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PLUMBING.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNEI BUILDER DELCARATION
<br />I hcrcby alfirh und6 lcnalr, of frj!ry thar I M cr€ry,r fon $c Clnrelo6 Lhen* llw for lhe toUowing M$n (Ss.7031.5
<br />Bu.inc$ and Pmfeisio. C.de): Any Cny or Couory whih rquiB a F.mir ro oBrru.l, rlro. imphr, d.mlnh or Epcn uy
<br />struorc. prior
<br />'o
<br />ns issumc. !!s r.auiEs tn lppltml aor su.h Fmi lo nk. sigr.d slarcmnl llEl lE or slt t li.cnsd ,tlrs6t
<br />ro lnc pEvicions of iE Comrero'3 Lic.ns{ L{w (Ch!flc, 9. Comftrcing wnh Sccrion 7000 of Diviion 3 of lh. Busincsr md
<br />Pmfissions Code) or thd h. or sh. is ercnpl lh@from ud the b!5i! for thc sllcgcd .r.mgiion. AnyviolariorofscdionT0ll.Sbyany
<br />,pplicanr for . pcmn subjdrs rhc q,pliotrr to ! civil lcMhy of mt mrc rhu 6w t!.dtn doll]* (S500).
<br />Ed, as ownr or rhc pmrny, or my coplorss qirt s{e.s as lh€ir sL conp.nssrion. will do t}p *dt .d th. slit16 is tur
<br />ift lcd trofercd fd slc (54,?044. Busincss dd P,oibssbrs Cdci Th. C-raldor's Liu* Llw d@s not apply ro e ow.o ol
<br />th. pDpcny wlD hiildJ o, inprbB tEb...rd *ho do.. sh e* hinscllor hdclfor t@udt nk or lE own.oployss.
<br />povidd lhar such inp|lwmds e ml hlcrd.d o.olY.rcd aor $lc. l[ howE dE toi]dtrE or inVrDEmit ! sld withi, oc ]@
<br />of@nllhlbl! dE OwM Brilhr wiu lErc rlE htrkn ofFovi.E UEr h. or str did d htild or in{mE dE p,Dpsty for dE Flryoe of
<br />-1.
<br />rs owrcr of lh. ,"opcny, am cxclusivcly conhc'in8 with liccn$d ont@ros lo snnMt llE prere.l lSN. ?e4. Bulies
<br />a.d Pr.Esbn Codc Th. CrnrEcro. s Li..Ea Llw d@s nd lppty to d o{nc, or pmFny who builds or impmvcs rhcr.on.
<br />,nd vho sntncrsfor slch phJ€rs sirh a Conr@ro(, liccnsd ,rusoanr rorhc Conracror's Liccn* t w)
<br />-l
<br />umeicmrrr lider Sccr
<br />D.b..r/zLl/(g "*ffia
<br />I lEEby dffrn lndo F..hy of pdjlry oe of lh. tollo*ing ddlmriois:
<br />I hr!.dd q ill nri'nri. a Crn,fiut of Con\rnr h Srlaln\urr fin sorkr^ ro tf,tr\dn . rs Dn'rill.d hrhyScdion.lTl)Ool rh.
<br />lrb.r (i d. i{n rh. |xnnnran.c.ldrc kod ntrs,hi.hrhc prinir h issucd
<br />_l hovc !d will miorain wortcB corye nsltion i.su6ncc. s EquiEd by Scc'ion l?m of E kbor Codc. tor rhc pnrol1rec or
<br />thc work for which lhn lcmil is hsucd. My qortcN comFnslhfl insuEmc trtr dd l,olty nlmho ei
<br />Ernn.s
<br />L&l ccni y rh inrhctcdorron.cofrhcwoikforwhichrhispcrenirh{ucd,Ishalln.t.nployanypcsonin!n,Nnid
<br />s as ro bcmm subiccl lo lhc wo s sryctrsthn hws of &lifomi!. lnd lgre rhot ifI should hecom slblrl ro 0r
<br />worlcK' mnp.n$rion lmvisions of S.nio. l?u, of thc &bor Codc, , nEll fonhrnh d,nlrly wirh rl6e polisioE..
<br />WARNIIIGT Failure r. scnrc wGk is' onpcnsarion covcmSc is lnhviul. lnd shull rubFcl !n cntloFr ro dimiml lEmlrics tr.d
<br />.ivil fincs up ro om hundEd ltousnd dollaE ($,00,000). in addilion ro rhc co( of onwnslion, dNmgcs !s providcd for lhr
<br />SNlion 1076 oalh. bhor Codc. i crcsr lnd lnorryt fes
<br />o,n -IStl?aLfL- swu*,
<br />D!!t A&UIQN
<br />I hcfthy annmrndrr l.fulry.f Jtrrlurt lhrr I m li.cD{d uM$ frn,v,\nr olChitlcr 9lcannrncir! \irh Sc.ri{'n 7(X{)ofl)r'\nr l
<br />of rhc lJu\in.s\ rn(lllofcsion\ (id., ind nry lnr sc i\ i'r lnllnrdr r[r.r
<br />Lic.e Numbcr:
<br />CoNSTRUCT](N I TNDIN(i A(;ENCY
<br />I hcEhy rm,rn undcr Ftrdryofprrury ln3l rhcrc is u.onsrrucrbn lcdiu !scn., rd
<br />'h. lLrrortunc. trrh. work for $hich rhis IEnnn is
<br />nsucd (sN 1097.civ. c ).
<br />aItutaNfDl:clrlaafirN
<br />I hNb,nflnnuM.r |rn.lry ol Nrlury onc ol rhc lolhwnrS Nla,rriotr{
<br />Dcnv'lirion Pcrnir\ Alhc\ro\ Norificarn,n I;cdrrrl Rcguhrnnr (Tirlcl0, Prn6)
<br />Rcquircd If, Icr.l Noriliclri,,r
<br />l.cni!rlftt rhclcdcfulrcgulrri,in{ rc8{dirgr\hcqo\rcnr,r lar. Nr,'|)|nicahlc nr n,ttn+d
<br />rtnrlc 'mnri,,n.d nmr.n, f{n in\p.cin,
<br />lppli.!nl or AEcnl sknnlurc:x
<br />N d lZEttF.€t/),
<br />UNDER GHOUND
<br />Waste & Vent
<br />Water-Under f loor ualtj)
<br />Gas-tlntffiloor 6tocc, r\9-v4v V,l/{v,
<br />Buildinq Sewer U
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipino
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />P{rap/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 />Rough Plumbing
<br />Final Gas Test 5-:d-tY X"W,i,
<br />FINAL 5-rd -ly
<br />Notes, Remarks, Etc.fY)
<br />--t
<br />APPROVALS
<br />TOP OUT
<br />POOL/SPA
<br />Meter Release
<br />vMJ4v)
<br />L.dd\ Addrsr:
<br />-
<br />I
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