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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Water-Under lloor
<br />Gas-Underlloor
<br />Bui lding Sewer
<br />lnterce ptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pi ptng
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />M ain Drain/Pool Piping
<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
<br />Meter Release n
<br />FINAL 6/tqh"r .,laa.-
<br />Notes , Remarks, Etc. t 'I'' "'':' "c7
<br />OWNER BUILDIiII DELCAIIATION
<br />I h.nby rrni,n rnd$,cfulrr or pcrjor, rhd I anr excnrfl tiom rhc ContrrdoH Liccns l-08 for rhc followi.E rcrs. (Sc..7oll5
<br />Busircss xl Phrcssn C*lc) ny Cir, r counry *hirh rcquircs n pcnnir ro consrtucr. llrcr. inlrrovc- dcnolish or rct)ln ntr,
<br />{tucrtrc- prirro ils nsrtrcc, alw r.quncs rhc npolicrtrr f(, \u.h pcml t,lilc 0 siSNd {8omnr that thor shc h li.cn*d por\r.!r
<br />ro rhc pnrvtion\ of th. ConrNror's Liccnscd lj* (Chtrtrrcr 9, Conm.n.in! trnh Secrnrn 7fi)0 ol Dilhnnr I oflhc Businc$ ann
<br />Pbrc$nr.sCodcrorrhlr hcorshc t c\cmpr rhcrcriom 0ft rh.tust tbr rhc,ll.sc{lcxcmlrion A.rvi.lrtionolsarionT0lll.ihy !'
<br />!ppli.n.' lnru prrnir suhj..Brhc arpli.anr b acivilpcmlirot!.r nErcrhln llrc hund,.d doll$ (55Ix))
<br />l, 6 o*n( of thc Foltny. or n, €mglotds *irn *!gca 6 rlEi slc onlJcrsrhfl, *iI do tn. wo* and th srtrt@ t mr
<br />intcri.d or otr r.d aor eL (Se.7044, ABircrs ,.d Phfeliionr Cod.: Tne C.nth.ld r Li@ne Lra dGs Nr q,ply ro o owr of
<br />lhc poFny Dho tniktr or iqFG fictqa lid *lb &a sh mn hiDs.ll or lEr$lf o. lnrcugh his or lEr o*n.q,loyt6.
<br />providcd lh.l sh ihpmEE.ts@ bt i e.(k orotrcrcd fo. s.h. lr. h6*q. dE toiUirg d lr{NEftfl i. $ld witho oe Fq
<br />of conphlbn, fie Oerc, Buil&r BiU h6E dE hrd.n of Imein8 tur hE or shc dn ml boild or irproE $c popeny for thc puFe of
<br />-1.
<br />!s owmr of rhc pn,,r.ny, &n cx.lxsi!.ly cont& tre rirt liccnsd cofltructoB ro .onnrcr rlE pmj.d {S(. ?0{. Ausim$
<br />ad Profesbn Code: Thc Conlr&lor's Liccnsc Li* dms no' apllyro an own.r .r pr.Ffly who build\ or inprov.a
<br />'hchn,,rd sho conr.rcNntr \urhpmj..rs Nirh x ) liccns.t pununt ro rhc Cotrrrrcrols l-i:cns t q)
<br />i
<br />t) r'( I \R\ r)\
<br />-l
<br />h.rc !d vill @iniah t CcnilE c olcr.gr ro Sdf.lNE for @rt6 @npcNion, ar FDritcd for by Sedon l70O of rhc
<br />l:bq Coda tor tlE paf(lrl{N ofdE srt fo. which rl* P.mi k l!sr.d.
<br />_l hlvc ond vill nrinlrin workcs .omFnsalirn i.subft.. a* rcquircd hy Ssrion 3700 or rh. t $or Gd., for lh. poft,r@e of
<br />lfic *oIk lbr whkh lhis Frmn is is$cd. My workcs .onFnsalion iniur.m. cmic. and Fnic, nunh.r ml
<br />t'olicyNun$cr Erttc\
<br />-l
<br />ccnily rhlI in thc r€rlormare ofric work fo. *hi.h rhis p.rmh is issucd. I shall nol cmployany petron in any mMn.r$ as ro tEs r subjcd ro rhc wo.k6'odpcnsatio. hws ofcllifomia, und as@ thd if I sholld t com subrcct ro tlr
<br />wortcn'comr.nsrionlsrisions.fs.diorlTmofrhcljtrtrCrne.tnE[.fonheiih.onrplr*irhrhocpmvhions.
<br />covcEg! h unkwiil. ond shall $bttt atr cnrplorr lo aiminol FMllis lnd
<br />civil nnc\ of kr.rc hun,lrcJ rMusr olh6 00.000). in o&ilion lo thc cost ofcoryrctrmliotr, damScs as providcd for lhc
<br />S{tio. 1076 of lh. tid Cod.. i.bE{
<br />,",.,5/?/tg
<br />!]!!!.\!t!ll1
<br />I hcrcty ufirnundcr DcnrllyorDeriury I onli.ensdu cr ImvisionofChaplcr 9(.omntrncnrg wiin S{lion ?mo) olDivisio.l
<br />of rt Blsi"css md Pmlt.sions Codc. ond my lb.ns b in fuu foro ad .nccr
<br />SNIIAIJqUONIINDING.6IiENS
<br />I h.ru$y uitirn ondcr rEn ly ot pcrjury tfill thsr h n onrlru.tion lcndin8 !8cnc, aor lhc Frfomncc or lhc work for uhi.h lhn p.mil b
<br />hsucd (Scc.3097, Civ. C ).
<br />A}IIJCAIIII(;IABAIIIIN
<br />I lmh, aniot undcr pcnrlry ni pcrrury orc of lhc l'olbwnr8 delnrntions:
<br />Dcfrrilion PernrnsAsbcsos Notiic im Fcdcal Rcgul{rionr frirlct0. Pnn6)
<br />Rq',tun kncrol Nnir&arion
<br />qd rcgtlatiotrs Egodirg asbcaros r.mval ec nor q,pli.rbL b lhir pmjd.
<br />rhn rtplicartf,n !d slltc thar rhc |tnve inlbrrotion isconccr.l agre tocomplywirh lllCirylnd Counry
<br />lo buildinS on*ru.rion.,id hcmby.urhorizc rcFc*nldiv6 ollhis Cny. Cou.ryroc crulnniE
<br />.C.l*',.l,tt.O f,
<br />z
<br />I
<br />Waste & Vent
<br />Area./Storm Drain
<br />& P C fo, rhir rcron
<br />.c]7e-.€\ + Q+,---i,
<br />I ncrcby ofno und( !.olry or roj!ry one of rhc {ououins d(hrarions:
<br />+ Ge^-'"^-
<br />tadq s ad&Hr
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<br />I
<br />=
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