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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNER BUILDER DELC,{RATION <br />I hcrcby atfirn undcr Fn.lly of p.rjury lt'd I m cx.npl fi,om rh. C.nlh.ton' Liftre Ijw for lhc lollovin8 rclsn (Se.?031.5 <br />Businc$ and Profcision Codc): Any Cily or Counl, {htn r.quircs 0 Frnit lo o.nruct. .lts. iq,rcve dsmlish or 'lpsn lny <br />!l cr!e.,,rio, ro iri iriumc. .L$ Equacs rh. aptli.ml lor sch l,mir ro 6lc ! sigftd 3rd.ftfl rhar lt or dE k lic.Nd plr$sir <br />lo rhc provisiom of lt! ContEclols Liensd Las {Ch!pr6 9. Commftirg with SNlion 7000 of Ditisio. I ol UE Buirc$ and <br />Pof.ssio.s Codc) or thll lEor sh. iscxctrpl ttErcfrommd E bacis fo. lhc alhg.d er.np on- tuy violdioo ol Se.ti.n ?031.5 by a.y <br />attli.a.l for i pemar sublrrs rhc aipli.er ro . civil p.Mlty of mr mB lhu filc hundEd dollu! (l5m), <br />I.tr\orrcrolrh.proNny.ornrycDployccs*irhtrdlcsrsrhctrslc..mncn\di.n.Nilldorhctr(nkmrlrh.{nEruaismr <br />ir{cNlcd or off.r.d for slc (s.r 7(llJ. Br\incs\ rnd hofc\sio.s c (lcr'l lE cotrrrn l,tr \ t.iccnsc lj* doc\ Dor |aply h rtr.wncr oi <br />rhcpnrp.'l! rehohnrld\orin0nivc\ihcFri.rMuh)doc\{'rh*()rkhinr\clforhc^cllorrhru!ghhi\orh.rownc rtl()yccs. <br />ol (n\rlciir[, Ilr Owncr aulucr willhnvc rhcburdcnofF,vin! rhJrhcorstu did n hildori'ryrort rhc nnlrny lffrhL pumsol <br />-1. <br />!s owncr olt propcny. M eklulitcly .oru&ri.g wiln licctr*d co ,&106 lo @n$tucr rt l,ni*l (Scc. 7044, Bcmas <br />ard PNftasi{ Codc: Ttc Conlroclols LianF L,w do6 mi xpply 16 d o*..r of |,otEny who huil& or impmws rhcmn.a.d rho co.rek fo 3sh Foiitr wirh r Conmcro(s) li(Tscd pu^unr ro thc ConlBdols Ltcns L.w). <br />undd Serion- <br />^'l <br />DEcLilSAM <br />I heEby arrn undcr penalry of !.rru.y oM of rhc followins dclaBrions: <br />lf,hrCoJc- n)rr[c Nrinrrcc.lrhc s1trk hr $hich rlt lcrn irNsucd <br />-l havc afld will minroin workcn conlcns ion insuEtuc. !s rcquied by SNl ion 3700 ol thc Llbor A!dc. for rhc p6l6rmncc of <br />lhc *tr* for which fiis r.rmn ir isflcd. My worke^ ompcn$rion inru.e. c!trier,.d lolty n!nb., e: <br />-l <br />c.nify rhlr itr rhclrc fornunccofltc wort for whkhrhis Dcrnril ri issucd,I snllloot cmrLyanyFson inonynunocr <br />s asbrr$ft birr ro rhc w*cB mrFnsrhn taws ot Calitomia, od usrcc thlt il I should tE{otu obj(l ro llE <br />workdc on'JrEsarion tDviiioni or Sdio. 1700 of rhc Lih.r Codc. I shaU. fonhwnh .oddy wnn rhos llolhbB.. <br />WARNINC: rlilurc lo scurc Mrkctr comrcnsalio. mvcmgc is !n10wtu1. &d shall subjd u cmlloFr lo ainrinal lcmltics and <br />cilil fincs up lo orc hundrcd lhousrnd do *t;ffi,ffi:--" <br />D&CIdSAIIIIN <br />lhc Li}xn Crxlc- inrcrc\l rnd <br />I h.r$y lfrn unde peDlry of p.dury lhal I u lie$cd unLr Fovisior oI Cha0t6 9 (@nmein8 wilh S.crbn 7000) of Divilioi 3 <br />ol rlE B$iKr..d PrlfdsioN Cod.. ard ny ticcM ir in tuU forc lrn.ffdr. <br />DriP: Conln.l.r <br />CONSIAICUO.II"LENDI!(i.AGENCI <br />Ihcrcbyslfiirnundcrpcnahyofpcrjurylhdlnerciiron$rudionLndinSdSckylor$cp.rfonMnccolthcwolkrnrnichlhisrErnrilis <br />issucd (Scc 1097, Civ. C.). <br />AfILII;AITI.IIECI.AAA.IION <br />I M,y diimunds p.trtrhy oiFcrj!ryorc olrhc loUowins dccluturi.ns: <br />Dcmlni.n Pcrnna-Asb.s.s Norifi.arnrn rcd.rnl Reularion\ (Iitlc :10. Pad6) <br />-Rcquncd <br />IJlr.. oi Ndif(dirn <br />_l ccni{y llEl thc fcd.ml rcgularions Ee0rding 6b6ros Bmvd m nor .,plicohl. to rhis pr.i,t <br />I.cnifyrh,lhrrc rud rhi\rtpli.nn,n rnd nakrh!! rhc fi,vc inlbnrB!n,n i\cotrccr IrgrdbcomplysirhallCiryrndCounry <br />ordnrnkcsatul srrrc InesL-.t in!ri buikli !frlhcrctyflurh.ri7, rcpEsenrdrilc( olrhh Cny rM C. <br />$ovc tunrioocd prapcn, fo. <br />A ppl icanl or Aaent S ianllu a <br />UNDEB GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underlloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Rool Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <br />Fill Linei Back Flow <br />Pool HeateriGas Line <br />Miscellaneous <br />Gas Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release <br />tplq lfi1n .afuirC-a'(l 'r.l) <br />Notes, Remarks, Etc.UI <br />ID/SIG. <br />P.rDllE u!r. Odd):_ <br />Water Service <br />FINAL