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PLUMBING.INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNER BUII,DER DELCARATION
<br />I hcrcby rlfinn u.ds ncnrhy {,4 pcrju.y rhd I afr cxc rr rr,m rh. co.trcros Li.cnsc l-a* tur rhc fdlo*int rc& (Sh-.703r.5
<br />Busn'c$ uRl Pnlcs\n,tr Gxtc): Any Ciry or C.utrry shiLh icqtrtcs r Fnnir h con(dcr. rlrd. nnpi.\c. dc,mlish ,{ Ep.n .'i'y .{ru.r!r.. rnxb i( issumcc. also rL'quncs Ihc 0lplictrnl ti,r $ch Frmir ro lilc ! siEncd n{rcd.trr rho' tEor stc L\ liccn{'l nu^urnr
<br />ro thc florirnns ol rhc Conrrrcxn \ Liccnscd Lls lch+rcr 9. ConnncNinB *ih Sccli{,n ,ixD ol Divisi.n I .r rhc lru\incs und
<br />Pmtc\sionr ctd.roi rhrr tr ur sltr l.rc.Drth.r.fiomnnd th! Usis for rh. rlhlcd.rcmpri.n. AnyviohrionofSccrion 70.11 5 byrny
<br />rlpli.rnr larnpcnnr rhjccls rhe nppliclnr b!civilpcMhyornor !ftrh lilc hundrcd dollan (5500)
<br />-1.
<br />!s o*icr ntr hc pr,txdy, or my .mployss *iln waScs as thcn sb .om!.nsalion. sill 116 tlE wo* &d lh. nrEi@ ir mr
<br />inr.dcn oroffdcd for sk {38.7044. Businc*.nd P.ofcssior Codq Ttr Co mlols Lkcns L3* des mt lprly lo .. owmt.t
<br />th€ porEny eh) hiikrr o, inpmEs dEmn..,n who dG uh w tinsclf., ltMlr or rhmuSh hir or lEr o*n cnlloyc.s.
<br />provided rhar flch impmrmnrs e nor in(cnd.n .r olTcEd tor ek. lf, krw6, ln huaui.8 ot i'r\ftE@.r is $d wnhin orc ,ta
<br />ofcorptcriotr $. o'rrc. Buin6 will h6E rhc hldcn of,rDri.g der lEodE dil rcl hlh d i,pmrc th. preFty fot r noqbsoa
<br />l. as owflr ol thc pmrBny. !m qchsiwly contucting *irh liccnsn coitrado* to .oNlMl ItE F.itl {Se! 7044, Bllilcs
<br />ad Ptofcsir Codc: Tnc Cont,rroas Liccnsc Ltw do.s nor opply ro on owtur of pmFny who huitds or iryrorcs lhcr@n.
<br />ahd who € o.ls lor such I,lirrs *iln u Cotrrtrto(s) li.cns{ ,u6@l to lhc Conl@lols Li.cns L€s).
<br />-,
<br />mcxcmrl undcr Scl
<br />Drlcr- O,mt:-
<br />.uo8f,EBS:gOM@tA:UON
<br />DECI/IIAIIOU
<br />I h.Ehy alfirm und.r pcMlry of pdjury or otlh. {olloaing d6Lr.rio.s:
<br />lhr\cmdqlllnudlrn!Ccnii.arcnfCon\cnrkrS.ll,n\uru[orqorkr^-.onDcn\0riur.!\Pn,vidrdturb,SLtri.n171)O.lrhc
<br />lrlbrr c(nic, ktr rhc,rlirnn.n.c orrhc so for tr[ich rhc pcnnir is i\\ucd
<br />-l hlvc .d will rointsin wotlcB .onp.n$tion in.urmc. I r.quircd by Sal nrn 1700 of rhc Lihor Cod., for thc loforMrcc ol
<br />h hsEir My wMk6 onFnsdion insunncc tricr o'd tblicy.unhcr m:
<br />l"
<br />BtlJ r.rZ\ r3rr p?o .\.\, r=
<br />-l
<br />ccrriay thll in rle notormre oflh. vork for whah lhis pcrni h ns!.rl I shrll rer cmlloyany pcmn i, !ry man*r
<br />er s 16 b..om subj.rr b rnc wortcF enlrtnsaion laws of Califomh. and a8B ln ifI stbuld h.coft bicr ro rlE
<br />wortft omp.ns.lion pmvisions of Sation lT00 of lhc tibo. Cod.. l rlsll. fonhwilh ohPly snh lbe lEvkio.s..
<br />WARNINC: l-silurc h s.xic wo crs .omn ns.lion colcmBe is u.lswlirl. !!d rh,ll suhir( an cnplo,tr lo sihinal FMhas rd
<br />h on. huidr rhour!.d dollff\ (S100-ux)). ir lndilion h rh. $\r or
<br />,"[AY llfoflIil:
<br />I leEby lftm und.r len.lly ol pdiury lhd I u lier*d udcr pmvirion ofchrfld 9 (@mmEing wilt S.dirn 7000) of DMsio. 3
<br />of th. Budsls {d Pof*btu Cod.. aln ny kte ir i. tuI fo@ lrn.Eer.
<br />/ffi(44
<br />saNuBlJulo lJi [INGl(iENLr
<br />Ihcr.hyrftnundcrFnrhyoftrJurylhrrrhLrctr.onddcrt.hndir!r80tr,forthcrEnnntu.corrhrsorkforwhichrhi\Pcrn n
<br />issucd (Scc. .1097. Civ. C )
<br />Atfuc NfD[rlr$arloB
<br />l,r,$y dld undc. p.n,hy orpcrjuryonc oflh. rolh*nr8 dcclarllion\:
<br />t)cnn,lirnnr Pcirnils-Ashc(os N.ri6carnnr F.dcral R.gulsrtrns (Tirlc l0. PM6)
<br />R.qun d hrt.r olNolillrlbn
<br />-l
<br />.d i{y ihnr rhc acd.ral rcSulolions Esardins aslFsloF rcmval ae ior trprlh,bh b rhis pmjccl.
<br />{.cnfiy $st t tse. *d thtt .pDlt.iion oid srarc rhd rhc atov. in I aEmroconplywirh lll Ciryaod Counr,
<br />orditunes !.d Sllrc L!$ rcldi.8 io hrildin8 v.s oiihis Cny.nd Counry 16 cor.r utb. [E
<br />abovc mcnrioncdpo!.ny
<br />ADplir l 0r Alcnl Signrlurc:
<br />UNDER GBOUND
<br />Waste & Vent
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Rool Drain
<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 />Houqh Plumbinq ,/2 (lz9-rrt llz:Il+€l
<br />Final Gas Test
<br />Meter Release
<br />FINAL b/'L+z/t ,D -rs
<br />Notes, Remarks, Etc
<br />APPROVALS DATE
<br />Water-Under floor
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