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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 Pipino
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Linei 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 ?/ttzr-,'il%Final Gas Test
<br />Meter Release
<br />FINAL gft-(//5 s\6Y
<br />Notes, Remarks, Etc
<br />OIVNER BUIT,DER DEI-CARAl'I()N
<br />I hr.c6t rlltnr undcr |Enrlry rn nrrirry rl l an, crrn,pr thnn rhc Conrncus Lic.nsc Lrw lnr rhc n,ll,Nir8 r.)v'n ISN 7(J:.1 5
<br />n' rlr pi({i\ on\ ul rlf, (i rx.ru't l-i.cn\cd l-rs lahrDrc,9. Connn.Dcing sirh S.cri 7(XX} of Divnio loIrhc Bu(irrcs\ rtrd
<br />rlpli.rrrnlrnI[rnlirsuhjc.hrhcJpllicanrt']ri\'ilFnalrrotnormoturhinll\chulrcdJ.lLrrsll5({)
<br />-1.
<br />I owmr of $e poFny, or my .mployccs with wa8cs 6 lhcn $b mmFnsal ion. wiu do $c wnt .!!d rlE sdD is ml
<br />i.r. jln or o,I@d fm slc (Sa ?044. Busircss ,fld Ptuacssions Code: Tlt C.drtc!.t s LienF t w dns n n lpdy ro !n owncr ot
<br />ihc !ftFn, who hi dr 6, i'rroB rhc6n. rid who dG skh wo* hiN.lf or h.Mlf or rhnush hir or h( o*n cn:Phy.cs,
<br />p,ovidcd thor such i,nF[Ecoricturi..drdordtultrsL.ltlsM.ltEhuildiryorirpmtmntir$ldwhhi.ocFd
<br />of.oq)lcrbr rtEOsM Bu dd*illluE r blrdcn 6f pmlins Iiar L or.hc dil ml hild or i,{mE $c FotEry for it purFs of
<br />-1,
<br />asowturolrhc p6Fny, am.x.lusivclyco mdirE wirh liccns.d contrcloF ro con\rtucl llt lorn lsc. rot4. Busnc*
<br />,irl lhtsrion cdc: Thc Conrtrto* Liccnsc Law dcs nol apply b !n owncr of ptoFdy who buitds or imptovcs thcr@i.
<br />lnd wno coalmcls tor slch pmjccrs sirh a Co dlo(r) lbc.sed pmMr ro E ContEcloas LLus L3w)
<br />-l
<br />!'n dcmfl !.dq Sccri.A. & P.C. f.. lhis EMn.
<br />D.r.:- OwNr
<br />-l
<br />h.!c od will mam.i! a C.nifr{. ot CoBnr to Scll-lBm for mrtss @mpcnsdion, ar lovt.i iot by Satnn 37m of lhc
<br />L{bor Code for rtc Frfo,rr*e of rlr wo.t fd whkh rh. Frmit i! is.ued.
<br />_lh.wundsillniinraio*orlc.oqxn*aiioninsuEmc..sFqundbySalionl70OoftlEL$o,Codc,forilrcp.rformicof
<br />rhc work for whhh rhis Fmil ir is$cd. My wo*ns comp.ns.lion insunme .si6 ard Plicy nnnb.r e:
<br />^
<br />s^.rdwts\ CaSh \NS
<br />_l ccnilr rhur ln rhc pcrf.rtu..c ol rhc work ror vhich rhir p.rnil is hsucd.l shall mr empk,y rny pcMn in oy monncr
<br />$ di lo tE\onE subiel b
<br />'hc
<br />workrl conrrnsulior ls*s of Colifornia. ed 8gft rhai if I rhould h.com subicd to thc
<br />wort n' compcn$iion pmvhions ol Serion l?00 oI thc L.bor Cod.. I $lull. forlhwirh enply with rhose lmvtions..
<br />WARNINC Fuilurc ro r.!r wi .n'conD.nsdrion srcn8. is unl.pfnl. lnd shall subj(t !. ciplordr !o dhir.l lrMhi.s.nd
<br />.ivil Ui.\ urr ro oic hlndrcd rhousand dollas (Sl(x).filo). in.ddilion to lhc cosl ofcoftFn\.rion, domgcs as Providctl lor thc
<br />Srdtr,n:l(,76otrhc ljh/ Cudc. hrcrc( Md
<br />*"JUL1]8 L0l0 ^
<br />I hcEby off.,n !nd$ pcn.lty oi,'ciury lhal I am povnion dlc-lBprc 9(comkins silt SNlion 7u)0) of Divhk rll
<br />of rhc Busims &d Pmfcssio.s Co.lc. lid ny lice.sc is itr 6lll fore od efi6l
<br />.o$.0*,g \ooqqa4
<br />Yq*+r ro,,
<br />C{INEITICUQN.LINDITTCAGEXCI
<br />I hcrbynrnr undcr Fnnlry of pcrjury 'lu 'n
<br />rc is r consdcrbn lcndins oscncy tor rh. ,.nnmncc of rhc vort for which rhis Fmir ir
<br />i\sucd (S$ :1097. Cir C )
<br />A.ETIICANTDEC!$AIION
<br />I hNht nninn uMci Fnahyol,)crjury o.c ofthc rblloqins dcchnlbns.
<br />D.'nniri{,n Pcrmi( Ash.{os Noriticdiotr F.dcr.l R.Suldioni (Tirlc 40. Pan6)
<br />-Rcqutcd
<br />l.ncr of N.rin.rrd'
<br />I rcnityrharrhc fidctulr.8uhrnff EB.rdnrE ashcsros .cnrova I a r. nor arplicftl.r. rhislfoj.cr
<br />ga1-enily rhd I h.vc rc.dlhir appliclrt,nand {!rcrhd rhcrhrc i'lr.nndrion is cotrccr I asiLtri,omplywirhrllciryrtrd Counly
<br />udnrn cs Md str( trrsrlnlitrg lohuiliirscotrsrruclion. dhcrchyaurlllrnctuloscnldivcsoarhhCiryandCountybcnr.rxB,nrtr
<br />.\t,t,li nl.rixrnl SiB nlurs
<br />ped't€e iin! (pdir), -S.,Q
<br />'dtlu L s 2010
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<br />.UOBtrEBS:.GAIIIESAITqN
<br />DECI.AIAIIOU
<br />I hcrchy afiirm und.r FnnlryoflErjuryoB o,lh. followin8 deluslions:
<br />u,,,,.,*.-In". BNuwch\c(l \?rqoJ@ 'it t.\.tq
<br />ljnd( . Ndm:
<br />-
<br />L.ndcis A&Es:
<br />!ln!c nEnrioncd rr.pcny,.r insFr.r io. purpo*i.
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