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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND /.^\
<br />Waste & Vent 6-11-lY g
<br />Water-Under lloor \J
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent ^n-lb , \zD'e t')
<br />)Water Piping (.l/ub )@-
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Tesl
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<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 Release "A\7-Zo-lY Nt[tt}
<br />Notes, Remarks, Etc \_/
<br />OWNCI' BUILDER DELCARATION
<br />I hcr.hy nlrnm undn ltnrlry ol pcrjury rhrl I !n crcnrfl ri.D rh' 6nlmcl.r' l,iccn{ lrw r.r rhc rolk,sing rersn (Scc ?011.5
<br />BL\ir.ss $d Pnn ssiotr Codc) Any City or Counry {hich rcqutc\ ! F-i,nir n) .o.srfl.'. alrcr. imlnrc. dcnnlish nr ruFn st
<br />(ru.trc. Eiorlo irs isruime. ah. rcqltcs rh. {Ilicrnr fi, su.h Frnir ro ulc r siEncd srarerunr ihat h.or sh. t li.ctr$d purumt
<br />b rhr pnivnn,n\ urrlf conra.ld \ Lic.trscd Low (Chrlrcr 9. Conrmcn.ins wirh s(rion 7t(l) ol Division I ofrht Brsin.s.id
<br />Pmfcsi. ns Codcr o, thrr hcorshc i\crcnur rieclionand th. h nntrrhcnllc8cd.xcnuion Anyvdllioo.lS.cri ?0.1l5bynny
<br />.!rlicanl lb!rDcnnir slbjccr\rhc appli.rnr k,,.ivilr.tralryolrx, nn. rltrn liv. hundrcd dollsfi ( l5m)
<br />-1,
<br />s owM oarlE pmD.ny. m hy cftplott.s with wagcs ri rh.ir sl. .onp.Ndion. Mll do lhc erl Nld rlE ltutw i3 tul
<br />iincid.d 6iof.r.d rd $1. (Se 7044. Busi,.ss d Pm6ssioN Co<tc: TIE Contdols LtcN bw dci mr.p!lylo uo*mof
<br />rhc l,mrErry who hlildl or i'robE thd6.. rd vln dG uh elt hituctr or h.Rlf or thmu8h his 6 ho ow!.tplo)tcs.
<br />provi&d rh0t sKh impmEc'nr e er hkrxlcd orotu for slc,lf. novqti th.lriildinS or inptlrm.t t sld wiriin oB Fe
<br />orotrphriorl r osm Buiuf wiU lEw 0E hink orpmvi.s lnsr lr or srE dil mr ttrild or inprcw d. FDiEty Lr E Ftr!.sof
<br />t, .s owocr ot rhc lrordy, am cxclusivcly conl[crins wirh liccoed .onttu roN ro snslrucl llE pmi{l (56. 7OH, Buiinc$
<br />lnd Pmftrsion Code: The C6nrtutor'* Lkcnsc kw dds not apply lo an o*nu oa proncrry who bnilds or imProvcs lhcrcon.
<br />rnd who 6ntmk lor such poJcds sirh , Co.tndo,ls) !k nsed pxd@r lo lh. C.ntEclols Lian* L€s).
<br />-,
<br />uncxc.U urn r Sal
<br />X?3a,,....,.,'r-u:(t aarla!
<br />I hr\ c Md *ill nui,rrlin x Ccn ificarc of coh{nr ro scll-lrntrc f(, Bolkdi conDdn\ n[ N tln)vdcd lor iy Sccri,rn ]7(x) ol rhc
<br />Lrh, Ollc.lirrhc pcrionninccoflhc Rtrk f(n wh(h rhc rMnn is i$u.d
<br />-l h.re and villminr.in work R .onFnsotion insuramc. !s rcquircd by S*ri.n l7{xi oflhc Llhor Codc. foi thc pertornlm. of
<br />lhc work for whkn rhis l.miI is is .d. My wortc6' ompc.salion iflrnrakc.min.nd nolky numSct 4:
<br />'a-o va
<br />-rl
<br />-l.cnify
<br />thor in rhc lcrtdrmocc orrhc wolk ror which rhis Frmil h hsmd.l shlll noi erfloy.ny p.mn in lny mnnd
<br />sn!r.lE.nrsubF.irorhcworkElcom,En{ionb*sofcalilon.,nd!g@ihaiillsthuldbe.oftsubierlorlE
<br />mrrctr enrpcns.r ion pmvhionr of Salion l?o) o{ th€ Labor Codc. I shal. r.,nhwnh con'ly pith lios lrevisions.
<br />WAININCT Failuc ro sDrc m.kc* conf.ns ion ovcmBc n lnhwfuL qrd shrll subj.rl M.nplotsr lo di{iml lxMhie tnd
<br />civil fincs ur ro orc hundrcd lhousand dolhs (3100,000), in lddnion 16 th. con of car4.nslion. damBca !r pmvid.d lor dc
<br />Seclion 1076 oathc t hr C.dc. int.rcsl end 0ll*a-/4t?
<br />t]I(]"laarlaN
<br />Ihcrchyrllir uddnctritydlpcrJuryihriIrnlicc{dundcrpro!i!i,DolChiprcr9l(onuncrciDgwirhS..ron7(XX))olI)ivtianl
<br />ol rh. Bu\i'rc$ rnd Ptufcssio,rCod.. dnlmy liccn\c h hlllbrec rRlc c.rE o9
<br />#",.,&ru:I E( c"^*a",
<br />(;oxsrSL{:ul}Nr[lDlNc-f{jEllr
<br />I hcrcb, ll'rtn under rtmlrrorp.rjury rhnr rh.rc k d.on{flctiotr tndin8 lscncy tur rhc Frfonn,ne ofrhc sork for which rhis Imnir is
<br />tsucd (Scc.1097, Civ. C.).
<br />A.PILICANLDtrCLIf,{IIO!
<br />Ihc.cbta0tmunderpcnrllyofI,!rj!ryoncof thcrolto*in8dccla iotrs:
<br />Drmlirion Pcrmirs.Asb.sos Nolificathn ltdeml Rcslblnri\ (Tirlc 40. PM6)
<br />R.quncd kncr ol Nolifrdion
<br />l..niryrhd rrr icrlcral rc8lloriom rcsa.din8 ashcdor rcfl)valrd norltFliclhlc h rhi\ Proicr
<br />-l
<br />cen ity thd I luE md rhis applic{tion &d nirc rhr! rhc drw i.fonmliotr is coEcl. I !g@ lo .omply wilh {ll Cily end Counl,
<br />ordinamcs &d Sr.rc tlws rcllrins ro lriuioe cdn.mcdor. a.d h@by Ndoriz rcprcsntaliEs of lhi! Cny and Counly lo cnls upon lhc
<br />rtxx. 'mnri{, rd p()pcny for
<br />i*"**"^,,&'14'!*
<br />5tr8t
<br />a
<br />Fill Line/Back Flow
<br />FINAL
<br />Q
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