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APPROVALS DATE ID/SIG.COMMENTS UNDER GROUND Waste & Vent Water-Under lloor Building Sewer Area,iStorm Drain lnterceptor/ Clarif ier TOP OUT Waste & Vent Water Pipinq Gas Pipinq Rool Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line q\\q\\u .^u44(1 It/ain Drain/Pool Pipino 7z--'-''b'/'/q aa Pool Heater/Gas Line P*A.r-7//ltlrl q(6 Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Bouqh Plumbinq Final Gas Test Meter Release FINAL Notes, Remarks, Etc. OWNT'R BTJILDI'II DELCARA'IION I hcrcby nfinn und.r ltnalry ol p.rtury thar I im crcnDr imr thc A,nlnctna l,icen\. Ij$ r(tr rhc rolkr*in8 rc,$n (sc.70ll 5 Busincs\ and P,otc\rnrn Codc): An! Cir, or Connry *nicn r.quncs r F.mir b .onio.r. rlrcr. nnlrovc. d.trhlhh "r rcwir dtry ntu.ror., trirb n\ i\\uanc.. rl$ rcqrncs rhcinlli.rtrr ntr su.h Fnn[ lo l]lc, siencn srlrcm lnd hcor lhc i\ li.cnscd tu^ua r,, rh. ptrivntnr\ ol'rhc Conklc(r \ l.ir.n\dd lr* (Ch,fl$ 9, Co'ntun.$g rnh Sc.rion Tuxl of Dilhion .1 ol lhc llusincs\ lnd Pn,fcsn,is(i c)orrhrrh.orsh.i\cx.inflrh.r.lionrMthchrsislorrherllc8.dcrcnrnlion.AnyvioldionotScrrkn?0.ll5l,yri, {pli.rnr rorr rcnnir suhlchrhc rpnlicnnl baciviltcni[yolnol nmrcrhrn nve hhdtd dollm (S5(n) _1. as osn ! of rhc prop.n y. ,n ny cnll lottc! tr irh $r!.\ rs Ihsii q,lc .o rFn\rl irtrr. sill Jo rh( *o* .nd llrc slruhrc i\ idcnd.{ ordll.rcrlfor srlc (sc 1011, Busirc$ od Pi'tu$nnN Ctrlc I hc Cnnrlcntr s t,ien\. U* do.\ ioi lntly tu m o*.c. of rhcptriFny who 6uikl\o' i'npn)vcs ihcr$n. s sho d(r\\u.hM)* hnnscllor hcr{lf.r rhrru8h hi\ or hcr o*n cnuIoy.r\ fr.vii.t rh su(h nnpntrTnrnrs e mr inc ct .r oftcrn hr !,1c. ll l.i'sc\ cr rh. hliklinB .. iqnorBnt h $ld wirhin nc )rr of.otrDlcrirr. rl'( Owtrd Burkld trillh[r rhc budcn ol pnlvhS rhlt h( or +hc dil r! huiu or inwovc llN rolf,nt for rhc purjxrc ol -,. .s owrcr of thc FoFny. an crcllsivcly conrrscr ins wnh [ccnsd conrdclG ro ..nsMr llf, pDrcd (Scc. ?o44, Bu\ifts .rd hDfslbn Cod.r Th. Conrm.rors Lic.mc tiw des.or.!olyro atrowncr oftroFny who builds or improws thed,n. rtrd wno conttucrs for such pmFrs sirh a Contrscro(s) liccnscd pursuur ro rhe Conu-acror'r Liftnr L!s) -l amcxcnDl undcr Sation-, a. & P C. lor rhn Ea$n D8re: Orne Itaxf,Eis:cl)urENtArlllN DECLASAITqN I herb, dlfird !.dcr lJcnrlry of rojury .nc ollhc followint deldaiions: -l lE!. rn will minroin ! C.rrif.areof Codc roSclilNefdtrrk6 @nFisrion. rs Fovncd for 6y Sdlion 3700 oftk Llbor Codc. for thc psfor,rm. of lh. mrl for whth llE osnl is nslcd, _l hlve and will mainrah pork.s compcos.lion iNur0Bc. .s ..quted hy Sd ior 1700 of lhe Labor Codc. tui rhc Polorromc of rhc qorl lor shich fiil p.mn as h$.d My work6 ompcn$lio insftre cMi.r rn policy .un$cr d: _l ccniiy ihlr in thc plnhrinancc olrhc wo'k fitr whi.h rhi\ pcnnir t i\\ucd. I shnll mi nn! pcron in any nrn.r $ as ro tE 5m rublrt k, rhc work s .omlEns.rion laws ol C.lifomi.. and {odr.i d,npen{tnri ln)ytions ofsc.rion 1700 ofrh. tlt rCodc.l j.cl un cnrployq lo rihinal Fmhics md ion- datuEG ar pn,vid.d fn rhc ncin8 wilh Satbn ?000) of Diti\ion l ol rh. htrinr\\ x d Pn,l.l!o Codc. !d my li.cne ir in tull loEc ud I h.Eby !,Iro uod.r ncn.lry ol Fqu.y rhd rlm h ! connddio. lcndine aBcfty for lhc tlcrfomrc or rh. sort ao. whkh rhis Imt h hsu.n (Sa. 109?. Ci!. C. ). l-BfLlCAIiLDEllAtrrlIl0N I tRty nmund.rl.nrlryrf tlrjuryoitr of rhc inlhqiredccl nii(rr: Dtnn'liriqr l,crnils A\txdo\ Norili.rr!,,n Frdrrrl R.grhrnnr\ I I'irld 40. Pan6) -l{equn (l Idrcrol Norillcrri{m l!rc tror Jppliclhlc t, rhi\ nhl..r abvc int imrion is comct I agN lo ompl, wifi all r. ,rd hcEby .u'h.rir rclrcsnl.livcs of rtis City 6nd Pemir@I\( 6 2 PLUMBING-INSPECTOR RECORD Gas-Underlloor Fill Line/Back Flow q*5 Foalryofpruury rhlt I am liccnsl uRh, povtn)n tf,nd.i" Addc$'- I _l