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PLUMBING.INSPECTOR RECORD
<br />DATE COMMENTS OWNER BUILDER DELCANAION
<br />I hcrcby afiift lidq I'ishy of p.rjury th.t I M .r.,pl 6!m thc Crr@l6 Lieoc bw for ll* aollo*in! E.oD (S!t-70l l J
<br />Busincss lrd Prcf8ion Codc): tuy Cily or Co!'ny whicn rc1uiB. Frnil lo oNnu.t, dl6. itrprcvc d€mlish or rcPon .ry
<br />shcrrc. prior ro ns issudc. oho equiEr ihc +plicml lor such Fnil to 6lc ! .igftd s|,r.mnl lhal lE or she it liencd puuutn
<br />ro the Eovjrions of lh. C. nclols Lien*d Lls (Chlprcr 9. Conmn irg onh S6lion 7000 of Division 3 of ttt Busire$ tnd
<br />PDf.sions Codc) or Ih:r h. d slr i! cxcnq lncEton,rd lhc b..is for th. rlLlcd crctrplio.. Any violdk'n ofSe.6. ?011.5 6y ary
<br />lrplicait for e pcmi subj*r rhc applicsnl lo ! citil peMly of iol mc $e fiv. hu tEd dollus (5500).
<br />-1.
<br />$ ow6 ot rhc FoFny. or my cnplorB. sirh w.Bci $ rh.ir ek strpcns,rion, will.lo 0r wo dndEsnulek mr
<br />inlcnd.d or ofi.Ed for sh (Sd.7044. Burin.$ Md Prof.siof,s Codc: Thc Conr&ffit Lkn. L5q d.cs ml lDltly lo u o*F of
<br />rhc pDpcny eho hild! or irpmrcs lLmn. ard $lb .locs rkh eo* himll o.lErslf or thmugh hn 6r h.r own cmPlolccs.
<br />prcvid.d rh.r sut imlmvmn|scmri..d.d of.Ed for $lc. ll lrwcw, dF tuildinS or itrPtftcfl Lr su wnninoft ,w
<br />ot6,pLrio( tho owmr Buitbr s hE rlE b'r,nd ohbvin8 rhd rE or dE rtil mt hriu q inp,DE dx po!6ly for tlE plrposof
<br />-1.
<br />!s o*rcr ofrlrc Impcnr. am cx.lusircly conidinB wilh liensd conl6.1ou ro o.slrucl lh. pmj.cr (Sd IX4. BLs'Ns
<br />aid PDli.jio. C.d.r Th. Conlmtols l-iccnse Lls docs mt npPly r. !n owncr oftmpcfly{ho blilds or inPmvcs lhticon.
<br />u.d vho snrfflr for skh tNi.lt wilh . ConlEclo(t liccn*d p!B@r lo th. Conlmclols Liccn* Liw).
<br />-l
<br />6 .r.np ltt<hr Scclb. . B- & P.C. ior fiL !!@n.
<br />IASEEBS:.CQMIINSAIXIN
<br />IECIA8AIIIN
<br />I hcrcby trfirm undcr pcnalry oa pe.jury onc ofthc followi.S dccLralions:
<br />I havc rn will Minloin ! Ccnirtar. or consnr ro Sclrlnsurc lor so,ksc coflp.ns ion, aumvidcd for by sNtion:17fi) ofthc
<br />Irrbr Codc.lorthc pcrformstrcc ofthe wolt f.t which rh. Fnnir il issucd.
<br />n *orkc6 .onFNlion insuEncc. ss rcqliEn bySdioo 37m of rlE Llbor Cor!..Ior lhc Fifollruc of
<br />pcrmir B irsed Myworkm coq,cflslhn insumfte ceir e P.liynumbcr@t
<br />-l
<br />ccnify Ual i. rhc Frformme of lhc *ort for whichlhir !.roir ir issucd. I shullnol.noloy a.y Fmn in !n, turcr
<br />s as ro trcs,ft subj$r ro rhc wori6 omp.Narion lows of Cdifomia. lnd a-q@ 'h{ if I snould b..om subiYr ro dx
<br />wot*rs.onpcnstionpmvnionsofSedi.n:ITUJoflh.l,borCodc.lshall,fonhwi'hconplywnnlhosrmvisio.s
<br />WARNINC: Frilxrc ro sur. wo cn comFnsarn,n .ovcElc is nnlaqtul. aad shrll ruhjdr d.mFlo'tr lo sininnl FMhi.r lnd
<br />civil fin*s !p ro on. hundrcn liousond dolles (Sl0omo) in rddnbn ro rnc cosl .f.onDcnstiion. danEscs tr lrt'vir'd f'r rh'
<br />S..rn,n .1076 ofrh. ht$r Codc. inrqrcn lod atrormy s aes
<br />TtAY-+-?-$ll &TLN&,IIIIJI
<br />I hcrcby r0n undcrncnllryorFjij"ryrh,rIanrli.ctrxnundcrpmvi\ionorCh,rn9lc.mnrcncinswirhs..ridr7flx))olDivnionI
<br />ol rhc Busi..ssrtrd Phic$ions Codc. ! myli.ri$ h i'r fulliirr.c nlld crltcl
<br />tlffi,qa.
<br />CO}I,iIAI.ICIII]Ij.LEUDINC.AGENCT
<br />I h.rhtJfirmu cr lEnrhyot!.rjnryrhd rh.n is a constdctio,,cndinr rscmy for rhc,Erlbrmmc olrh. *ork for qhich thn IEmi ia
<br />is\ucd 1sN.3097, civ. c.)
<br />L.n<lcat AddB
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<br />AT&TIANLPEEIIBAIX}!
<br />I lrnby lmundd pctralty ollcrjury ond.r'h.lollowing dcclarcriotrs:
<br />Dcnmlirn,n Pcr.rirl^strnos Norificatn,n F€dcrul Rcsulari.n. (Tnlc 40. PJn6)
<br />_RLqun d l.nciof Norfrcrlhn
<br />I ccnilyrh,t rlD tcdernl rcsllariois rsddinB dsb.{os r.rmvnl urc mr lpllicrbt ro rhis p(+cl
<br />d.cnib rhar I h$t ,crd rhis 0rplicar ion and rrlrc rhot rhc ahvc inaoflMr io. is cor6.'l I !a.e u .o'nly Rilh .ll c , lnd cl,nnrv
<br />ordinaiccs lnd shr. L!w*rcLnin8 rohrildins a.d county ro cnr.r uliln rhc
<br />uhow mf,rioncd !rcI'cny for i.iFction
<br />Applirant or ABent Sipnllure:
<br />Pemile ntrne lDri.l)
<br />,,tx,1'' 1 7
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Waler Pipino
<br />Gas Pipinq
<br />Roof Drain
<br />TubiShower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main 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 />Rouqh Plumbinq q,z4r 9-it ,LT.CN4,)
<br />Final Gas Test
<br />Meter Release
<br />FINAL I hr?v,lz S\ trg
<br />Notes, Bemarks, Etc.
<br />APPROVALS ID/SIG.
<br />l. \. ra''.
<br />Vak*;,,^
<br />Lcndcl\ Nam
<br />-*r;a*-
<br />Gas-Underfloor
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