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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 />Buildino Sewer
<br />Area/Slorm Drain
<br />lnterceptori Clarif ier
<br />TOP OUT
<br />Waste & Vent l-/4-r9 , /.).1/Q 1?)
<br />Water Pipinq
<br />Gas Pipinq
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main 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 />Back Flow Device
<br />Rough Plumbinq s-72-/a,.hJ*.@
<br />Final Gas Test
<br />Meter Release
<br />FINAL ba8-/8'//.fDh ':!DNotes, Remarks, Etc.
<br />OWNDN BU!LDEi DI]LCARA'I'ION
<br />I h.rcbt rlllrm trMcr pctrrlr! oi pcrjry rhd I nm.rcnr fom rhc C.ntrdou Li..n\c tjw r(r rhc i(nb{i,r8 ,caen 6 cc 7o.l l 5
<br />8u\nrs rnd Prolcssion C.dcr Any Ciry or Corory shich r.quircs r ,krnrir ti conirucr, !llq. imF)v., rknnth or rcr0n nny
<br />srucrurc, pritr t, ir\ i\\!an d. rlkr r.qunc\ rhc rmli.a fd su.h tEnir ro lilc a siEmd srlrcmnr rhsr lE or \hc is li.ctrtd |[Fulnr
<br />b tl[ pn)rni.Ds ol rhc Contrcxn\ Lkn\cd Lrw (ChrJrlcr 9. Gnnnlo.ilE sirh sc.rion 7{xxr oI Divkion.l oirnc B!sin$\ and
<br />P,ofcssionsaidc) orrhrrhcorshc ngcnq,r rh.dr. udrhch!\i\ntrrh.rlirlcdcx.mflion Atryvid$ionotSecri ?0ll5byroy
<br />6pplicanrrurrrnnir\!hjsr\rhcJpplicanrr,rciviltrciahy.imrnucrhrnlirchunnrcddoll.r(S5(x))
<br />-1.
<br />ss o*mr of rtc Impent or ny etrglorrci snh wlrcr &i th.n sb @np.nsdion. vill do th *!ik 8d tlt $tucl@ t mt
<br />i.rerdrd o, o,IcEn for sb (Sc.7044. DusiE$ tr.d P,llclsionr Cod.: TIE Conh.lols Lien* Liw d@s mr ,p!ly !o d owmr of
<br />rh. ropcny llshoildsorin.aBrr6En.,!!dwt'dcMhsahimsclrorherelrorlhmu3intorh.roMcnployc.s.
<br />lrovid.d lhli sEh impmtmnrs N ml hrod.d or otu for slc. li how.6. rlE bnildihs or in?mwmnr it $ld withr orc Fa
<br />ofconplctt'tr ln osn.r Builder will fiarc rlf, hd.n olproving tn.r he or shc dil tur build d idIioE thc |,oFiy for llE turys of
<br />l. as own.r .f rhc pmrcny. am cxclusivcly corrE r in8 wirh li.enscd .onlncbn ro .ustrtr l 'lI pmr.d (S.c. ?044. Busin$\
<br />!fld PlDftsion Codc: Thc Co.lnclor'. Lj.e.* lje doc..or appl, ro 3n owncr oftmFay *ho hlilds or imrmvc. thcr$n,
<br />and vho smEd$ for such pmirls wirh aCorrruronO lt.nsn purunr rolhcCo.tradoi. Lie.s. t *).
<br />I dcxcnrd undn S(uon .B &PC for'hir(!s.
<br />lloa5E8s:coMfEtarlaN
<br />DECLAN-ATI(iN
<br />I hcrcby flmrn undcr pcnaltyofp.rhryoncotrhc following dcclddrio.s:
<br />-lnsvc.
<br />will minrain r Ccnificatc of ConFnr ro Sclf.lnsw ftr so*oC ont trelion, $ pmvi&d for by SElion 1700 of the
<br />Llhor Codc, for rhc pcrfoMc of thc mrk lor shth thc pqnir is issu.d
<br />I h.rc rndwill minrain sortcri omF.sarion insur.rc.. a\ rcqlircd b, Scclion l70oortu ktxx Codc, aor lhc pcrlomftc of
<br />lhc wort fm phich lhis n rmil is isso.t My *orkc6 on{Enerbn insrr.m. .aEkt ard lDlty numh.r ac:
<br />Policy Numilci-Expitcs
<br />-lcenifyrh
<br />inthcr'e ormrcof r,E wo.l( for which lhk p.roji i. ksu.d,I shall not e,I!lo, a.r r.rsn insyronn.r
<br />$ s io bcstr suhirt ro th. wortdl arlPcn$tion laas of Cdifomia, lnd slr thd ir I slruld hc.om sublrl lo tL
<br />*0116 smFnslion,mvtbns of S.nion 1700 of llr t tor Cdc I slall. fonhwath otrlply silfi lh$ pmrisiots..
<br />$ARNlNcr Fnilurc n' $curc $orkcrs conrp.n\dnnr .otcrlsc is unlawtul. and \h,ll {bli,.r {r .nrrloyr. t(i rinriml rtulri\ aid
<br />.iril litr.s ut' ro otrc hundrcd thou\und (lolhr\ (Sllr.()(xr), in rddni{in b rh,- on olco.llfnsrlidr drrBgcs as p!,vilc{l tu rhd
<br />s.fl..n rr/i,.,r rl,.l Jhr (ndc. ir(c'c r onJ rtr.1m) \ l.(.
<br />ApDlient
<br />IICENIELCANITACrcA
<br />DECI,Af,AIIOI!
<br />I hdby sfrn udcr Fulry of Frjuy Lttil I m l&.ned u.dq Fvision of Ct+ld 9 (oltftmi.e with S..ri,! ruo) of Didtion ,
<br />of $. Blsims lnd Pbfcsios Corh. dd ny lkcM i! Ii tuU foc &d elTe.l.
<br />I-ir \c Ch\s Li.cn\c Nun u
<br />COXiIBII]IIOIiIEIDINGIGEIII
<br />I hcEny offirm unncr lEnlhy or Frj!ry rhi rh$. n a onnrudbn hrding d8cnc, ror lhc pcrformRt ol rh. w.rk ror *hich
<br />'hn lErmi n
<br />i$x.d (Scc 1097, Civ. C.).
<br />AIII.ICANLDECI.IIAAII{I!
<br />I hft$y omm undcr pcnclty oI pcrrtr, onc orrhc tollowinS d.cldrdri.ns:
<br />Dcrmlir,on PcrnirlAsb.nos Notifi€orion ltdcml RcBubtions (Tirlc 40, l-lno
<br />RcquiEd trtrs olNorif$thn
<br />-l
<br />.eflify that rhc lcddal rcElhrions Egldin! srb.{os rcmvd dc nor .rplic"blc lo thh rojccl
<br />_l .6rify rhlr I hrw rcad rhii rpplicsrion $d sal. rhd rn( ,hor i.fomri.n is orer, I ag.€ ro omply wilt 3ll Cily lnd Couity
<br />ordiMftcs dd Smrc Ll*. Ebring to brilding corulltr.iiotr ad heE$y aulho.ix EFcs lrivcs otftb Cny ad Counly lo.nts upon lh.
<br />abovc mnrkr*n pmFny fr icpeton punmi
<br /> Dpli.sr or agenr siEn.r
<br />-
<br />Roof Drain
<br />Lrndd'rN@'-
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