|
PLUMBING.INSPECTOR RECORD
<br />OWN!:R AUILDER DELCARATION
<br />I lrcrcby rllirN u.dcr !.n,hy 0l pcrjury rhd I m cx.,np' rn'n rhc G)nrr.ntrr Li.cnsc ltr$ ftr rtu f{,lhwing r.i$n (scc 7o,ll t
<br />Br\nrss rnd Pro,!\snrn Gic) Any Cily or (i)utrly whi.h rcquncr a Annn lo .otrirldr. !lr.r. i pruvc. dcnmlirh or Npln rny
<br />nrudurc. ri(* k, iN i\surncc, dn, rcqun.\ihc t'ppli.ant lor nEh rEnn (, rilca sisncd slor.mnt rhlt hco! \hc is lietr\cd ru6ulnr
<br />k, rhc pnni\ion\ olrh. Contnclofs Licen*d L,w (Cha cr 9. conmrn.ir8 wirh SccrioD 7(xx) or Divtion I olrhc ausinc$ lnd
<br />Pn,rcsnri\ C.dc)o.thlr hcorshc Gcic'.pr lhcrctromand lhcb$is n,lhcallc8edcrc.rflion. Any viollliotrotSsrbn'70.115 hr!n,
<br />atnli.lnt lu r If,nnir subrc.hrhc atpli.rnrbacililtrnrlrrofnolmmrhrnfivchu.drcddoll3r(S5tu)
<br />-1.
<br />!. owN of th. pr6Fny, or oy .nphrr6 wirh wrgcs s rh.t $h @hpcnglion. eil do rl* so* ad tlr sEEfift is nor
<br />irlc'i(H or oficEd for sh (Sa,?044- Busimss .nd Prcfcrshns Cod.: Th. C., Blols LitN trw d..3 mt +ply lo .n ower of
<br />$c poFny wlD hikti n it9fts $c6i. drd qho .lo.s sh wrft himrlf or hcrslf or ttmuSn his or ltr o*n.mployes.
<br />Imvidd lhlr 3uch inprcE@nti6 ml i c'id.d tr ofcrcd for $lc. r. ho$w, llE huildi,g m irp,DEmnt k sld wnhin om yr
<br />oloirlclba thc Owmr Auiud *iI h.w dr h!d.n ofpmvinS ind h. o. rh. dil rcl bdld o, atr{ll@ tu pqsry for d* plrpoe of
<br />-1,
<br />as owmr oflh. pq,crly. am crclusivcly contrr.linS wnh leosd codraclo ro .otr(tuct ihe r.mr$l (S(. ,044, 8!sms
<br />nd Eots\iln Crdc: Thc Contturols Lkcnrc Law des nor apply ro !n owncr of prcrcny *ho buids or improvcs $ceon.
<br />and *ho €onlEcts for su.h tmirls w n a Conh.lo(, li@.sed puNuur ro rhc Con'n rofs Lieri. tis).
<br />I mcrcm undcrscrion .B & Pc.Iortirr&sn
<br />Ormr_ _
<br />uQBrE&tglltfENsa.rr0ts
<br />DECLAN-AAION
<br />I icrchy oltirm undcr Dcnally of ncrrury otrcof'hc follopirn rlc.ld,rioni:
<br />l halc md sillnuinruin aC.nificricolConscnrr, Sclilnstrc f.r wdkcr'co Fna(hn.0! !(,vidcdlhrhySccrnnrlTlx)olrh.
<br />tlbor Aic- ior lhc I'. hrnuncc oflhc *orl tor which rhc Fnnir is hsxcd.
<br />_l narc &d *ill nlinrain work * @mp.n!.tion insolee. as ftIlift{ b, Sdion l70O of lhe tjbor Co.!.. {or rhc pcrfomrce of
<br />thc work for whhh rhir Fmit ii ilsri. My mrkch .ompcn{ion i.su@ @ic, rld lDlhy numh.r el
<br />Pol'cv Nunhcr Jrni,€s
<br />-l
<br />c.nify lh.t in th. pcrfolmre ollhc wort for which fiir pemir is ir$cd. I rhru .or cn{loy aoy p.66n in rny mnmr
<br />s as lo txsft mbj..i ro thc *odm oqxnerion laa! ofoliaornia. and aBr. Inll it I should hccom subjKr ro rtrqod(nl smrrcnsali.n pmvbions ol Scdio. l?00 ol lhc Lilx{ Codc. I nall fonhwirh onply wnh Uoe povi\i.B..
<br />WARNINC: Flilurc lo $c!r wo*c6 conlcnsaliotr ovcm8c iq unhwtul. and sholl subirl .n cmplorr lo ain nd pcMllics and
<br />civ nncr rp ro onc hund.d riolsnd dollus ($100.000). in oddirion ro rnc co.r of.ompcnstion. damgcs ss prcvijed for th.
<br />Cdc. inrcesr und artorNy\ aes
<br />2o a
<br />DICI.EMI]ON
<br />Ihcrehyrf,tmu.,lcrI'.tulryofpcrjuryth0tIanliccNnuM.rEovisi(.1chaFdr9(connftncinAwiihsc.ri,.?(x)l))olDiuisio.l
<br />oI rlr Busir.\s and I'mfcrstrs Codc. md ny li.cn\c h in rull forcc rrxl.fl.rr
<br />o,/z 6 D
<br />CANEIBI,]qUONIINI}INC.AIiEN.CI
<br />I h.(hy rlltd rndrr lcnxlry of p.rjurr rhar rnc,c is u c.tr{rucriotr htJirs iscEy ln rlt ncllolrttcc olthc wnrk nt wnich rhn n rnrir is
<br />n\uc.l (Scc.1097. Civ C.).
<br />I.cnifyrhor rhc fcdch, rcsularir,rr Egarding a\h.rlos rcn$val lrc nor amlicnblch lhix D(+cl
<br />-l
<br />ccnify lnal I hnvc rcrd lhis applicllion.nl $.rc lh.l rhc nhovc inf.rurion n cor.d.I lgr ro enpl, with allCnr&d Co!.ry
<br />odimms.nd S{arc tlwrmbling ro building co ion. &vl hcrehya!$oriz. rcpree arive. of $h City&d Connry lo cmc upon rrE
<br />dh)vc nrdiotrcd prcpcny lar inspc.r
<br />Appllunl or Ascnl Slgnsture
<br />APPROVALS ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptori Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P-trap/Drain Line
<br />Ir/ain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Waler Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing ,l/Lx/ts 5t\tr$
<br />Final Gas Test
<br />Meter Release
<br />FINAL l/)lu,/6 Ad
<br />Notes Remarks, Etc.
<br />P.mlle n.nelpnn()
<br />4 /o
<br />DATE
<br />kdd.r'r ArtdM*
<br />-
<br />lrtllldttflfll,A.t,drto!
<br />I h.d)y rflnm undcr pcrrlry ol rrrjuryonc oilhc nnhwin8 dc.hr.riotrs:
<br />r).nmlirir,rcnnn\ A\h({os Norilic!li, l;.dcrnl R.!uhrn,nr (Tirlc-10, Pnn6r
<br />R.qrnc{t l..rcr ol Notilicari{{
<br />Gas-Underfloor
<br />POOL/SPA
<br />Back Flow Device
|