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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 />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />ingGas Pi
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pi ping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn S prinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release IL
<br />FINAL a /zftt q/)
<br />Notes Remarks, Etc
<br />J
<br />OWNEN BUILDER DELCARATION
<br />I hcrcby 3inm !.d.r pe.rlry olprjury thar I d.x.rDr noD rh. Conr.d6 Lic.e t w for $. followi.e @bn (5*.?0.11.5
<br />Bui..s. .nd Prcf.sion Cod.): Any Ciry or Counly vhth (guiE. a Fmn to otrnru.( rlrd. impovl' &mlht or Erun rny
<br />srrucluE, p.br lo ir. i@Ec, d$ rcquic th. appli6t for d.h p.mit ro fi|.. sismd natcnml ttur lE or sh. ie licdr.d purunr
<br />io lhc rmvirioN oftlE Conlftcto.3 Lic.o*d Law (Cnlpt.r 9. Com.minS wnn Slcrion 1000 of Divirion I ofrh. Busin.s.nd
<br />Pof.sioN Coi.) o. tlul lE or 3lE 6 .x.q!l rh.,.fmn &d rlE tslii for rhc alks.d d.nnrion. Anyliohrbnolsc.rirn 7011.5 by any
<br />.ppliclnt for!Fmil bjr{l9llf,.pplicaollo!.av,l!.eltyofmlmcthanliv.hurdrddoUas($t00).
<br />_I. er 6s6 of rh. ,oFny, or hy .nphrln qith wasd s th.t $k 6trE Mliotr wiU &, rh. tu* n rfi. d.!.rE i ml
<br />int nd.d or ofr.Ed for eL (Sc.7044, BBim$ rnd PmfBri.N Cod.: l-h. Conlr.cld r Lh.n.. bw doB ml .ptlly io an ownr of
<br />lh. pDF ty wtb t ild! or i,poE itE6q at wlb .to6 tuch s* him.lf or lteltor thoulh hir or h.. oM .Dploy.d,
<br />!rcvidcil rhlr s.h inehtEEntseful inl6'.t dffo,H formL.ll lsw,ltE lruildiry or i,rproltrdnr ir sld qhhin om rw
<br />ofcotr{,l.lio4 itF Owrcr Buildd wiu h.v. th. btEhn otpmrine rhal lE or !h. did ml huild or inp6r rhc Dmpdry tlr rlE pulFe of
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<br />as owrur ofth. rml.nx .m.xcluliv€ly onlrrd in8 wnh LcenFd conlEcr.fl io oa{rucr rlE lmr.ct (S{.7041. Burh*
<br />..d Po&s&n Cod.: l'i. Conl6cl6* Liccns. ljw &rs mr lpply to an o*ncr ofpmn ny vno brildr or inDor! lhs6c
<br />of,d who onrE6 for NcnDmjek wnh a C.nl6cro(9 lt..{.d tltM ro th. Co.lB.loa s limr tiw).
<br />I h.r.by.Iliin undd n.Mllyof pdjuryon.oarhe
<br />_lh.vc&lwllnrn amiCcnii(lrcolcotrs.nrr' S.lflnguR tir \hlt.E conD.ns io . s rmvdcd lbr by Sccl r l70l)olrhc
<br />Lah.r ( odc. rirr rhe p6rbrmm. ofrh. *ork nr *h'ch rh. p.mr r rfl.d
<br />_l hsv. .nd *ill mainl.in slt.d con{r.ne.lion irsBme, rs requn d by S.d ion 1700 ol rhc L.bo. Cod., lor the dfom.nc. of
<br />$cerklorati€hlthFmitisisucd.Mywort6qrDpc@ri.niMura.mrids.dricynumb€rR:
<br />-l
<br />c.nily ihar in rh. l..fo.mrceofthc wort lor s,hkh rnis pernil is issu.d, I slEll not .mrloy any I].Ron in dny man..r
<br />m as ro b(om nbj.cr ro rhr wo&crc conpmrdron lAqs of Cslifomia. aDd .src. rhar if I ihoulrl l'cod. iubjei lo rlE
<br />rorkds' comr.norion Imviriom ol S.dion 3700 otrhc Llhtr Code I ih6ll, lf,nhwirh c.oply wnh llse povi.i.nr
<br />\YARN lNG Inilur. b *crrc work. ' .omrLnsnnrn c.\!mg. is unh{ 1u1, rnd shall srhj.rr .,, .'nploEr n, d'ntrtu] rMlri6 rnd
<br />\(.rrr )vrt .'l rl,rl.'l\, C.,'{ 'nr.'!n.,nLlrt{'.c!,1!.\ ?z )
<br />,",.- tr//1/b ,oo,,,,* >L -Lf-/ / r r( t\\9!'(J+(rx^( lok
<br />' *t**t
<br />' ''n
<br />of
<br />'hc
<br />BusiBs &d PoaBiioN Cod., ad my lic.r€ b in tull l6rc. r.d .ll..!
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<br />COlSIBUqnONJilDrNCilGliICI
<br />I hcrht afliirn undcr Fnrhroiprrudrlnr rh.rc is a consru.lr)n lcndirs.scDcy lix rh. lcrnrnnncc.trlE sork nn *hrh rhh ll(rnir is
<br />tsuc.t(ss. ll0q7.(rr (-).
<br />-l
<br />ccnify th.t rhc f.d.ml E8lhtiotrs Egadin8 Nb.nos r.mml m mr amlic0blc h rhis !mj.d
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<br />PolicyNunrb.r ltprc\:
<br />AttucAlLtl[cLAaA]IO!
<br />I nRhyommu.d.r pcmhy ofpcrjury om ofln Lllowrn! deldtioNl
<br />D.mohion P.rmn*Asb.sbs Noriicdio. [.d.r,lR.euLtions (1 nL 40, Pan6)
<br />-R.qurR:d
<br />L.tl.. olNornstion
<br />dircrhir rh. ikn? inlbirnirrn
<br />Applics or Asenl Slr.irt'm: K
<br />P.mIca,nrtp.im, K
<br />lnterceptor/ Clarifier
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