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PLUMBING.INSPECTOR BECORD
<br />APPROVALS DATE COMMENTSID/SIG.
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor t-21-tO l)lJt -/9
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />I nterceptor/ CIarif ier
<br />TOP OUT
<br />Waste & Vent rQ,)r :kt
<br />Water Piping q\"".\/R
<br />Gas Piping >' ly
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain Drain/Pool Pipino
<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 ; -Zq -/A 6,)
<br />Final Gas Test /a*-G.J!(,t{(*t
<br />Meler Release
<br />FINAL I i -rv- r9 .'d
<br />Notes, Remarks, Etc.
<br />r)\lNt:R II ll.t)t:R I)l.L( \R1',l l()N
<br />I hcruhy lrfinn undcr pcnilry of pcriury rh l m cxempr Innn thc Co rrcror'Li..osc l!* lu rhc t lk,wilB rca$n 1sc.70ll5
<br />Br\inc\s ,nd Polcsion (ixld) Any Cily.r C.xnry shi.h .cquirc\ r Fnnir ro coned.r. rhcr. irntlrovc. dcmoli\n .r rcf^'n ,'nj
<br />{ru.rutu. priorio irs rsurtr.c, ah. rcquncsrhc aptlicmr ror su.h trmirro ilc!si8ncd srl'lcmnr rhlt h.or snc Ls li..h\cd Puhamr
<br />lo lhc provnnnr\ ol rhc Conrrncl,n \ l,iccn\cd tf,* (Chrfler 9, (i,mnrncins rirh sc.ln, 70(xr oI Ditisi,rn I ol rh. Ausinc$ rnn
<br />Pn)rcssi(,ns A'dc) or rhrr hcor\hr I u. rrrrh.rcrr,mandrhrh^nlnrrhrallc8cd.rcnni(in A,ryviol0riono{Scclt,i70.ll5hyxny
<br />aptlicrnr ftn.p.nnir sublcck rhc anfliclnr loa.ivilpcnixyol nor nrncrh.n tivc hunlnd dollm (5500).
<br />-1,
<br />as own.r ol lhc tmFdy. or ny .a'r,loFs wilh *.9.s !s ttun sh con .nsolion. {ill do llE *tr* a'd lhc aret@ n rci
<br />inr.ndcd or offcrd for slc (Se.?044. Businc$ ed Profcssions Cod.: TIE Co.r&roas Liccn* Lae docs nor 0pply lo $ o*Nr of
<br />fie poFny elb b{itir or irUrcB t @n. ffd wlh d66 Mh srt hanicf or l*Mlf or dmu8,r nis or hs opn ctrtttloyc6,
<br />pbvidcd rhul seh ir{,owft.B e ior hrcdcn o, oficrc<! for eb. lt ho*w, ta buitdi.C or i,ilmEmnl is $td onhin onc jta
<br />of@'rykrion. rhc OwE Buildcr wiu lEw llrc hln a ofprcving oul hc or sh. dll ml build or inpmE rhc proIEIy fd rlE II{FE of
<br />-1.
<br />trsowncrolrhc Dot.ny, amcrchsirlyconrructing qirh licc.sed contrucroN ro.onrurcr rlf r.ixr (Sd.7041. Bu\incs\
<br />&d EDBrb. Gdcr Thc Conreroas Li...rc Lle d6e. nor appty ro a, 6*ocr ol fmFny who builds or improvcs lhcrco..
<br />and afio onttrlslbr such rmjcc|s wirfi a Contmcro(, li.cnsd ,,usuoir h rhc Confa.rols Licens liq)
<br />-l
<br />omeicnpr ullccr Scctio B. & P.C. forthir ed$n.
<br />u0axr&5:]coMtBtAr0!
<br />DECI,ASAITA
<br />I hcrcby nmrn u.dfi Dcr6hy of rEriury orc ot lh. aollowine declardions:
<br />_l hak ad will tuinrrh . ccrrifMrc of con* ro sclf'lns!rc for ertd @nDcBario[ 3s pmvidcd for by scrion 3?m of$.
<br />Llhtr Codc, for lh. pafollMc of lhe mrt for *tkh lh. psni n iswd.
<br />IhavcrndwillnEinrdinworkrJLnnl|lcns0rionin\urikc.dsrcquiftdbyStrrion17IDoIth.tihorCodc,forlhcFrfolmanccoa
<br />rh. work fd which rhb p.mi! i\ iisu.n. My e.rk.rs onp.nsdion insur.ncc cffiicr ori lolicy.umbcr uc:
<br />P,'li.vNunhcr: ErDm!
<br />_l c.niry lhar in rh. F ormmc of rhc work ror which rhk ,rmir h nsucd. I shnll mr cmploy afly pcNn in uy dancr
<br />s as t, bc.o'B subj.cl to lhc *orkc6' .omtcnsalion laws of Califortria, ond agN lhal if I sh,lld hccom suh.id lo lrx
<br />workdc conFnsrion tmvhions of Sc{liofl 3700 of lhc L.trr Codc. I drll. aonhvilh conpl, wirh rlhs nn,vtlions..
<br />WARNING: Failurc lo $curc rcrtcB' compcns0lion svcft8c k uohwtul. and shlll subjcct an cmplorrr ro didin.l lxMhas tnd
<br />civil 6ng up ro onc hundrcd tk,usd doilau lSloo.uro), lddniotr to lhc cosr ofconpcnrario.. dlnEg.s as pmvid.d ror lh.
<br />S..rnr 1(rrar.rrh.rrl.tr(1xl. i'ncr(xnd
<br />t)u( t. (R \r t0N
<br />I hcNb, amrnr utrdcr rcnslly oi tcrjury rtu I am li$nsn u cr pnviii,. orchnprcr 9 (.unnr*ncnre wirh S€tion r0O0) ol Divish -l
<br />or rhc Busnr\s,nd Pmrrssionsaodc. and mylicctrs is ir lull lor.c ond clIccP
<br />\^+'> 9 -7o t-\ta
<br />D<.?.o ..{ i. >
<br />CONjiIASCIIANIENDING.&GEICI
<br />I hcNhyrmflnu&lcr pcnahyollBrjryIhst lhLic ho.onsrrucrion lc in-q u8cncy f{tr rhc l.rrdu&c or rhc sork lor which this Frnil is
<br />i\s!.d (Sc. :1097, Ci! C ).
<br />AIfUIAI[DtrCLAAAIII]N
<br />Ilrtrbyrnn,trdddNn lryolfcrltrrt.mol rhcliilkrtrnrtdc.lnhri(rs
<br />t).nn)liri{)n P.rmir\ Ashc{o\ Notn.rri({ FcJ.Bl Rcgrhriinn(rit.t0,Irr{6)
<br />Rcqrnrd I-d(.rol Norifieri(in
<br />-l
<br />ccnify thot rhc f.dcfrl re8ukrions Esardins astEslos rcmovd qrc mr a,,pliclbk ro lhis lmirl
<br />_lcrniiyrhlr I hxrc rcad rhi\aptli.art,ndd ddc rh ihcah)rinf,nmdk n.omct.I rlrcchonplywilnollCnyud Counry
<br />ordinai.$ md Srarc Lawq rchri.A h bui nrg nrorivcs ofrhh Cny lnd Cou.ryio cmor rllon 'r.abovc nEntioncd pmlcny for
<br />lr,If,M
<br />Area/Storm Drain
<br />n </tlt8
<br />L.rnd! Addls'
<br />-
<br />*,.i S/t-lZ
<br />tK*
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