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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE rD/srG.COMMENTS <br />UNDER GROUND I I <br />Waste & Vent sl2rl IB <br />Water-Under Iloor | 't <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />la'ia_"4:,1D_ <br />Gas Piping n-z-18 i rfi- 6a \tefi-- <br />Roof Drain 77-z-r,-zB ZZQ^'>) <br />Tub/Shower Test 3p 2yr?^z 4,[t-*rz- <br />Rough Water Heater c-rPa--. 4rrJ <br />Ptrap/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 />Rough Plumbing l,D-U-L$) <br />Final Gas Test <br />Meter Release /z-q-/8 ,Z? <br />€ <br />Notes Bemarks Etc.-4 /2t*- <br />2 -1€. <br />C-? 2 b-- <br />* <br />"L4 <br />OWNEI BT'ILDER DELCAXATION <br />I lErcby .rrn und.r pcMly of pcrjury thd I m.rcnfl nlm th. Cirrrsdm Liens L,w aor E lollowinS ,!en (5.<.7011.5 <br />Blsincss sd Prof.*sion Cod.)r Any Cny or Colnry whth rc$iEs a p.mit lo @nrld.l rllf, in'prcve. &mlish or tIEi lny <br />iuucrurc. prht lo ns i!$aN. alro EqliB rlE .pplic6r fo, slch Fmil ro fiL ! s'gftd slsr.rnr thd l* or sh. h liensd ploam <br />to dE provisiotu of th. Conrturolr Licnscd L.w (Chrprcr 9. Cltlftrcing eirh S@don '7000 of Diviiio, 3 of llE Busincs ed <br />Prcfc s io ns C.d.) or r hrr h. or she is .x.npr ltricfro m and the b.sh for r hc alh8.d cr.op' ion. Any viohlion of S..r ion 701 L 5 by dny <br />applicad 16r a lcmir iubicrs 0r. rpplkanl lo tr ciril pcmiy of ror mE rh& fivc hudEd dolhrs (tim). <br />-1. <br />ss ow.cr of rh. r,trFny. or my cq,loles *irh *agcs s rhcn sE strlEnarion. sill do tlr ootk .!d tlE slrEl@ is mt <br />inr.'dcd or oficrcd for Ml. (56.?(}14. Busincs and Profcssio.i Codc: Thc Conin t6ai Li.cM ltw do.s nor spply lo r. owtur oa <br />tn preFny who boildr q irq,bE tlEmh..rd who &n Mh slt himllor h.*lf or lhough his q ls o*n ctltloyes. <br />lrovided ihar such inrDEm.lsc nor hrcndeddolYcEd fot sle.lf. houer. th.brildi.s or i'rDbEE n$Bwi6i.omFe <br />of o'Iplcrio'! tlE O*ftr Builli ,ill luw dE hit!.r of nmli.s dEr ,l. o*lt did mr toild 6. inpior rh. Fopory ro, dE pupos or <br />#ss orner of rlE !,mpcny. ad cxclusiEly contmctins wnh ficensd .oiradoa lo onsrud rh. Imj.!' (S.c. ?04.1. Brsincs <br />PlDtusbi Co<hr Thc Conlr&lor's Liccns L.w docs mr .IJply lo an own.r of prcp.ny who builds or iryrovcs thcrmn. <br />ud sho conrracrsfor such pn,j*ts $irh r Conirucr('rls) ltlnscd rursuDn' h rhc C(,ntrcktr s Li.c.sc t w) <br />I s'ncrchprond.r Scorbn ,B &P.C forrhisrcNofl <br />la86EXii:.C0MrBSAIxO! <br />DECI,AMIION <br />I lErcby .flim un&r F.aly of Fjury oE of lh. followi.S delr6lio.s: <br />I hnvc d sillmridlnrrCcnilic.lcofConsctrrr'S.lf.ln\rrcntrsorkcr'cornpcnsarior.!sInovid.df(trtysc.ii.n:l7lx)ufrhc <br />Lrh, Codc, for rhc l.rfomrncc of rhc solt frwhi.h rhc pcrnrir n isnrcd. <br />-l h0vc.nd willmointain *orleu comp€nsrlhn insur.ncc. as rcquiE{ by Scclion 1700 of rhc kbor Codc. for thc pcrfom... of <br />lhc srk for whah <br />'hh <br />p.mil G hsucd My vorkcs coqrcnslhn insuraft. @trud poli.y turbcr @i <br />-l <br />ccnily rhlr in rn.ocrformre of rh. wort fd *hicn orh F nn is issed. I rhlll nor ctr!,loy !.y I*.s. io a.y lMmr <br />so $ ro b.com sublcd ro rhc srk6 ompcnsdion hes otcolifomia. .nd aBm th0' if I should b.coft slbj.rl lo lh. <br />w. <d{ @drcnsark n pnvi-rio.. ua Sarion 3110 of rhc Ltbo C.dc, I sltrll. fonhwnh omply wirh rtre pDviiiotr\.. <br />WARNINO: Frilurc ro wlrc slrk s ompcnerion .owasc ii lnla*tuI. Md sndl subj.Ei ra mplorr to ainhd ,cMltis ald <br />cilil fines u, ro om hundrcd rhousrd d6uds ($lo0.u)lr. in addir ion. damscs !s pnvidcd aor rhc <br />DESLIXAIqN <br />I h.ruhy,lIirm und$ tr.noltyoflkrjury rld I m licensl undd ,mvi\irtr ofChuptcr 9 (Nm@(ins sirh sccrbn 7000)ofDivnion l <br />ol rhc Businc$ d Prnfc\\bnr c{d.. 8nd my li.cnsc is in trll ro.o dd cflt.'. <br />f-e-,o <br />CONiIAUqIXNIEIDIdCAGEN.CI <br />I h.ohy ,ltun undcr l.mky of p.rju4hal thcrcis.$n( ctbn tndins lscncr rb, rhc p$fornutu olrh.workrorqnichIhis [rmn h <br />ksucd (Scc :l0r7.Civ. C ). <br />dtftrcnlfDl,clAtArrox <br />! rErchy !ni,o utrdcr pcnrlit of p.rjury o.c olrhc followin-! dcc,0rrlions <br />Dcrmhn'n P.'nnr Astisr.s NorificJrnrn r-cd.hl Rcguhriotr\ (TirlI.10, Pin6) <br />-Rcquncd <br />lxlrs.f lrorifi crri,n <br />_l ccnily thai rh. rcdc,al egllarions rcglrdi.8 ssh.sbs Emvil ac nol +pliclblc lo lfiis pnjccl <br />-l <br />(nifyrhd I lEn rcadrnisappltar rhrr i',l,ffrxr otr Arodr(r I almrooq,lywirn aI Cilyund Cou.ly <br />ivlsoflnkCny d Counry ro cnlduDorhcodinoRrs and Srutc ljws Ebrinr lo <br />6bov. <br />'Enliomd <br />pmlBny ror <br />Appuonl or As.nr SlgDluE: --- Dil.,f-t- tP <br />;+ <br />POOL/SPA <br />Back Flow Device <br />FINAL '3c z? <br />A,) /ndl,< /84i /7 fb/l <br />L.dld! A(h!* <br />-