cod.. I shdl. lonhqilh omply wilh thos prcvnions.
<br />WAnNING: Foilurc lo slrc work .l comrc.salion otnsc is urlnwtul. lnd sh,ll subiri d mploycr ro aimlnrl [EMlrics ond
<br />civil fincs ry ro orc huidrcd rhousnd dolls (Sl00,l)00). in addiraon r. rhc coi otcomrcnelion, dmgcs as providcd fo.lhc
<br />ntrh. btIr cade inr€E{ ind[-2t- ttr
<br />^:n:k-
<br />DECLAAdII(X
<br />I hcrhyr|]nmrndcr pcnnlrt o f Frjory rltu I r licc $dundrrItulnn,n.lChrlr0r9(connmncin8silhSr..rior7(ix)rofDiri\n,n.l
<br />ol lh. Busirc$ itrd holcssi,,n\Cdc, a'kl Dy liccnsc i\ i'r f!11lnRrr rlfu.r
<br />lc3 rr tt/t kccfr.
<br />(;ONSIf,ICUANIi DIN{illiENg
<br />I hcEby amrm under Fnrlry of Frjury rhar rh.rc t a $.ntocrion tndinr ls.ncy ror lh. ldfornucc of lne rork lor shich rhis Fnir n
<br />i\qucd (sd.lo97.civ c ).
<br />ATIIICANI.DICLAtsAII!'B
<br />I h.Eby0fiinnu er r.nnlly olFrri&, onc ofrhc tulkrsjng dc.hElions
<br />Dcnx,lnion Pci,nik-Asb.stos Nolilicrlion lrcdcrulRcxuhlions (rirlc.l0. Prna,
<br />Rcquircd Lncr ol rLrifi rhn
<br />-l
<br />ccnify Inar rh. f.dcr! I rcsllal io.s RErdiry nsh.do\ dmvalirc nor atplictrhk b rhis rrcjccr
<br />-l
<br />ccnify rh,l I hav. ft.d $k ipllicdrhn a,n sd hll fic !bor. infomlion n con8l. I sE d lo on ,ly *nh all Cily tnd Couory
<br />6rd4.,tr6 r.d Srrl. llws rchinS b blilding .o,nMriotr atn hcrt'y audoriu rcFEs.ntalivcs of lhis Cily tud Couly ro .nrd !po. dE
<br />{hovc mnrioNd pslcny aor inrperiotr
<br />Appli(ml or A*.nl SIf mlure:(*s -a
<br />UNDER GROUND
<br />Gas Service
<br />lf
<br />L.dci\ Ad&r$:
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