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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oTVNl]T BTIILDI]R DELCARATION
<br />Ihcrchyrlfir undcr NDrlry of pcrjury rhlt I .m excnrrr riom tht A,nrrocb^ l,iccnsc l]w nrrho rolk,wir! rcnwr (Sc.70ll s
<br />llusirc\\ nfrl ttorisiotr CGlcr: Any Cir, or Counry shich r.quics r Fnnir t, .rn{fl.r. dlrcr. nn,r)vc. d.nxtli\h or rclrn i(I
<br />nrudurc. rior b irs i\\urtr.r. rl{, ftqunr\rhc rlPlicdnr f{r \u.h p.mirb filc 3 {ilncd st orent lhll hcor dt n licci{d tl!(u! r
<br />x, rhc privi{i,N ol rl{ ConrG.tr\ Liccnsdd L,* (Chalrs 9. Cohnrn.nrg sirh S..riotr 7(XD .f Divnion I oi rhc Bu\irc\\ ann
<br />rttli.r turr|fnnirrlbjcdsrhc.IplicMrro!ciril,,cmIyolNrmorcrhrinrchundrcdddlhr(s500r.
<br />_1. ( o*trcr ol rhc rRrJrnt. {tr ny cnfl,)yN\ *irh sn[rs r\ rhcir {,lc {trnttnsd irr. Lvill Jo lh. work d llt srndorc n a{
<br />ificfdL{ orollarcd lor (ll! (5.{.?04-1. Bn{incs\ ird ProltsioN CL{c lhtOn r]cntr\l.tan\.li,sd.c\nordPllyronno}nuof
<br />rlrp(,I).ny sln' tn'iltl\ or nnpnncs rlf,Rrr, rtulwM do.\ \u.h s1'* hintrr]for hch.lfor rhtr,ulh his or ncr owtr cnrploycc\.
<br />|m^ nlcd rlrrr surh nnrfl{dril\ dc nor ir ri,ldd .r ottodl n, \rlc. ll. hosorr, ihc hnlklill8 .r irprcvcDrnr is sLl $ilhin om rtr
<br />otconrlcrion. rlrc Owmr tnri c. willhlvc rbc blrdctr oi prNiry rhlll h!or\lrJid rt hrild or iqmk rh. ln,Fdy ln, rh. |]uqr)t or
<br />-1.
<br />asowncrolrhc I'opcny, !ncxclusivelyconrraclins wilh liccnsd conrrloBr. consh.' llI pnj.g (Se. ?044. B$imrs
<br />.d EDr6sim Coder Th. Contrror's Liccbsc trw do.s 60l,pplt ro an owncr ofprotcny wfio b!ilds or inpn,v.l lhdcon.
<br />and qho contEdsfor such rojds *irh a conrhcrods) liccnred lxBux.r rorhcc.ntBcror's Li.!n* llq).
<br />I sncrcmDl un&r Sdrion .8.&P.C larrhs Eis,
<br />uolsEal:loMtENsarlt)!
<br />DECI,ABAIXIN
<br />I h.rcby omm tn.Lr lrmhy of ncrjlry oft ol lh. fouowim dccldalions:
<br />-l
<br />hsw !d*ill tuinl.h aC.nifo& of Cotr{ ro Sclf.lnse for w,ks. oq!.r$rion. &i lovi{l.d for by S.ction 3700 oflhc
<br />trhor C.d.. fM llE Fnol1rr,E ofthc wo for qhth lh. lshil ls isrucd,
<br />J hse snd will maimain m,k6 comp.ns.tion iBunRc. as rcquiEd by Selion 3700 .f llc Ubor C.dc. to, thc F.formft. of
<br />rhe sork for whi.h rhii pcmll Lc L$ucd. My workcrs ompcn$lion insuErcc ceir ud lolicy numh.r @l
<br />_l enify lhat in $c lcrfo.mRc oflh. wort for whi.h rhk p.rnrn is issucd. I stall nor cdploylny pcro. i. n.y mnncr
<br />$ os ro be6fl suhid lo th. wort6 or{tnslion laws of Califodia. and .g@ th.. il I ihould bc.om tubrc.t lo llE
<br />workss'com,'.nslior,rmvisionsoasc.lionlT(rOollteLltorC.dc,!nEU.i.nhwnhconplyvilhrnostrcvisio \.
<br />WARNNG: Flilurc ro scnr. so*cis' onFnsalion .oko8c is unhwtul, a slEll subjcr an cmPl.rtr ro dninal FMki* 3.d
<br />civil fin.s !p ro otu hundcd rhou$nd dolls {Slm.ooo). in addnion lo lhc cosl ofc.mpcnsdion. drm8.s ii proridcd lor rh.
<br />(idr. nn.r.i nnJanonicy \ f.rl
<br />J v
<br />DEII.AXAIIQ]T
<br />I hcrby afllrd uid.r p.6dryorpcrjury rld I rar 1i..tr{at undcr provhtu olChlplcr 9 (fl,mntncnr! wirh sc.rinr T(xxr)oiDivhi.,n 3
<br />ol rhc BurirEs\{in Pmb\i,,irCodc. dld nr! li.ctr{ h id lullfor.c d cflccr
<br /><-5 9 331r
<br />c()Nlila!.qlloNrEN.uM;-a1i[Nt.I
<br />nsucd rS( :1rn7. Ci!. C l
<br />APPI ICANT I'ECLAI'ATION
<br />I hrd,,lriin xndrr pcnrlr, ol p.riury on orrhclblk)winBdc.Lotions:
<br />Dcmnirion Pernrirs A\hcdor Noritl.nin,n F.dcrrl Rcgul i{,r\{TIlc {0. P t6)
<br />Rcq!nLi t.c(cr of N{niiLarir
<br />-l
<br />.cnify thor rnc fcdcdl rcBlldtions ,.srding asb.sros rcmovul a( nor JpplicabL ro thB tmrc.(
<br />-l
<br />ccnify rhur I Mvc rcad rhir aDp li.rrn r d{arc rhrrrh.rlyivc rnnrn i(nr
<br />ordinnnccs and Shlc ljws rcliring
<br />abow mntion d poFdy for
<br />Appli.ont or 8ent Sknalu
<br />L.4
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line << \I t
<br />Main DrairylPool Pipinq qzlsr,)toluv \\v /vvt w
<br />Fi ll Li n{6aci}i-tiD'r .*,..6
<br />Pool HeatEfaEfneqtlct Ll1,L\\b At"1@
<br />I
<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
<br />Meter Release
<br />FINAL lnla>/ts 1\'f(
<br />Notes, Remarks, Etc.
<br />Boof Drain
<br />Drl€: OEr..:
<br />LanJ.' \ A'jdrc{
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