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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE lD/stG.COMMENTS O*n..Buitd.r D.cta.tion <br />I h€r.by rmrm unda p.m lr y ot p.qury tlsi I !n .r.nrfl lorm rh. Conlnctos LcB. hw lor rhe lollowins rason (s.c ?or I 5 Busi.6s <br />Md PruGssion Code): Any Cny or Counry whi.h icqut6 a p..mir to cosrrud..h.r. impro\.. dcmotih or rcpair rny sltuclur.. prior ro irs <br />ilsuncc.lls r.qtrts rhcappli.rnl rorru.hp.mit to fi1.. sisn.d d!r.m.nt rhst h.orshc i! li(.ns.d puEunnltorh.pro\istr6.lrhc <br />Cont..ror's L@tu.n Ltw(Chlprs e. Coomc.ci.! w'lh s.cldn T00oofDivD$n.] oarh. Busin6srnd Proi.sionr cod.) or rhar h. oi <br />!h. ii.rctrrfl lh...fron .nd rh. h.rir f.r th. .ll.rcd .r.nption .Any violarionofserion 70ll 5 by any.pplic! ror ! rcmn lubj.cls rh. <br />lpplictnlIoicivilp.n.hyoln rmi.$.n liv.luodr.ddolls(1500). <br />_1, a owns ol lh. pbp.rly. or my mploy.6 *alh w!a.r a lh.n sk conp.n! ion, will do lh. worl dd lh. nrucru. ir n6r intcndcd <br />.r offi.d f6r sl. ( s4 704{. B6rn63 hd ProlBrotu cod. Th. co.k...oas Lic..!. Law do6 .or .ppty io rn own6 of rh. prcpdy <br />who build. or inprov6 rhqon, ud lho doa iucn s6rl hiotclfo. h@llor rhmu3h hk or ha onn.dptoy*s, provid.d rhll ruch <br />impr.vcn. i r. mr inrcnd.d or ofcr.d for iil.. I L ho*cv6. thc buildirg or imporfr.nr i! rold *thio on. y... of coipl.tior. rh. <br />Oso6.Build.r will n!v.lt. burd.n ofproli.8 thrt hc orrh. nol build or inpov. for (h. porpos ol!iL). <br />._1, c oenr of th. propcny. d .xcl$iv.ly conln.li.B siih lic.rscd .ontrsctoB ro coNrtud thc Foi.d ( S*. 704a. Buii$ 6id <br />kof.sion Co.L Th. Conr6croa3 LE.ns. tlr dod nor lpp,y to rnoM.r ofpropaly who bu,l& or improv6 rhd@n..nd who <br />.onl.t.t lor luch prorers with r conr.cto(, lic.nlcd puBunl lo lh. co.t...ror'r Lic.nr. h* ) <br />_l m.x.mpi undd S..rion _.& & P.C. for thi! ,.en. <br />WORXERS CONTPf, NSATION DECLARATION <br />I hcr.by.,Iim ufllq p.nalry of pcrjury on. olth.follo*in8 d.clrr.tions <br />I hi!. tnd will minnin 6 Cfi ifictl. oacons. $ S.lf-lnsur. for wort.rs conrpcn$riDn. is pror'd.d lor bys(ron ll?ooofth. <br />Labor Codc- iorthcp.raormnc.oflh.work t.ishi.h th. ponit is isskd. <br />_I h,v. !.d lilldlinllD wolt.E 6Bp.@rio. '.su6nc., re r.qutr n ny S.dir. ]r0oollh.kbor cod.. forrh.Ddfor@nc.ofthc <br />wo,k for whrch rnis p.rm i3 issued MyworkcR c.nrp.Mlion insurdnc. clridmd poli., oumb.r arc: <br />. U,". t -J 9lr-t -s F.r* \*<., CO.. <br />Por'cy Nunb.r . 4q31o8 3So.--I e+i'*, tlO 2Q.lS <br />(Tnis 3.dion ,ftd mr b. .onpl.rcd ifrh. p.mn i br o|t. hlodrcd dolhR lS l00l or l.s) <br />_l c.rlify rh in rh. p.rfoMc. of rh. worl for which rhL Frmir i5 i!ru.d. I ,hill Ft .oploy ..y p.Bon in .ny m.nn.r so rs ro <br />tiernEsutrdcr brh.*ork€rs enrp.nsrnn hNs olcrlilornr. ani a-lrcc rhai 'rl t,t <br />con!.n$lhn p,ovitioB of S(rion 1700 oarh.lrb(rrCod.I shlll. aon <br />"*')4 <br />WARNINC F.ilur. ro r€cu.. *ort.6 @mp.Mtioi 6vs.s. !. lnLqtul, tnd .h.ll !u$j..t m cnployo io oimi.al p.Dlt i6 lhd .iv il <br />fin6 up lo onc hun&.d rhoE .d dollm ($t 00.000).i. .ddnior 1o th. cGr .l cosp.@rio.. d!@g6 s prcvid.d tor rh. Selio, 1076 ol <br />thG Lrbor Cod., 'nrddr tid ilrorn.y i ts <br />LICENSf, D CONTILAC'f ORS DECLARATION <br />I ht.by itnm udcrpcnallyoapcrjury rh l am lic.B.d undcrproyision ofCn.ptc!e(commcn.ir* $irh s.crion 1000)dr[,ntiotr ! ol <br />rh.liusin.$ and Prolt$ions ( od.. and ny li..N. i! in i'll ioE. and elTecr <br />riccnscCre: . 6 <br />D"., '/O. o2.l< <br />l-iccor l,mua a Q 92!Q <br />y. LIP B,,a U C* <br />( oNslRl ( t l(,\ t.t Nt)tN(:.\(;r\( \ <br />I ndcby afiim udd p.mlly orp..jory thrt rhc,. is, coGtruction r.ndin8 ra.n y for rh. <br />isiu.d (Sec. l097, Civ. C ) <br />AIPLTCANI"S DECLARATION <br />D.eolirion Pmits'Alt or Norifiuliotr r.dad R.rubdoa (Thk 40. P.n 6) <br />_R.quftd t nnof Nodfiorion <br />lccniaythrl th. l|d.Bl Eaul.lio6 r.sedins &.b6los r.60\!l!r. mi hpplicabl. ro rhir proj.cl <br />@-l cgriry lhlr I h.v. rad rl !appliorionlndstrt.tl ln..bovc intom.tion L.or.<t I .sr..lo comply * nh rlt Cil, lnd Coufly <br />tn..i rd Sur. Lwr.clriDg .nd hs.b, aulhoria rpr.s..ralitts ofthis City rnd Counly io mr.r upo. $. <br />abo\c n.dio..d prop.ny fo! <br />eppricant or tgcm sig. I <br />rcrmirrcc mnctprlal: K e ( <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Rough Water Heater <br />POOL/SPA <br />P{rap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />M isc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device )tb 9[t)lr5 <br />Rough Plumbing L <br />Meter Release <br />-'FINAL /o-S-/3 J/e{.-t-@)-t <br />Notes, Remarks, Etc. <br />lnsp3clion Foms\Pluftbin9-lnspaclor R6!od.doc 03.31.06 <br />Tub/Shower Test <br />Final Gas Test <br />o". {e- <22.!l <br />*o-d.e+-'q",, <br />:1(2 a2-15