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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS oWN!:I{ BUN-DER IJEI,CAR{]'ION
<br />I hcrcl,y alltu uRlcr p(ulr, {'f p.rlury rhd I tnn ct. U from rh- Cotrhcftrs t-i.cnsc ljw fdr rhc lalb{iu rc6{r (Scc l0ll 5
<br />Bu\inc\l J'd Pr.fc(\i,r Cd.): Any Ciry or C.unry whi.h rcqtirc\ r Frnrir h coNru.r, xlrcr. inrli(^t. dcrdnh or rclrn any
<br />srrudurc. rrior ti ik isluMcc- slv) tuquncirhc ll)oli.rtrr lot such Pcanir lo lilc s \is,f,d {dc *nr rhd lror shc is li.cnscJ Prllurnr
<br />k, rhc pn,vi\i( \ .frh. Cotrrrcrois Licctrscd Llw (Chrrr.r 9. clnn mcnrs siih Scclion Tri()l) ol Divi\i.n I .r rhc Btrsirrci\ nnd
<br />I,rorls\n,nr(bdc)or rhrr h or sh. s .kmrr rhlrcrmn .nd rhct'\is Inr r[callcrcdcicmprnrn anyvidrrion.iScu'inr 70]l5 hy3ny
<br />apflic{ r r,rs p.nnir rubJd.h(h. rmli.a.l h acivil|.na[yolnor morc rirn nlc huidrcd dolid\(35001
<br />-1.
<br />&s oemr of th. I,ol*ny. or ny .rlplorr. wilh wr8!s s iFir $lc on!.Mlio.. *iI do ir! wt dd tlE slrd@ h ml
<br />i c'd.d or orcrcd for slc (Sc.?044. 8udfts ud P,lf.sriors C.dq TIE C! ocroa3 LieN ljw &rcs nol rpply ro & owE ol
<br />dE FoF.y who hiftls or i,qtuB rlE@n, d who rlB sh w* hins.lfor hmlf or lhrcu8ll ti. c hr ovn.r9loyccs,
<br />provilcd rhar such improw s e ml i cnd.d troficnd for sle, lt ho*.E. tlE hrildi'B 6 nrptDEEfl k $U wilhin om )€r
<br />ofotrq,hrior tlE OwM Build, wiU haw 0E hrhn ofpoving tlEl lE or slE dil ml hild or irpow 0'c FoPdly for tlE pt!|b* of
<br />-1.
<br />.i owfr of rhc ,io!.nr. m cxclusitly o rrclinB with liccn*dcoorrlom lo.onsrtud llt por.cl {Scc.7044. BusiN
<br />,d Proi*riu Codd Th€ Conrrckrt Li.en* tlw des ml sr'lly lo d own.. ot DroFny sno builds or improtr rhm6n
<br />ond who ontEcrs for sucn pmjers qirh a Conmd6(, licced puRMr lo lnc Conlturol! Lien€ tte).
<br />-l
<br />amcxcmpr ud.r Setioi-, B. & P.c for lhi. t!@n.
<br />Drl.:__ Owner:
<br />IOASEISIAMSENIAIION
<br />DECLARAT'ON
<br />I hcEby artrm under pcn.ll, of Frjlry orc 6f thc following delr.iioni:
<br />I h.votukt$ill rn.ir{CcnificrrcofCon{ roSclflr\urcr{tr$orkc^..nDcrsrion.!snmvidslturhySNrioDl7(x)ol,hc
<br />lj}t{tr Gxlc. turrtu n.rnm rc.flM\ork hr$hich,hcpcnnir i\i$td
<br />-l
<br />hav. ,d will minlsin *ortc* conllcNolion iasaxq .r EquiEd by Ssliofl 3700 of lhc lrboi C!dc, for fic F{o anaof
<br />fic sork for ehich rnis lf,rmil is is.t. My *o e6 odpcnsdl.n insuBK .tfrcr &n polty n!nb., @:
<br />-l.cnify
<br />th.l io lhc prformmc of lhc so for uhi.h lhis Frmir h L\rucd,I shall ml €rPloy tny persi i. nny Mncr
<br />$ s ro h@om subjer ro rhe *oiGi .on{rns! ion l,ws ol Califomia. .nd B8N ltar if I slbutd tr.oG rubiEl to lhc
<br />qort.ts @npcBlion povisionr of Sdion 1700 ol lhc Llt{r Codc. I nE[ fonnNilh compl, *,th rhos Pmvisions
<br />WARNINC Frilurc to suc Bor*c6 coma.nsation.ovcEBc is unlawful. strd shlll slhj.ci an cinploycr to aininll FnalEs ud
<br />civil fincs un Ioorc thdrcd rholsa.d dollos (!10o,0o0), in 0ddnion to lhc co or.omD.nklio.. drm8cs as Fovidcd for rhc
<br />S.cri.n 1016 nfrhc lihorcndc inrcr.n MJ
<br />"",",t6ltp.[ tE
<br />^,0,,*o")4-
<br />DECI.AAA.III]N
<br />I hcrcby aritnrundcr pcnnhy oI r.rjury Ihd I an li.cn*d undcr pnvttun oaChalrd 9{connmmins *irh S.cli,n 70fl, ofDivi'ion I
<br />ol rh. Btr(i',.s,M Pmfc(ions Codr. r m! li.cnsc i\ ii full lircc od cffccr.
<br />\t
<br />EANSIBUI:UANuIIIIINCAGIiI'CI
<br />Ihcab!altrntund*nnrhyolpcrjuryrhdrhcrcil!con(rucrirLndinBr*cncyforrhcPcrlbrnEn.torrh.*orktuf,hichlhnIEn.irt
<br />i$ud (Scc. .l(r97, Civ C )
<br />I enify rhrt th. fcned Eslhthns EgardinB a.b.srd rcmvdl m not lppltobk l. lhh p&,xr.
<br />-l
<br />ccnif, llBr I haw rcld rhh .mlh,iion aid $ulc thal thc at-E iflfomion i. .onsr. I {8rs to conqtly qnh lll City &d Counry
<br />odinanccs und Srurc hws rhnE ro buildi.8 con(ru.riotr and ncreby lurhod. i.
<br />rbvc trrnriuEd pmpcny i, in\pdt,n lurl$sc*
<br />Applic. or Agerl Slgolu )4
<br />*-**';.ltil;Lf,
<br />UNDER GROUND .4.
<br />Waste & Vent ?1 lo,
<br />Water-Under floor / ''\-)
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent t J.r.,t '0 .,[*a n
<br />Water Pipinq /D)yt o\-,
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{raplDrain Line
<br />ltrlain 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 />I
<br />Rouqh Plumbinq Yt /rr>
<br />Final Gas Test tl 'ul
<br />Meter Release
<br />FINAL lp t I (Ti >r)
<br />Notes, Remarks, Etc UI
<br />ts(to o
<br />conrncror:)l_
<br />l. r' .
<br />^.1d,-.:
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<br />A.EEUIANLDECLAXATA!
<br />I hdry.IlnnuDdcr pctrrllyof pcrjtryo c olihc r.llowingd.cl0tuliotrs:
<br />Dcfr,liri,n Pcnnns-Asb.sos Notilicltion Icdcol Rcaullrions (Tirlc 40. Pr6)
<br />_Rcquncd blrcr ol Ndif{llion
<br />Dr Ullt)\
<br />Gas-Underfloor
<br />Back Flow Device
<br />,t ttP fttltt+"
<br />r.nc.erJ4
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