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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE to/stG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Water Pipinq
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq <n 9/k rM Pljiu4
<br />Final Gas Test
<br />Meter Release
<br />FINAL 6/?4 h,r tDffD
<br />Notes, Remarks, Etc
<br />OWNER BUILI'ER DELO{RATION
<br />I lErcby ,ffrn under Fndly of pclrtry lhal I d cicn{, tue llt Co.lt&roB LiceM L3v aorfic followi.g @$n (5€.7031:5
<br />Blsincss od ftnfcsion Codc): tu, Cny or Counly whth EtuiEs s Fmn ro coisltucl. ,l!d. imomve d.m,ish or qEn any'
<br />3mc$rc. prbr ro its issa@. abo Equircs ltf, .ppli.ul for $ch pcdil lo lih , sigki slalemnl thlt lE or shc n [.cB.i pN.!l
<br />lo rhc provisions ofrtr Coorra(loas Li6n$d Llw (Chrpir 9. ComBminB *ilh Sr.lion ?000 of Division J ofllE Bosircss and
<br />Prcfcssions Codc) or rh(r h. o, sh. ir .xctrrrl lh.rcfrDm cnd llE heiis for ft. alLgcn .xcnlPaon. Any viohtion of Sslioi ?011.5 by tny
<br />apDlicad for a pcmil iubjdB thc amli.a ba€ivilFmllyofnol ftrclhd livc hundrcd doll,rs (s500).
<br />-1.
<br />!s o*n.r of rh. porE ry. or my .rDlolRs wnh ws8.s * lh.n st .ompcns.rhn, will & rlE Brk ud llf $nrrE ir hr
<br />inleid.d or otrcrcd ftr sl. (5(.7044. Blsimss and Profcssions Cod., Thc Contrelols Liccn* t2{ docs .ol alply lo an owmt or
<br />lhc pqEny vno boildr or ing,lh llE bn, td wh. itEs Bh mrk himsclf or h@lf or ihhll8h ni or hs oM cmPlottc..
<br />providcd rhd such inqn,kmnls N ml inlcnd.d orof.r.d i'or sb. Ii ln}.€. rlE hlirrin8 or inpowE neUenhinorcr&
<br />ofm,rrlcrion. rll Oeer Builic. pill i!* llE hlrtcn of pmi.g d.r lE d sh. di.l tul tdikl or i.PreE d. Fopdry for dE pt{hs ot
<br />-1.
<br />s o{ncr of rhe lfrltrry. m.klusiwly of,keling with liccnsd contdlors ro @n{fl.r thc lmicl (S(. ?044. BusinBs
<br />rrd Ebftsbo Codc: The Conrmlol s Liens Llw dei Nr q'pl, ro db owmr of Iml'crly who huilds or impturcs thcon.
<br />and who @ @rs a.r such prolccts wnh a Contldo(9 licened l|lBudt ro rhc C{nlra.brs Liensc L3w).
<br />-l
<br />amcxcmtt undr Sdjon+ B. & P.C for thb Mson.
<br />Dal.:-
<br />-
<br />o*n.r:
<br />]TABf,!f,Lg)I,T!NIAIIO!
<br />DECLISAIIIIN
<br />I hcrby laliin u<Lr pcn lly or pdrury o* of lh. follo*ing dcchrelions:
<br />-llurr
<br />willnuinrsinaC.nifi.ricorconscnrlosclf.l.surclor$ortc6comFtrrdn,n.dsttuvidcdforbyScrioilTlt)orrhc
<br />Lrh)r CGlc. Ior I hc ncrlornunc nI rhc *or* for *hi.h thc Frnrir is i$ucd.
<br />-l nlvc and sill minliin so.kcB comFnsrlion in$om.. $ rquircd b, S*rion !700 of rlE L.bor Codc, for lh. Pe.ro!1rec ol
<br />rhc srk foi qhkh rhlr Dcmi i. bscd. My e.rksC compcns iotr in$rec.mj( 3,i FIicy numbcr @:
<br />-l.cnifyrhsi
<br />in rtu p.rrormnc ofltc work tor whictlhn r'€rmil is issued.l shall nor cmPloy any peror in dn, franmr
<br />h ns ro tEom subj.rr ro rh. eoric6'ompcns,rton lass or Cdifonin. lnd lse lhal if I st uld lt.om subid to llt
<br />mrtcu' mryrcnsarion pmvirioB of S..lion J70o of llE tjinr Cod.. I shlll, aodt*ilh comply wnh rho$ Pmvisio.r.
<br />WARNINC: Fuilurc ro sm work$s'compcns0lion covcmSe i\ unlu,tll. aid *hdll subj.rt an cmrloys It ci6in0l Fmhi.x ond
<br />civil finc\ !p ro oe hudrcd ihou$nd dolltrB (5100.000), in lddition ro rh. .o( of co'nFNlion. d0nEss !r Provilcd lor lnc
<br />Sdion 1076 ot rhc Lihr Cric, inlcEsl a.d anorEy s tes.
<br />fiAra? m$
<br />I h.Ehy dfrm lndd l,cElry of perjury td I m lienscd !d.t pFvilion of Chrylg 9 (.onmeir8 wnh Setion 1000) of Divhion 3
<br />ol rlE Buii6s rnd PrDf.sioB C.dc. {n hy |itns n in tull fo@ lnd cflar.
<br />\ racerqqPr
<br />",," [iAY 1 l01 """',"",", (44ed>,.
<br />IaNIIAUS,UIINIENDTNIACEICI
<br />I hcrh, ar'lto unJcr Fnalry or p.rjry lhoilhcrc h o conslrud ion Lndins lscn.y ror rh. Frforfrmc of lhc work ror which rhis lomit is
<br />issucd (Scc ll097.Civ. C ).
<br />dttlrc lfDIcL/$AIlllN
<br />I tErchy.film undcr Fnrhy or pcrFry oR ofrh.lblk'win8 dcchrn'i(,ns
<br />Dcnn ibn Pcrnrih-Asicsros NorilirDri.n Fcdchl Rcguh( ns (T[lc40, PM6)
<br />-R.q!ircd
<br />L.rrcr oa N.rifrnri,'
<br />I Lrniry rhd rhc rodcrr| .c8uhtions rElrdios !\h\r.s rcfr)vll arc or lmlic$lc lo lhh !rcrd
<br />/-, -n,rr,n,,, *,'","uO,nn rpnli.ark'i,!d d,rc rhnr rhc trlDrc inhrndn,n ncomcl !ssrNio.o'hPlywirhnllCilyandCounry
<br />odinam.s end shr. trws rcbrins Io buildine con{rucrbtr m.l h.rcby uulturne rctrc*nlairci o lrltr\( 'rv rl(nu r) k, drlr uturllf,t.-!k !c e.rioNd prcpeny lor insFrtio. purpo$s.
<br />,\pplicnnl or ,\arnl Sixn tun
<br />I l.r. rl
<br />Waste & Vent
<br />Pool Heater/Gas Line
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