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PLUMBING.INSPECTOR RECORD <br />DATE rD/stG.COMMENTS OWNER BUII-DER DELC R{TION <br />I lrrchyrnn lndcr p.nlxy or Frjury rhar I an cxcnrpl ri$n rh. ConrrccroE L'ccnsc tiq id lh. nnbsi.r tclvn,lsit7o.rl5 <br />au\inc{ .nd Pn,fc$hn Cqtr: An, Ciry or G,tnty which !.qtires r lEntr Io con{rud. llrcr. i.,rro\t. .hmlish or rclan my <br />(flcrurc. prtuto ns nsu.ncc. sl\o cqunr\rhl {01'.nnt lor su.h Fiinir lo filc ! sisn d {ll.dtnr rh,' rRor she is liceNcd plFunr <br />io rhc rmrirbns orrh. C trta.kr's Liccnscd Llw (Chrnlcr ,. Coantncing wirh Se.rion 70u) oa Dilhion I ol rhc Btrcin.rs lnd <br />Pn,rc*nnrs codc) .r rhdt lEor shc hcxcnDl rhcr.rrooond rhtbrsi\ nn rhcnllc8.icxcmPlion AnyriolsriodorsccriotrT0ll.5bytny <br />nDIli(rnl lor r pcrnrilsuticcis rhc trnt,li..nr fu.civilpcnnktulnor nmrclhan nvc hundrcd dollm {5500). <br />I, ss ownr of th. totEny. tr dy cq,lorEs wnh sager as rh.n $b .onpcns0rion. wil do llE *Gt !d lh. slmlh k ml <br />inrcnd.d or oficr.d for ek (56.70i4. Blsims ed Rold3khs Cod.: 'rh. Conh.lols Li.tn$ Llw dms nol +ply lo d owtur oa <br />rhc pmFnr eho builj. or inpreE dEE( &n wlF dG sh a* hituclr or h.Mlf or rnmus! his or lEr oqn cnqloy.ci <br />pmvid.d rhar rucn imrmEEnr3 m mr i,iicnd.d oro,Icrn tur $lc. lf. rhwE llE buildlna N inpmtmn ir $td wirhi, om }{a <br />ol6'ri,briJ., rlE Owmr Builtr will h!'! llE h{.dm of Fleins dEr lr or slE dt d hdld or irpror dE Forrny for llE ,,nrF,r of <br />1.0. owrcr ofrh.,mprny, amcxclusiElyconrructio-q snh licctrscd coita.lm ro on(rucl lhc pmJ.{! (Se.7Or4. Busrnc$ <br />ad Eoftssim Codc: Thc G,nrra.toa* Li..nsc Law do.s nor al,ply lo 0noprcr of[opcny sho hlilds or improves lhcrcnn, <br />lnd who .onba.s lor such Imjc.c wilh a co k-ro(9 li€cnscd pu6@r tu rhc conlractols Liccn* Lav) <br />-l <br />an cxcmfl undcr Serio B.&PC forrhiieeron. <br />UT,IATESS:.COMPJNAITAN <br />DECI.A.SAIIAN <br />t h.rcby rffirm undcr pcnalry ol pc.jury 6rc ol fic aououiog delalrbns: <br />-l <br />havc rd will Dihrdin i C.dia.0tc of Conr.t b Scla tnsurc |or $brt6 mnrp.nslion.as pmvided tortySsliool7moffic <br />L{bor Cod.. for rhc lf,rfortuN ol rhe work for which <br />'tu <br />p.mi h kucd. <br />ltl h,k a.d eill @iflain workcs somrcnsrlion insutrncc. !s rcquired by S.dion lTuo or thc trhor codc lor lnc Frotnune or <br />lhc wort lor whhh rhis Frmil ii issu.{. Mrworkdi omrEnsrrn}o nrsuian{ cmicr ad Plicy nombd e: <br />Et4k tiMJ <br />z a <br />-l <br />c.niry rhar in rhe p.rformncc of lhc *ork lor whict lhir lern n i$ued. I snlll not cqtloy any pcMn in nn, Mmr <br />s as ro bcom subjccr ro rhc soltol cdrwnsatioo l.*s of Cllifornir. and oarc fial if I rh.!B h..oe subicl to th. <br />wo*ss compcnslionpmvhbnsofS(lion 1700.1$c lithr Crxic.l stull. fonhwilt anlly *irh lh.* ,,mvkions.. <br />WARNTNG: Frilurc t) \r.urc sorkcrL .ompcn{rion colcrr8c i\ unhwlnl itkl rh.ll srhjLtr !n cmnloycr rn Gimnhl lamlic\ otrd <br />civil lincl !p h onc hntrdrcd ihousrnd dolllls (Sl(x)-(x)o), ir rddirnni ro rhc.o( oi conDcnslrnin. dntus.s ds providcd hi rhc <br />sc.rn)n:1076oftl[ trtrr (oJc. iNcre( ud dktrrcy \ ltc\ <br />o <br />DIC|IIBAIION <br />I h.rcbyafltrm undcr Nnnlry ol tErjury thd I am liccn*l uidcr f'ovisnD olChllrcr 9lconuttrcin! {irh S.crbn TtXlO) olDivision l <br />ol rl( tlr\itu$ rnd ltoLl\i,rNCodc. md my liccnr is ir Inllhre udcfl.{t. <br />R D <br />s/totlb <br />CONIIBI!:IIONIEIDIIIi.&GENII <br />I hcahr rffirnr undcr FnJry or pcrjury rld lh.rc h a q'n{ocrio. htuli E a8cn.y rbt Ih. Iltrforromc of lhc work ror q lich rhis l^-rnil n <br />irsu.d (Scc. 309'7. Civ C.) <br />AIPI.ICAN[DIT;IrIAA.IT,IB <br />I ts:l,y srmr u nd.r l)..alr, or pcrjury onc ol rhc r'ollouins dclMr ions: <br />D.trElirion Pcrnih Asbcdos Norincdion Fcdcral Rcs!,.lions (-lillc4u. Pd6) <br />-R.a!ned <br />L.nerof N.rirkali,n <br />l.cniry rhir rhc fd.r,l rcSuldir),s rcaardins !\ts\lns BnDhl urc nornptlic0hlclo lhnpn+d <br />Al!cn'lyrhrlhJrcrcldrhi\opnli.rn,nmJ{rrrrh rhc rhivc inb.m$ion is c.trcd l nsd ro onll]ly wirh all Cny rnd Coutrrt <br />ordinr..cs dSl.lcl-r$rcl in!hhuildirg.onslflclion.dfrlhcEhyrurktrizercrc\c.rlriv.solrhkCiryrndCounlynr.nrdruF)nrhr <br />slx,!. *nrnnrd roNny tu insnccrion p!{i*s <br />Applimn( or ,{8€nl Sl8tr.luE.lxrffit*s/lbt <br />UNDER GROUND <br />Waste & Vent <br />Gas-Underfloor <br />Buildinq Sewer <br />Areaistorm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipino <br />Gas Pipino <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />It/ain Drain/Pool Pipinq <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 Plumbing 51'r/'a 5-To L<*9*41 <br />Final Gas Test <br />Meter Release <br />FINAL t/5 rh ax Llzat f4l <br />Notes, Remarks, Elc. <br />APPROVALS <br />Lcndcr'r AddE$ <br />- <br />Water-Under Iloor <br />Roof Drain