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PLUMBING.INSPECTOR RECORD <br />DATE COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under lloor <br />Buildinq Sewer <br />Area,/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Test <br />Bouoh Water Heater <br />POOL/SPA <br />51P{rap/Drain Line <br />Main Drain/Pool Pipina 5L159 c ?4 t9 /{J'4L4(',a ) <br />Fill Line/Back Flow <br />Pool Heater/Gas Line f7 s I t Utzat ) <br />1 <br />Gas Service <br />Waler Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meler Release <br />FINAL <br />Notes, Remarks, Etc. <br />OlINER BUILDEI' D .CARATI()N <br />I hcrcb, nfirn undcr p.nalry or r.rjury ih{ I an cxcrnpl tnnn rhc Cofta.n"s'l-ic.nsc ljs tor rhc rdk,vir8 rc0lln lsl.7o.l15 <br />Bu\irc\\ rnd Prindsi,'n Codc) Any Ciry or Coury whic[ rcqurt\ d |fn r x] c.n(dcr. 3lrd. inr[otc, dlr.di\h .r r.Fir atry <br />{n.rtrrr. l)rirk, irs isu f,c. rl$ rcqdirc\ rh. rptlicrnr ror iu.hr.nnir lo lilt r \ig.td nsrNrnr rhd hcor shc i{ li..nscd n!N$r <br />l lhc povisi,nr\ oi lhc A,nrn'.ror's l-iccn*d l,ow (Chrr.t 9. Co'nnrkinr wirh Sccli'r 7(tx) or Drv ion :l oi rh. Busincs\ m <br />Pn,fc\\i{'n\ Co,lo) orrlrrhcor\he iscrcmpr rhcrcftona rhr h$is fnlhc rll.Sd trcnlflrn'n Anrviol!rionofSc.ri,)n70.ll5bvrny <br />!p!lic(trlforrncanirstrbj..trrhc rfpli.anr t, !civilNrtrlryolnor'norcrhnn fivc hundrcddollar\ r!5()0) <br />l. d owncr olrh. !$prny. or my cnlllt.ycc\ *nh hg.\ $ rhcn $t c.nDtnlarn,n. silldo rhc $ork.nd rtf, (duc i( n.r <br />icrrdL\l orofitrcd l(, slc (Se.' 7odr. ansincsmd ltolcssion\ Conc:'thc Cotu!.rtr \ Li.cnsc Lcw doci or ,rlly to on otrncr or <br />rhcpoFtny *h, hilds or irnpm\cs rhcFn. rtul *ho dms such k,lk hnnscllor hcrcllor thn'u8h hi. ot hct o*ncdphyes. <br />nmvnhd Ihnr such irn0rotcEnh d frn i ctrdLt o ollcNl fo. \rk li ho{ cl ci rh: bnilding or iq,tr*crnr is nrkl $ithir" 'n. Jtr <br />ol(,rrldri'.. rnc Owncr Auiilcr willhrvc rhc buidci.flroling drt lr or shc did tror tDild.r ir{rovc lhe Pmpcny fd (hc Pu{rJEol <br />-1. <br />No{ftrofrhl Ir pqry, am.xclusivclycoilractinS eith li.enscd conlraclou lo oNlrud tlt r,ojcct lscr. ?044. Bu\incrs <br />rJld h)tssbn Codc: Ttu Conlnclo* Liccrc tie docs mr.pply lo an o*nc, oflmFny who builds or imProvc. lh.ron <br />ond who co.rErs for och prcjels Nith s Conlnclo(9 liccnscd p!6@r <br />'o <br />rhc C.ntr..lois Ltcnsc lls). <br />I n cxcru urnlcr Ssrion-. B. & t'C lor lhn r.rnnr <br />woRKEfs' coluPFnlsaTloll <br />DECIASAtrON <br />I h.rcb, alfird lndcr p.n"xy of p€jury om of rlt followin8 dd@rionr: <br />I hrvcurl{illnui rinrCcnilirnrcofc.trsc.l!)scllrltr{rcrnrlvorkc^'conY'cn{$ion.r\P'o\ntdnrhvSccrir)n:17(x)olrhc <br />Irltrtr (ixlc, Lr rhc It,li)m!u.c ofrh! \ork tu trhtlr rlt rcnnir i\ i!\ucd <br />-l <br />havc lnd *ill tui.rai! v.rkcB co,ry.trsuliofl insuiamc, os rquncd by Scclion 37m of lhe Lrho, Codc for llE I'.rfomm. ol <br />STTTE <br />h ksEd. My wort6 comtcostion insoiMcc Etr dt polic, nlnhct ml <br />FuAo <br />t/_ <br />-l <br />ccnify rhar in rh. tcrrorMNc of $c wort for which lhis pcrmi! is tsucd. I shall .ol cnPloy any Fson in anv m.nd <br />$ e\ ro bccom subjcd lo thc sorlcB'ompcnerion hwr ot C0lifomia. &d ,8N rhll il I shotld bccom sulticr ro rlE <br />*odor.o.rFnsrionpovisionsofSerion:1700ollhcrjborCodc,Ishsll.fonhwirh.omplyenhtts*pmltiotr3.. <br />WARNING Failxrc ro surc workcF ompcn\ari.n mrtfl8c is xnllqtul. lnd rhlll *utFr m cnll,h}lr lo di'nindl lEMllics and <br />.ivil lircs up ro .n. hu.drcd lhotsand dollaB (S .o of @nFns4ion, dlMgcs ar Providcd for th. <br />Secrioi 1076 ofih. tiho. Codc, intcrcsr ddL<^ <br />A <br />DEII.A8AIION <br />I hcEhyrl|trnr unn$ p.naxy.fDcrjury rhsr I nm liccnwl undcr pn'visio..lCh0plcr 9lcommncinE wnh SLrtion 7O0O) ofDivision l <br />.. rh. Bn\inc\s ,nd Pmfesiur Cod.. rnd nry ltcnr i\ in ,nll forcc g!-9llilcr <br />z <br />.vr2-r ouJ <br />CONS'I'RI]CT!(IN I FNDINC GENC'V <br />I hcrcby rflir undurpcnahyolNrjuryrhdihrcisd.onstd.rirtndinsoEcncyrDrrhcFribrmlnccofrh.*orknrwnkhlhhIEnnilir <br />nslcd (Sec l{}97. Civ. C.). <br />AfIU{:ANIDEICI.ASAIION <br />I ha.t'y .ftm u.der pcnalty of p.rjury oE of dE followinS d.chrutions: <br />Dcmlirior Pc.nir$Asbcslos Nolificdion Fcd@l Rcguhtionr flnL &. Pan6) <br />Rrqutcd tr(.rol Norific i,n <br />l.cnlyrhrr lhc fedcr.l rcsula ri.B rcg.rdi.8 .shcstos r!n$v!l arc mr appliohh ro rhis proirr <br />I ccniiyth l hnvc rc rhi\trpplicirio corccr I oBrN lo comply uirh allCilyBnd Counry <br />,cpr$cnrrriv.s of lnjs Chy and C6sly to <br />ub.!c ftnriomd prop.ny lot <br />Applig l or.\xrnl SiAnrl0 <br />?t <br />APPROVALS ID/SIG. <br />Gas-Underfloor <br />72 <br />Miscellaneous <br />4KK <br />t ndeis Mm: <br />- <br />kndr't Addcs!. <br />- <br />odinaNcs ad Slarc L3ws ehling