|
PLUMBING.INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<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 />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Belease
<br />FINAL 38.//.?r)
<br />Notes, Bemarks, Etc.
<br />OWNER BUILDER DELCARAIION
<br />I h.Eby afiirn undcr p.Blry of rErjury rh{ I an cxcnfl fmn rhc ConhdoB' Lt nE Li* for lh. following Erstr (S(.?0ll.l
<br />Busin ss and Pmfcsion Cdc): Any Cily or Counry *hi.h rcqlircs ! Is to onslfucr, rlrcr. iq,rcr. dcmlLrh or qEn u,
<br />srtucr!rc. Fior ro irs i$utuc. alrc rciut s thc lpplt,nr for suh l*mir to filc ! sigrd sllrmfl tur L or 3h. i.! li.c.sd trN.nr
<br />lo lhc provisions olllE Cimmcltrt Li.cn$d Lw (Chaplcr L Com@kin8 wni Scclion ?0m or Division 3 of th. Businoss and
<br />PDfcsio.s Cndc) or lhat hc or shc is cicmpl lhcErrcft.nd lh. bash aor lh. lllc8cd crcnflion. Any viohtn,n ofsc<rion 70:11.5 by any
<br />amli.nrl f6r a Frmi slbiccr( rhc lpplicanr k, a civil F..h, of mr mr rtu fivc hundnd dou&s ($500).
<br />-1.
<br />as o*tur ol rhc popcrry, or m, cmployccs qnh *ascs as rhct solc mqEosari6.. will do dE wk {d
<br />'h.
<br />sltu1uE h ml
<br />inr.^rL\r or ollmd aor €lc (se 7044. BNin s rd Prolessions Cod.: Th. ConrEcrols Licen* tl{ ttr$ hr ,pply io an owmr ol
<br />rhc pmpcd, who t4ilds d irfm6 rhc@,r, $d who dixs skh M,l hims.lror ncrclf or rhmud hn or ller o*n cryloyccs, I
<br />lrovidcd lhar such in{,mEmnls m flor in'cnd.d or ofiftd fm sL. ll h.mycr, ltr hildi,g or inlrowmnl is sE *nhin orc Jau
<br />otcohpLrb( IEOsftr Blitid willhaw rtu bodcnofpmling fi lE or slf, did mr blild or nr{,oE ttc r'oFny f6. dE pu{D$ of
<br />-1.
<br />as owmr ol lh. ,n,Fny. am cxclusircly conlru.tinS wnh tccn*d ontroclm lo cotrsltu t llt prehd (S.c. 7Or4. BusiNr
<br />ond hDbrbn Codc: Thc Contdcroas Licemc Law docs mr.pplylo &n 6wncr ofponcny oho blilds or improw3 th.ron,
<br />.nd Bho onrari lor $ch tmjc.tl *irh ! Conua.t6(0 ltcn*n l)!nu6rr ro ftc Conraclols Usnr L,w).
<br />I ddcxc rfl un cr Sd.rn'
<br />o
<br />III(!2!-BIIAI
<br />I hercby {mdn undcr Fn.Iy or Frjury onc of lhc iollowinS d.clflio.s:
<br />-l
<br />hsw ad will @inreir ! Ccnifidr. of Consnl ro S.lfinsu. f.r worksl smpcnsarion, !s providdj for b, Secrion l7(x) ot thc
<br />tahor Code, fq th. FrfollMa of thc s* r.r which th. pemir ir i.sucd.
<br />_l havc snd will noinrain *orlcs ompcnsrrion imuturc., as rcquiEn b, Sccr ion l?0O of rhc l,bor Crdc, tor th. FrformN of
<br />thc worl for wnth rhn pcmt is isscd My erkcs @mtEnsalion inslmrcc cdic. ,n<t Flb, numb.r e]
<br />PolicvNunhr: Er.ncll
<br />_l ccniry rhat in rh. rt.lor@m olth. wDrk for ehkh lhtu Froi is Lqsucd.I shrll ml.q,loy!fly Frcn in 8ny Mtur
<br />m N ro b..om subj.rr to rnc mrtsc sn{rcnsarion hws of Cllifohb, and s8E rnd if I should t coft rubjEr 16 rrE
<br />mrk K sn{,.Nalio. pmvisions ofsdlion 3?ooofllE khor Codc.l shlll. fonnsilh oq)ly {ilh lhoc ptvisior!..
<br />WARNINC: Failure ro sur. *orkc^' coh!.nsdrbo colcrorr is unlnwfirl. rnd rh.ll subj.rl an cmploycr to aiDinll Fnahit md
<br />cilil fiics up lo om hundfud rlbuvnd doll.rs (Sl(X).fiI)), in rddirtun o rh..on of ion. d!m8.s .s pmvid.d lor ltc
<br />SccriD ll)76ol ihc ljhtr(i .. nnfcn drl M.nry \ I
<br />UIiCIJIAIIQN
<br />I hcrcbynlftnundcr pcnohyol'Frjurylh l .m licctrsJ undcr pn,vision ol Chq,rcr 9 (.onxmming ailh SNrion 7Om) or Dili\ion l
<br />ol rhc ar\itu* rnd Pn,fcs\ian\ C.d., dfil frylic.n\. t i full lorcc nlrffc.r
<br />Lic..sc ck$-Lift e Nudbcr:
<br />D.r.: C.rlEdoE
<br />laIiSIf,ll:Ilj]NI.TNDINGJlcINcI
<br />Ilrdl,yrft trnd.rn ndiy .f Frury thd rhor. ir ! .oN cri.n LndingtrA.nryforlhc Friornrin.cofrh.work l'or*hichrni\ pcnnir i\
<br />t\!ed (Sa..lO97,Civ C )
<br />ATILIIANI.DECUAA.IIOB
<br />I hr.{,! anim und$ lcnalryolp.rjury on. oithc folbsing drlearion\:
<br />Dcnrlirion Pcmits Asirsros Noriiicarion Fcd.r,lRcslhrnrns ('l irb rto. Pin6r
<br />-Rcq!ncd
<br />t.rrs oi Noriff,ation
<br />-l
<br />ccairythd I Mvc rendrhisappliclrionarxl srarc rhar rhc atnlc informar corr$r I aprE ro comply wirh dllCirylid Counr,
<br />ordinJnccsnnd sr!r.l r*s rclxrin! ro huilding connodion. ra rcllcs rtilcs ollhis Cnyand Colnryb c crrllondt
<br />abovc Bnlion.d pblny ror insp.clion
<br />Applirml {r,\E.nl Si,:ndtrrr
<br />P.mltc lM. (prtno:_
<br />,",'J-z-tX
<br />IIII
<br />TASA
<br />o^"Q-]: Jj
<br />l.cniryrhd rh. lcdcEl r.Bul0'hns ES ding ash.sds rc.$vulsrc nor amlicablc b rhis rbj..r.
<br />=
|