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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG, <br />Waste & Vent <br />Water-Under floor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/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 />Back Flow Device <br />Rough Plumbing <br />Meter Release <br />Notes Remarks Etc. <br />FINAL <br />OWNER BUTLDER OELCARATION <br />I h@by rlfrm unda pa.lty of Fj!.y lt'r I @ Bdpt too fi. Cltnr816 Lic@ bw for fi. followiq lg$n (se.7011.5 <br />Blsins ed Poadio. Cod.): Any Ciry or Coury whicn Equt6 . Fnt lo 6nsn.1 ala. inpre!.. &noli.h or Epan ey <br />rud6c Fiorlo tu irBte., ato rcqlnB rh. @pli6l lor sh pqnii lo fiL r siSn.d nndndn thi h. or sl'. b lic@r.d puMl <br />ro thc FovirioB of $. Co &lor's Li.aa.d Ijw (Chr!t6 9. CoMd.ing vth S.crioo 7O0O of Divilio. 3 of lb. Busind .nd <br />Prol*ioa cod.) or lh.r h. d JE b qopl $6.toF ard lhc bosi! lb. thc .ll.gcd q@p{ion. Any vioLttro ofsslion ?01 Lt b, 6y <br />applicel fot !r6on !ubj.$ln. rpplica to !.ivil p.lrllyof@r mor.lh6 fiv. hud&cd dond (S500). <br />-1. <br />s oMd oflh. propaty. or nyddord with qag6 s rh.n sb @mpGdion, wil & tlE@ ed 0'. drude is mr <br />nndd..l or olra.d for !.lc (Se,r044. BBilB od Preft*iioB Cod.i Th. C.r rrroi3 Li:tu kw &e @r eplr lo e ol,G ol <br />thc Flpdty {ho hlU& d iaplc t@r ed who &G such mll hid.llor h.s.lto. llElsh li5 or bd oM dploy.*. <br />providcdth.t ru.h iry€rsElrtdml inloxlcd orotu aor3&.1[ no*l€. tlEtrilditlsor ids!!6E neBvinn!@ rd <br />of@mptclio( lh. 0'*{6 Aliilq wil ltrv. fi. tE&r ofFDli,g thi lE or sh. dil ml huild or inprcrc th. FDFIy 6r $c F[!o* of <br />l. 6 ownq oarh. FlFry. m qcluiv.ly o EctinB wnh ficdal co,trddoa h coNtrucl rh. @!xl (56. ?044. &8i.6 <br />arxl Pot sion Cod.: Tlc Conl@to. s Lictu. L6w do6 ,or appl, ro a own6 ofpop.ny * ho builds or improvs tnden. <br />6d who @nn!.lsror su€h lirjd3wnh. c4ird.ro(, licss.d putso&r rorh.contradors Li.!@ trv). <br />-l <br />6 .rdf, uftk s6$on- B. & P.c. for tbb t6$r <br />UOATEErcOMIEIIAUA! <br />DECI.AI^IIO! <br />I h@by arm lnda pariy ofFjury oE oflh. fouowins d..hr iod: <br />_l nrv. sd vill 6ai,rain a CeliaF.r. ofcoBa ro SElf-lnJ@ for w 6 onpqudiotr. B Fovid.d for by Sdion 3700 ofllE <br />Labor codc- for rh. pcfolllj.N of$. sll fo. $,tich $c pqmn i! hs!.d <br />I lBv. and will mainlain wori6 comFsalion iroorance. B r.quircd by Set ion 3700 oflhc Lrbor Codc. for thc pqfolr@.c of <br />fi. mrt tor vhich lhis Fmil ir Lsu.d My work6 .onpmsslion iNursc. .eiq &rd policy oumbr d.: <br />PolicyNlmb.r: Expi6: <br />I cdiry rh.r in th. Flolmrcc olrh. wort for *hkh rhiu psnir is irsu.4 I slall oor .nploy e, Fson in @y men6 <br />e a lo bcoN 3ubjd to thc @116'conpo$rion la$! ofcrlifonia. ad d3R lnrl if I should t .onc aubjal lo lrt <br />srt6'@mpqBdionprctilioBofS.dionlT00ofrh.tlborCodelsldl.fonhwilhtohplywithlhospovisioB.. <br />WARNING: Fril(. io c@ erl6' 6mpoB rior cov@C. i! 6lawaul. md sn.U d mdoF ro diftinal poa,lb dd <br />.ivil nnd up ro onc bundr.d lnou.nd dollm (Sloo.olxr), i. addirion ro rh. cosl ioa. damags as providcd ftn rhe <br />DICLIAAII!]I <br />I hftby artrr undd psrlry of pdj!ry rhar I m lic6sn und.r trovilion olChallg 9(connlmcinA {ilfi Selion 7000) ofDilisnin l <br />or rhc Busin6 dd Pref*oa Cod., adl my l((a i! i. ('ll aor.c at .lldr q <br />g]f!!!!! I_ft! !.!mr,!! \! <br />I h@by amm od6 !.nrlt, oap.rlory lld rhe is , sBttu.lion kfrlir8 sBdcy aor th. Flom c. otlhc vorl rot $ti.h fiB p6oir i! <br />isu€d {sd. 3097, civ. c.). <br />AftLtcANr..DEClrAS4IlO! <br />I halb 6ftum onda po.ly or Fjury o.. oir[. touoaiie dc.lrarioBi <br />Dsnolnion P.mirsAsbdrd Nodfi..rioi Fcdfrl R.s diotu (Tn1. 40. Pan6) <br />-R.quir.d <br />k r otNotiicnio. <br />I cdiry $at rh. f.d6d rcgukrioB r.8&diry ab6tN rmovo, e. not Eprlicdble ro rht pojc(l. <br />I c6r it thar I havc @d rhis .pplicalion dd $alc lhal $e ioo i. corc(l. I aer@ lo comply sm a[ Cily ad Coum, <br />ordinamG ed Sl.t. L3ws Ebliu lo bu lurlbiz. cF66idiv6 oalhb Cily dd <br />.bo!c mdriond prcpdy for <br />Appllgnr orArdrShn.rn 7 <br />I <br />COMMENTS <br />UNDER GROUND <br />Gas-Underfloor <br />Final Gas Test <br />1/q9(/,t 5\ t+{ <br />a,.."".a,* 3 <br />'^'" /4,t <br />Ln.ra r A<ldB: <br />-