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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough 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 />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbing ?{blh
<br />Final Gas Test
<br />Meter Release
<br />d'Lo/ib
<br />Notes, Remarks, Etc
<br />OWNER BIJILDER DELCARAIION
<br />I h.rcb, arm und6 ,.oalry ol0cdury thor I m .knfl fDm th. Conlroclos Licensc Lw for l,E tolb*ins Men (SdJoll.5
<br />Burbc* lnd Pmfession Cod.) Ary Cily or Counly which rcquircs a rEdit lo @nsrocl, altq. irprevc, .hmliih or E!€n rly
<br />sldcluc, prior Io irs i!r!!fu. .ko r.glirs rhc amlkanr lor such Fmir ro liL ! .iemd slrl.Bnl lhd lI or shc k lkc#d puroa
<br />r. rhc prc{irion3 of iE Contrmror's Lienscd Lnw (Chspld 9. CoftmncinS $ith S*rion 7m 6f Divisioi I of$c Busii.s and
<br />Prcfcssions Cod.) or thal l* or shc is crcmfl rtrrcfmmlnd thc hssk for rhc llhgcd cxcnplion. Any violrio. or Sstbn ?01,.5 t'y .ny
<br />lpplicair tor s lcmi subj6rs rhc .pplicer ro . civil ,'cMlry of nor me lha fivc huidrcd dollss (S500).
<br />-1,
<br />s own6 of rnc psltny, d h,.ftplorr.s *irh wrse s rh.n sb @nocBdion. s do ttf, vot 8rd tlE slrEl@ ir mr
<br />inrcndcd o, o,IcEd ror sk (S6.7(X4, akinds ond PmLsriom Cod.: TIE C.nh.tols Liens Lie &.s ml aprly lo s oemr of
<br />ttu rmFny wl$ builds or itrploB rh.En, ud *lD dc ir:,l slt limclf or hmlf or lheugh his q h.. osn.nployccs.
<br />srevidcd rhar s.h ihptuEmnB c mr htsd4n or otr ttd for dL, lf. n lffi. d. t{'lling or inproEr.l is $ld wilhin orc Fr
<br />ofotrphtion. tlE Oercr Blildf wil haw tlE h!d.n of potins del lE or {E drd mr bild o. ilpr.rc tnc plolny ror fi. !urF$ of
<br />-1,
<br />s owns ofrne pmpcnr. snerclliivclyconrdins wnh laccnscd coolffdos to onslrlct lhc pmrcd (S(.7044, Bu!!6!
<br />,Jrl tt'fr$bn Codc: Th. Conld.roas Liccnsc bw do.s nol upptt lo nn owncr ot prcrrcny qho hlilds or io ov.! lhcron,
<br />and *h. .onrBcls {or sucn lmj.crs *ilh a Con'kro(9 liccoscd t)u(uMr ro rhc C.nrmrors Liens tiw).
<br />Imcrho! undcr Sdio( .B &PC forrhu@ei
<br />l)rr'
<br />l4l)8trEIS:grMtENrAIl)!
<br />DECLANATION
<br />I h.rcby rffirm uidq ncMlry o{ pojury on. olrh. aollowi'rg&.ld,rio..:
<br />-l
<br />h,E sdeillminlain !Ccnia&rcof Cons ro Sclt lae fr erkc6 @npen{ioi. a pmvid.d for by Se.lion 3700 of lhc
<br />Lrbff Codc fm llE Ffolmre of lhe mrt fd *hkh fic lonit is hsu.d.
<br />-l hdc a.d sill einrain wo,kc^ cor{Ens ioo insur!fte. s r.quimd hy Sel ior 3700 ot lh€ Libor Cod.. loi rh. ,,..f()t1Mc of
<br />thc work aor whi.h rhir lcrnfi i3 bsrn. My work6 ompcnsrion inrum( cMis crd loli.y numbcr dc:fir{*,,.eaf Cc>. }tts.
<br />Bfl.,\r, Ca fA
<br />-l
<br />ccnify rhar in fic llcrlortutuc otrhc work lbr shih rhii ltrmn is i..ucd. I snlll nol .oploy a.y pcmn in a.y mnrer
<br />s rc r. tr.om sublrt ro rhe *0*6 cohp.nsarion hws of Clliforni!. lnd !$& lhar it I ih.uld b$om subirl lo lhc
<br />workdr omp.nsarion pmvnions of S..lhn l?m of lhc LltDr Codc. I slEll. fonh*nh @npl, wilh rhos prcvisions..
<br />WARNINC F,ailulc ro wurc krk.n comFtrtarion .ovrrug. is unl0{ful. and shdl subjNr !n cmphyc, ro oninal lrmkts ond
<br />civil fir\ up k' om hu rD rhou\rtul dollrrs (Slm,oUD, in iddit ofcompcn\arion. dum!.i r\ providd! lor rh.
<br />sc.rkrtr.ro7a rn r[.l. lrtr(nr[. nr.(i
<br />D.' ltll rn ?01
<br />.J UL
<br />I hcruht rltrnundcr Fmlryol J'crlury lll lomliccnqlutdcrprovhi{]nofCnapir9(.o nncn.int qh Sc.riM 'lt[X] I ol l)i!i\im 3
<br />of rhc ausin.s and Pn,li ss nr.\ Codc. d trryliccn{ n ir lull tu(c tr clltcr
<br />\ce4cg1
<br />Ve (.ctw't-
<br />tQ!srx(-uu!-.lJd!J!t!lr-l!i.[!!r
<br />I undcr Irnrlty of ,crjur, rho, rhrc i! ! .onnrud!,o hnding ,8c.cy lor lnc penorroncc of lhc $orl ror which rhk Frmit is
<br />kiucd (S.c..1097. Civ. C ).
<br />AIIUIANLDECI.ABAIION
<br />I ffiry Jtinn uBld pcnalty otF.jury onc.lrh. tirlk,wi.r d{l,ra'iotrsl
<br />D.mlirion P.rfrnrAshcr.s Nolificllion ltdcral Re3ul.'ions t'lnt 40. PJn6)
<br />R.qun d kxcrof Norificario.
<br />I cdilyrhar rhr lddu.rl rceuhliont rcB dnr8 r\bcno\ rcnmvll lrc nor rlrli.rhlc k, rhh lm,j.ci.
<br />LI ccnrl\ rhJr l hr\c rc lrh^rnnlrrtrn'r'l{Jrrrh rhcih,vd irror.rtion t corcl laereroconrdywirhalTciry.ndCotrnry
<br />odi,anccs ud Srlrc LIws surinE kr hlildin! con{o.rion. od h&.hynutfu)rizc rcFrcscnl ilcsollthCiryn.dCoLnryrocorcr
<br />ohovc mnrioncd tmtcny lbr in$,ccr ion
<br />A
<br />\r{,#t0620 tr
<br />EN['.l
<br />shks
<br />FINAL
<br />\. \.\.r
<br />L.ndcls A&rcs{
<br />-
<br />Arlllcanr or Ag.nl SigmluE:
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