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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />I rmcxcm,'r undcr Sccr
<br />t8 7-C-qc-^.*
<br />ltoaKtr&::.ColtrllNldllllli
<br />[l]sliLBAII0!
<br />I hcrcby0Snmundcr penllryoipcriury.nc.lrh. rolhsir8dNlarulions:
<br />IhavcindwillmainrainaCcditu,rcorconscntbScl,:l'NurcrirsorkcN.o rr.nslrio1.u\ pmvidcd lnr hr sNrn,n 37()O ol rhc
<br />tilrr Cdd.. fr rhc pcranrmncc oflhc sork lor uhi.h thc r.m i\ ksucd.
<br />-l hlh &nd qiu Minlain *ort6s' con!.nsslion insuhec, as rcquitcd by Serion 37m of lh. Lqb.r Cod.. for lhc F folnle ot
<br />thc work for ohich this pcm is is$.d. My *mt6 odp.nsdion inrut$. @Er .,n Int , nunb.r @i
<br />coNiBuqul')N!BuNli-atiIlct
<br />I hcEh, oftirm undcr [E.olry ot p.rury rhd lhcrc n a onslru€riotr lc{dine i8cnc, ror lhc PcrforBec oa th. wotk for ehich lhir lxrmn is
<br />hsucd (Scc.309?, Civ. C.)
<br />AITUIANTDECI.ABAfION
<br />I h$$y nflinn und$ pcnllty ol pcrjury otu 6rrh. rollowinB d(hBlionrl
<br />Dcnelirii,n PcrnrarsAsb.sros Nolificrlion Fcdchl R.eultrions (Tnt lo. Pun6)
<br />_RL!xir.d lrncr of Notifi orhn
<br />l.cniiyrhd rlE lcdcrl csllori{,ns rcBrdint asb.sbs tcn$vdlrc nol lmli.trhlc
<br />'o
<br />rhis rojccr
<br />:ial (n ily rhir I h,vc rcd r hi\ .!pli.dn'n nd slolc rhlr rhc xhrrc inlnrnNn,r $ cotrr.^r I !-!@ ro .omlly wirh lll cirv and counrv
<br />. 'ln.d\ rnd Srrrr If,\ \ '.hr'ro hiklins onsrrucrioo. ad ncEby aurhoriz rcrc{nla|its otrhir Cily lrd Coutrlylo cnrf upon tlr
<br />LG*--,-",t"
<br />€.\Cul Aa.ezr*
<br />t)rL4
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area,/Storm Drarn
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Waler Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release I
<br />FINAL 1 It $-\i/\1\.^*1A
<br />Notes, Bemarks, Etc U I \-/
<br />TOP OUT
<br />Fill Line/Back Flow
<br />Back Flow Device
<br />OWNER BUILDEI{ DI]LCARATI('N
<br />I hcrchy uilirr undc Enrhy.f rclury rh l anr cxcnrtr fnnr lhc Contacn,N'Liccnsc taw lor rhc ii,liowing rcastr lscc7{).115
<br />Businc$ u,l Prcicsn,n C'{ c) Atry City or Cotrnr} wnich rcquire\ r Fnnil h mnnru.r. ills i,trPiovc d.nrlish or aPln rnv
<br />{ru.rurc. tri(r n, ih i\surncc. nko rcqlncs lh. lpplicr ror \o.hIfmir k) filc r sisncd slarctunr rhd hcor shc n liccn\cd Ft\u,nr
<br />lo rhc PNvisions ol lh. Cohtd.rolr Liccnscd L!$ (ChlPrcr 9. ConrnkkniS sirh sccriotr 7xr) oa Divi\ion I o, (hc Business and
<br />fnlcsnhs C6dc) or rhd trurshc i\ crcnrpi rhcrcli. rMd thc brsh for lh. rllcgcd ci.mprn,n AnyviohrionolSccrionTl).ll15hy.try
<br />rlpli.rnr turapcnnii suhjccr\ rh. urrli.Ld ro rcivil!.nrlryolnormrerhan fir. huMrcddollrr (3500)
<br />K1t.,.-EY... $icrnrrhr0mnny.orm,un'nl',)cc\* h r JEc\ r\ rhrn v,t cotrrNnsnridr. *ill d(J lhc worl dd rhc $81urc n iol
<br />inrc Lt or Ucrcd lor vlc (Sc 70{.1, tsu{iftls d PnrLrs.ns Codc: I hc Conrr.nr'r Liccnsc IjE dl)cs nol aPPlt u dndsrcr of
<br />rhc pmncny wb build\ or nryrolcs lncNr and *ho d€s such {!rl hi'nrclfor hctsclfot rnmuBh hi\ or lM.$..nDloyc$.
<br />,n*idcd rhrr \uch imfbvcnEnr m ml inrc.,lld or olircd fu \rlc ll hoscv.r. rlE lBiklins or inDtuwd isq'klwilhinoncttd
<br />olconDLrior, rhc Owi* Buildd wrllh!!c rhc hurdc! olnovine rhrr hc o' sh. dil frn hoikl ur ililr(& rh. PR,rcnt {d rlE fr4rc ol
<br />Ar o! rcr "i r h. nmn n !. J r o( lu\ r c D rvnr(rns Bilh liccn\cJ .onrmcros ro otrnocr rhe pmjccr (sc. ?01'1. Busirrc$
<br />a'xl fiofd{bn Codc:'lhc Cotrlrrcrrr's Liccnsc t-s* do.\ norrltly r. rn owDcr.lrr.nlrrysho builds or nnJ)(Ms lhcrcon
<br />and *ho conrrrh lbr \uch ptujc(h wirh . Cbntmclo( s) liccnsd lusur.r b rh. (n.r,.u s Lisn\c I is)
<br />Policy Nun$rr:-ExPncs
<br />-
<br />.t-
<br />L-]t 4niry,r', ,',r'" p",rn,*ncc otrhc,nrt ntr whirhrhh p.rnrir is issucd,I shlll.or cmlkiya.rFson inonynroE
<br />$ 0eto tr.om subiccl lo thc *o*c^ L\,npcnurion l.ss ofc.lifomia. lnd aEn. rhd ifI should h.tom srttiNl ro rtE
<br />workcJl comr.nsnlion I'mvhiois {t Sccr ion l7m or rh. ld,r Codc I sh.ll. fonhwirh .onDly rnfi lhor pDlisionr
<br />WARNINC: Itillr€ ro ccuE workcn (,npcNrtion covcflsc i5 uhwtul, .nd shall subicl an cmpldlt. ro riminll FMhics lod
<br />civil fincs up ro onc hundrcd thous|nd dolllN ($100.fiD). in addnn$ to th. cosl ofcomircnsaln,n, daduScs rs rrovidcd tor lhc
<br />sccrion :1076 ot rhc Litu Crd., Drcrcn lnd tr mr) \ !e';'; ;rj "^-,*7?.
<br />-t^.--t <-r*". _-
<br />UIIII}&-(ONIIACIAB
<br />DICI,AMII!]N
<br />I hdftby.mrmundcr r,cmll, ofterjury rhdr I dm li.tns{d und.t F}vhion otChpro 9(.ommmitrs vilh S.*rion 7mo) olDivkiotr l
<br />of lhc Bu\inc$ dnd Phfc$ions Codc. lnd hyliccnt L in tuU rd(. a cfiecr.
<br />lxtrJfl . Nrrtr
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