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PLUMBING-INSPECTOR BECORD
<br />DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{raplDrain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release IM",FINAL 1/73h.f, r,I
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCAIATION
<br />I h.r.by.ffEn undcr Fmlry ol rEiury rlur I @.r.mpI tbo rlE C.nrh.rm' Li..ns l,w for rlE foloqing r&$n (S4c,7011,5
<br />Dosituss sid Pmfcsion CodG): Any Cily or C,unr, whth '!q!iEs ! Icmi lo .oNlrud. dro. in'rtmvc. .hmlirh or EF, ry
<br />$trt!rc. prir lD irs hsl!!e. &!o (quiEs thc applicm for such pcmi m nk ! riSrEd sralcEnt thd h. or slE ir licned p!N8
<br />b lnc pmvilions of the ConlEcrols Liansd L3w (C'lEprr 9, Conmtuin8 sirh S*ion ?000 of Divkion 3 of lh. Blsire$ ed
<br />Profcasions Codc) or lhar hc or rhc k .xcnfl rhcchom and ,E basir aor rlE dhged dcaprion. An, violdion ols..lbr ?01,.5 by any
<br />! ,limr for ',cmit rubiccrs thc {ppli€.r lo . civil pcolry ot ior mrc lha ,ivc hundrcd dolhB (l5m).
<br />-1.
<br />&s owftr of rh. FotEny. or ny €.plor.cs with *ages !s rlEn $k oq,cnrdion. will do th. *(t &d r n 'ElE i! mr
<br />iotcnd.d d offotd lo, $h {Se.7044. 0usimi! aM Plaf6.io.s Codci Th. Conhloas LieN trw &i.s ml .ppl, lo s owmr of
<br />lhepoFny wh. hikls d itrptuGlncmi, !d wtn &E n mlt hinsclf.r hosltor lhDlgh hi! chdown.npl'r!6.
<br />provilcd rh!| su.h inpolmiti e d hisid.d ft o,IcEd for $lc. l( lnew. thc t{ildins or nr$rNm ir $U qlnh onc te6
<br />ofcorDlcrbn, ttc Os*r Blilds piu h.w te tddcn of nFvinB tlEr h. or snc did Nr hild or ittlN ln. poFny tor lh pulb* of
<br />_1, a\ owndr ofrtc pnncdy. rn.rctusivcly.o.rEcrios wirh li.en{d.onrn toa ro onjo.l ltE |,oirt (scc.7044. BusinAr
<br />otu Erfesi'n Codc: Thc Conlrucbls Liccnsc tjw docs tror trptly ro !n owncr oftr.pcny*ho builds.r imtmver rh.ro,n.
<br />lnd who .o rocrs fu \u.h rbicck unh d 6.rrd.1or1s) li.ci*d plrxanr iu rhc Conhcrors Liccns rlw).
<br />-l
<br />am.r.nfl u.dd Sel
<br />EOAf,EEIIIOMIENIAIIOB
<br />DECIdSAIII}!
<br />I hcrcby s,nrm und.r pctulry of pdjury om of rhc followinS deLmrionri
<br />-,
<br />hlvc o,n will minrain . C.nifr.rc of Con$nt to Sclf-lnsurc for *orlcn comgcns€lion. 6 prcvidci fo. b, Scclion 3?00 of ln
<br />rr$ Cod.. lor rh. p..lo,mmc of lh. Mrk for ehth llE Fmi ie nsucd.
<br />_l tavc and sill mainrain sortcs .onrFnrur iod inslEmc. as rquircd by SNrir 17m of rhc kbor Codc. for rhc pcrlormrc ol
<br />o^t t{-,
<br />o I I 4
<br />_l ccnily lh,l in thc r,.rformNc ollhc qork for which thn Frmir is issu.rl.l shall ml cnploy any Fcrsi in uny om@r
<br />s us ro t om subjd to Ih. *orkc6' .on{Enssrion hss of Cdlifomi!. ond !8e rhd af I should b€.m 3ubirl lo llE
<br />*olt6 oq,.nsrion pmvisions of sdhn 37u0 oa rlE L.hor cod.. I slBll- fonlisirh @dply eirh rhoe pNvtionr..
<br />MRNINGT F{ilxr ro sue aortcu $qrnstn'n .ovcmec is unlawful. and sholl \uhj$r $ cmplortr l. difrinol !.mlrie md
<br />ro om hu.dr.d lhorsand dolles ($lur,fiD), h uddilbn lo lhc.osr io., damgca as [ovidcd for 'h.::ylL7tr nr.rcd,nd ntornv \ f.cs
<br />tlt,( 1.,\R 1t t()t
<br />I h.rcny nflnnr undc! l.nlllrotpcrjlry rhlr I am liccnsn undcr pnvnionorChlprE 9(.dmmkin8 wirh S{lbn rdJO) ol'Divhion l
<br />oI rhc Busincss lnd Prcfcsriotrs Codc. 0 nry ltctrc ir itr {ull lorcc ad cfisr
<br />YakXI,.tli
<br />IA!flBIJqIIANIINI2IIGAGINCI
<br />I hcrcbt l,lfln umlcr n nrlrvofllrjrry rhd ihcrc is r.otritucri)n hMirg rlcfty f.r rhc nrrlbnnm.c ofrhc $ort fir *hich rhi\ Fr.,ir is
<br />i\sucd (Scc :l0i)7. Civ. C.)
<br />AIIIICANLDECIIBAIIO]T
<br />I ltfthy drm u.dcr pcmlry of pcrj!ry orc of lhe fo,lo*in8 d(larations:
<br />D.molition Pcrmit3-Ash.slos Notifi.alion Fcdenl R.8!hlions (Tilh.O. PM6)
<br />-Rcquired
<br />Lllcr of NolifMlion
<br />--zl (nify rhur rhc fdcml(Soldrionl rcgedrg d\be<o\ rcmv,l@ mr amlmhk ro rhs pmFr.
<br />al cdrrt rhd I h,!. rcrd lhn.pl,lrruonsnd $atc rhd thc shorc inforrolion iscoml.l aSre to.omi,ly*irh aI Cnydod Counry
<br />odinamcs lnd Sr.rc lr*s rchrii8lo building cnnstru.lion. uxl hrchyaurnorit rq,c*nkrivcs ofrhir Cnyaod C.unr
<br />"bovc
<br />ncnrioncd rmp.ny for in{,ccibn
<br />I.{pplionl or AEetrl Sianolure
<br />ulr(Z
<br />r
<br />IAPPROVALS
<br />Water Service
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