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PLUMBING.INSPECTOR RECORD
<br />tD/stG.COMMENTS
<br />UNDER GHOUND
<br />Waste & Vent {
<br />WaterUnder f loor
<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 6-zt-tB J)tdolD ,64
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipino
<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 />Rough Plumbing
<br />Final Gas Test L-r3-lg J)oJol ,rtQ
<br />Meter Release
<br />FINAL .-2/- i$'/rD
<br />Notes, Remarks, Etc.
<br />OWNER AUILDER DELCIRATION
<br />I hccby e rtrm undcr p.noty of pcrjury thsl I m cxemar for rlE C,ntn to( LitM Lr* ior rhc tollo{irg Eahn (S(.m3 ,.5
<br />Bosincss a Pofssion Codc): Any Cir, or Courty sticn Equic. i Fmi io @isrrud. allci impoE n mlsh or EI,!n sy
<br />irtucrurc. prtu lo irs i$!afc. also ,.qlarci rbe et lta tor such pcml lo 6L a *ign d slalctunl rlul lE or slr it lie.si l,umol
<br />ro lh. Fovi3io.s of rtu ConrBcrtr s Liccnscd Liw (Charrcr 9. Conftrcing with Scclion 7000 oa Diiision 3 of llE Blsincs and
<br />Piofe$ions Cod.) orrhar lEo, shc ir.icr9l rhcrcnon d lh. bsis for rl* dhEcd erchption. Aiy liol.lion otscdion 7011.5 by.ny
<br />lppliclnl flr r Fmi ilbj6c rh. s,plicur to a civil ,tn![y of nol mE lhln fiw h!'tt ed dous ($500).
<br />-1.
<br />!s ownd ofrhc propcny. or my cmplorrri with wagcs ai lhct ek @,{Ensrio.. will & llE *oik u'd d. srrele h nol
<br />i c.dad o, ofr.rcd for src (Se.7{x4, BBiftss sd Prof.$hff Codq TIE Conlr&1d s Lic..s |.lw dGs mt tplly lo & o*nd or
<br />thc polxn, wlb hiildr c inircB ll!c@o. .d wlb rte! skh w* hinsclf or lENlf or lhough his or h.r om .nlplofcs,
<br />provlLd thar sh inprNmnaEful hr..d.d oroltu for $jc. r. nowffi. rtE t{ildirS 6 inpmEmrl is hU wilhi. onc )Bt
<br />ofotrplction, fi. qrNr BlitL. *iI lEw ,E lrrdcn of pE!,lng tlrr lE or slE dii el h[ild or inprDw 0E propdly for d* FlFe of
<br />-1.
<br />!sowmrolrncrmr.ny, an.xcl!.iklyc. odir8 wirh li.cnsd contldos roc.nsrtuclrh. pNjccl (scc.7o4a. Busim$
<br />.nd Ploi:shn Codc: Thc Contrsroas Licchrc kv docs nor uDply to an own , of polEd! wno builds or iry,ror.s lherNn.
<br />lnd sho o 6.rs ,., such poiecrs *irh ! cobhdo($ lic.nscd puBmr to rnc contEcrols Lian* tie)
<br />-l
<br />anr *cmI,l under Sdaon-. B. & P.C ror rhis rc8$n
<br />lll8f,Exs:cqMriN$laN
<br />DECI,AMIII}!
<br />I h.Eby trfiirm md.r p.mlly of !.rjury orc of lh. following dKluotn nsl
<br />I hrvc rxl willnuiduirnCcnif'cri!olConscor roScll ln\uru n, workr* dnnpctr\ on.$ pnrvidcd l'or$ySccrion lT0oolihc
<br />ljlxr c(xlc,Inrrh. p.'ro nun.c orrhc sork lor w[ich rhc lrci,nn h hsucd
<br />_l hlvc and will @inrain wortctr compcns ion insuroncc. ar rcqltcd h, Sdion lr0o ol rhc tjhor Cod., for lhc l,crformne of
<br />rhc work ror ehich rhis l).mil is isscd. My workss onpcnsrirn anslnrcc.6tr !i Flicy oumb.r m:
<br />Il,lryNun,h.r ,lrtnd\
<br />-l.cnily
<br />thd in thc p.rformme oflhc *ork for whi.n thk p(mn ir issucd, I shall nol cq,loy any l,cson in any @nF
<br />$ &\ ro b.6m rubjer k! thc sr[n mmpcnsdlion lnes ofcdifomia. and lsnc thd ir I shouu b.lom subill lo tlr
<br />qorkcn mmncns0tion povlsions oI Sdion 3700 of lhc LilDr Codc, I {Ell. fonhwitn Nrply wnh 0Es lmirions..
<br />TV^RNING: t;lilurc kr scurc $ortcr( dn pcnetnnr cov.rec is unltrwiul. ond shall sunlccr un cq)lo}!. lo dinindlJxnihis ind
<br />civil 6ncs !p ro otrc hlndEd thou$nd dolld (S100.000). in
<br />G Lo lr)
<br />DFCI AIIAT|oN
<br />I hcrcby iflinnundcr p.nohyoipciury llEr I !d lien{rJ undcr lf.lisioi ofch+r.t 9 (connrencin! wilh S(rt'n 7(x[] orDivisio l
<br />or rhc Bu\incs\ and PnnasionsCodc, urd mylicctrs k h fulliorcc {n citcr
<br />L.I
<br />ATILTANIDECIAf,AIIIJN
<br />I hdr6y 6finn undcr p.nony olrrjuryonc ol'lhc lollowin8 dcclaations:
<br />Dcnbhion PcrnirrArlx{os Noiiicnlion F.dcEl Re8uh' ions (Tnt 4r, Pan6)
<br />Rcquhd r/icr of Norificalion
<br />-l
<br />ccnify rhar rhc ledcrrl Egllsrions rcSadin8 asbcsros rcmMl rc ior apdi.abk ro lht pmjc.L
<br />-l
<br />ccnify lhlt ! hlvc Ead rhn lppltatio. ard $arc lh'r ihc ,!ovc intoimrio. is .(rel. I !8re lo oq,ly wi$ all Cn, ad Counry
<br />ordin.mcs lnd Sratc Llws Ebrin8ro $oilding connrudn,n. rnd
<br />.bovc ncnlioncd php.dy for iNpc.l
<br />AppliGnl or A46l Signnlo T1-r
<br />rlrn ( irf, tr(l(,r(ryn'.nrd ntn, rlt
<br />,,," 6 1 z,frt,
<br />WEGE
<br />APPHOVALS DATE
<br />C(TNSTRUCTIoN t ENDIN(: AGXNCY
<br />I hcto$y l]irntrnds!.noxyolpcrur,rhdrnc,cn!c.nrrruclionkidins,!.ncyr.rlhcpctfoirumcofrhc*orlt'shichrhhr.iiniris
<br />irsu.d rSL{ 109?. Civ C.l.
<br />trnJr, . \,1.t,..\
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