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PLUMBING.INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oWNER BUII,DER DELCARA'f ION
<br />! hcrchy ailnm und.r p€mlly oI Eriu.y rhd I m crcmpr runr rh. Conllrk,r t-iccnsc tiw rff rlt lnllowi,rs rc on (Scc?Oll5
<br />hninc$ and Pronrsion C{ .): Ah, Ciry or Cuu , Rhtrh r.iuncs o pcrmir n, ..nitu.r. .hcr. in{m'c. d.mli\h or rcpat tuy
<br />tocrur.. pri{, b irs i*uM.c. nl$ requncs thc qrplictr0r lnr strch |*ir n tu fih r siBDcd sutcnrcnr rhar hcor \hc t liccn{d pursu{trr
<br />ro rh! pnr'i\ions ot rhc Contr.tr\ Li.cn*d hw (Chn0rd 9. CoatmcminE {irh Sd.ri(m 7Ux) ol Divkn,n :] otrhc Bo\nt.rlrnd
<br />Iloli\\i',ns Codc)ur rh.t hcorshc tcxcnrpr lhcrcliomund lhcbI\i\ fdrhc tll.gcdcxcrnPtion Anr!idrrioiofSc.ti)tr70ll5byrny
<br />,ptlrrnr ronpcrnrir nrh,.cs rhc rrplicao( ro !civilpctulryortur nDtcrhrtr litc hundrqlilollr\ (S5(x)r
<br />-1.
<br />as o{er of rhc rrbtEny, or n, envrloyer wilh *!ss ns thcn mk @npctrq&L will do llE uGt atd rhc snd@ ic rcr
<br />iflcded or ofl.Ed for sh (Sc.?044. Blsinc$ and PtDfcssions Cidcr Thc C.ntEclols Li@nE kw d@s nor npply to an owm! of
<br />lh. nmrEny *ho hrilds or irobrs lrEmn, sd who dG Mt sd{ tiNlf 6t hcsll or thsu8h his or hcr orn c'nployccs.
<br />lmvid.d rhal such in{mwds @ hr hrdd.d or olr.En fd ilc. ll lsvffi. llE blildi.g d iqrnrcEd h $ld $ilhin orc yct
<br />of@rlpbli.r. rlE Owft. Bujldc wil havc llf, hodcn ol[oving lh,l hc o, she did nol build or iq'mrc thc pqfty fo. $. pu4rs oa
<br />-1.
<br />os owr of thc rropeny, o cx.lu$ivcly onlnclins th liensn co.lt&rm io sniru.r llE Pm,..l (S(.7Ot4. Bus.cs
<br />@d Fd6sir codcr Tlrc Coflrmlor's LiccoE L.w docs mr qtply ro e owncr of ProFny *ln builds or imptoKs lhcmn.
<br />and who ootrulr lor soch lhjek {ilh s Cof,rRto(9 lic.ns.d 0!6unl to lhe ConlMro, s Lienr kw}
<br />-l
<br />dmcxcnfl !nd.. sedio4_.- B. & P.c. for this @s,
<br />Dol.:- orkr:
<br />1408f,Ef,t:coMfrNtArx.l!
<br />DECI.AIATO!
<br />I hscby .fiirm lndcrycnslry of !.rury orc 6l rhc lollowine delmliois:
<br />Ihr!crdwillnni 0intrCcnilic!rcotConicrrk'Sclflnsxrc r sorkcri.onDcnslri(trr. rt Ir.vnhd ior hySccri.n.]7(x)otrhc
<br />l:,htr C(xlc, br rhc pcrrorntrmc o I lhe rut lor $hich rhc pcmir i\ nrucd
<br />-l
<br />h!rc md will @inllin woltcs conpcNrlion insoDftc. &. rcgli .d by Selion 37m of lht L{b6, Code , lor ih. pcrforme of
<br />p.mn t nscn. My *o.km @mpctreii.n incuramc .ricr .,n poky fllnbs d:
<br />-l.cnity
<br />rhdr i6 th. pcrforflurcc oflhc vork lo. *hi:h rhi$ lcrn k ksu.d.l shrll rcl cmploy any pcMn in an, monmr
<br />$ !s ro h.sm subirr ro rtr *o*c6 codtEosarion l0ws or Californi( rnd ose lhtr ifl srsuld tE.off sbirr lo llt
<br />*ortqs' sqrcnsrion ,nvisioos or Sdrion 1700 ai lhc tihor Codc. I rutl. torlh{irh mq,ly *nh lhos pmvnion.
<br />WARNINGT Frilurc to surc w( en'codpcnsdrion .ovdaec is unlnqful. and shlll slbjer u. cnDlorcr nr aimiul lEdlrks dnd
<br />in sddniotr to rlE cosr ol.onpc.snlion. &mBcs as
<br />Ihcrcbyrfir.rututcrpcnnhyottrcrjurythirI!'nliccnvdtndcrnn)visn.rClrfrcr9(.onrtncingsirhs..1itrrtxl(,ofl)i\i\iotr.l
<br />.l rlt trnsinc$ rnl lhru\\ioi\ (td.. drd my li.cnr is in lullhrccudctltrr
<br />-
<br />Corlnclor:
<br />CONEIAUqBI,NIEIDINCAGINCI
<br />I hcEby alnrm undc. lcnrlry 6r p.rjury lhar rh.rc is . snsldction lcndin8 lsci.y ror rhc Frtbrnuncc oi thc wo.k Lr whi.h lhk Fn.il i\
<br />isuedlScc .i097. Civ. C.)
<br />landca\ Natu:
<br />-
<br />AI&,ICAITLDDIIAXAIIA!
<br />I M,y nliian undcr [tnalry or n rjxry onc ol rh. ftn hwinS dcclsrrion\:
<br />Dc'nolirionPrirnih.AslicsrosNorincurionF.d.El RcEUhrnrn\(TirL l0. PM6)
<br />Rcqxncd blrcr ol Nolifrnrit
<br />-l
<br />eni, rnd rhc fcdcdl Eglhribni E8{rlinE 6be slo. EmEt rc rcl q,Ilkabk lo $k lmiIl
<br />fuxtI havc 6!d rhh applicoiion sd slat. lh.l rhc ahvc inlorndion ir coret. I !8rc lo mryiy snh .U Cny lnd Co! y
<br />are LNr El,rilB ro building conslrucliotr. en hcrcby ofrhis Ciryand Counrl lo c.t.r upon
<br />!t !c mnr ioncd ,rep.ny lor insperion
<br />,\ppllco or A,t.nl Sicmlur:AYNVT
<br />UNDER GHOUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Pipinq
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main 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 />Bough Plumbinq qt +lt 27 Rl?n+*
<br />Meter Release
<br />FINAL l- r?- rs J),-(/;rg
<br />Notes, Remarks, Etc.
<br />Final Gas Test
<br />r.\ \-u.
<br />**:Wa?'.tqq,';;:,.
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