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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNliR trull-DtiR Dt Lc,\R,\'tloN <br />Ih.rdryrrrnnu..prnlllyoil).rjtrr),rlirIrrcicrprfmmrhcConrm.rffrLicctrr.l.!wn,rh.r{,llowi',srris,dlscc.7{).rl5 <br />au!k\\ aM P(,lt\\i,,i Codr) iy Cil or Counr! \hich r.qut \ rnnir r,.otrnfl.i. nlru, n$hvr, dcrxrlnh,r,rt\rn ! <br />{ru.rutc.p trr'rs nsurncc.nl\or.qut$rhci|)nli.iDrttr{rh0(rmir!,rlkrsis,icl{!r.nrnrrharlLorshc\li.cn\c,l lnr\trrnr <br />rptilicJn! lnrrpcnnir srhl.rt rhc appli.rtrt ro acivil ncmlryofmr nnrcrhrn li!c hrnd.cd d{,ttr\ r35(x)r <br />-1. <br />a oeM of lhe poFnt or my chPloyfts *ilh w.8.s !s thct sk compctrs.tion. qill do ltt wt !d tlE dnrclm ii tut <br />inr.nded ot olfcrcd ffr sl. (5(.70{4. B!.hcis ud PDf.lsions Codg Thc Conr.dofs Lien* Lrw docs nor lpply lo N owner ol <br />E FroFny slx' hilds or iqmB llrEn. &n wn) d6 Mh s* hins.lf or hwlf or lhm!8! his m t r osr.nploy.cs. <br />povt.irh{ such imFoEmd. e mr hl.n H or ori*d fo' sl.. lr, ho}ffi. rtE hiiuing or intftwr,l ir $u within m Jerofsnplrb^ lhc Owffi Build.r sill hlw tlE hn b ofFovj.g lh.r hc or .hc did Ni t ild or in{rrcrc rhe p6Fry for ilE Frpos of <br />-1. <br />.s ovmr of rlE pmt €ny, am crclusiwly .onhcli.8 Bart li.ctrcd coturdor ro onslEd lhc Fmj.d (Sd. ?O14. Busims <br />d.n troEs\imCdc: Tnc Conrr lor's Liccns L.w dms ml lpply to atr ow.cr of prcFny *ho b.ilds or imlrcrcs rhc,&.. <br />Md qho conr&ls fo iuch pmFk wnh r Conmdo(o licensd !!M ro lh€ Coon&tofs Liccnrc L{w), <br />-J @ .&opl u,tdq Slcrbi-- B. & P.c. lo. uris Eson. <br />UABtrEES..qQMTEdIAIIIIN <br />DEIIdXAIION <br />I hcrcby afirn und.r FMlry of Fj.ry ort of thc folh*ing d.clmriotrs: <br />t.rhor CoJc. ntr rtultrlnnn r..of rhc$ork tu sl'ich rlr |tnnir ir n\urJ <br />_! tuvc ond *ill nuintrin workcs .omrcnsllion inslmftc. as rcrruiEd by Sclion 3700 of lhc lj6or Codc. for lnc pcrao,fu'cc oa <br />rhc work for lhth thh pc,mir is issucd. My *orlc6 comtcnsrlion insurancc caricr 6n Flicy nlnbcr m: <br />potxylt^*,fu4*: ')-?i- / I <br />l.cdiry rhdr in rhr l)cirornuNc of rhc work ror *hhh rhir r.rmir h hsucd.l rhdll noi.nrploy trny !.r$n in any mmflcr <br />$ trs ro b.rom subi.rl lo lhc wotksl mmn nsalion Lws ofcolifornh. ond lsN lhal if! sbuld tEonE slbtccl ro lhc <br />so*cN or4rcn$lhnpmvnions of Sdiotr 1700 oflhc L{bor Codc.l shall. fonh*iih com0ly wirhlhos lhlisions. <br />WARNINC: FailuE lo $c@ etrt.6' omp.B8tion ov.E8. is unlawtuL Md sh8ll $bjel ao.mplqtr lo 6imhd ,lDltis a.d <br />civil lin* up ro oE hundEi thouerd dolls ($100.000), i. lddnioo b the .osl of ml,{Ensli.n. dld8cs rs potii.d for lhc <br />Sarion 1016oftn bbtrC.n,int rcsl lnd auomy\ fei <br />/, /t-t * <br />DECI.AAIIO <br />I hc{hy afli' d u dcr prnrlryofp.rjury rhtrr I ! r lft.\cd trndcr rs,listr,n ol ( h pr.r 1) (.on,tun.og wirh s..riotr TlxX)) olOivnion l <br />01 rhc ltusirc$0l1d PmttsiorN Codc. ad my liccnsc n htullr'orc_dtclncl. <br />n* Numb..: leif8e <br />g)NSIN.UEIIONIIiNDIN!-&{TXII <br />issucd (Sc..l097.Civ. C ). <br />A}ILICAXLDECLABAIIAN <br />I hcnt y affim !ndc! pcnalry ot lcrju.y ore of rhc follo$ins dahnr io.sl <br />Dcnditiotr Pcirnits,Asbcslos Noliicrlion Fcdcr.l Rqul0lions ( rnb 40. Pan6) <br />-Rcqutcd <br />Lcrtcr of Norifi orbn <br />-l <br />ccnify rhar fie tcdehl rcgl{rions rcCarding a.hfisEmovale mtsprliabh ro rhis pmirl. <br />-l <br />c.nafy rhJl I hnw rcld rhii lpplkdrion !,r! sl,tc lhll rhc !hov. infdmurion Lr conc.r. I rlxrr lo conply snh au Cily and co! y <br />odituecs ad Srerc LNe dbr ing to boildi.g .onnru.ri.n. ad hdcby luthorizc rpnennriw! 6f Oi. Cfty &d Counly lo cnls upon tlE <br />ahovc mnrioncd pmpcny for inlp€crion <br />Appll.ul or AEdl SicmI A <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trapi Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release h <br />FINAL <br />Notes Remarks Etc. <br />Gas Service <br />7//a//e '4fl)lU 7L.hl <br />o,l., ? A-/ 8 cn .*n 4 n-c/ <br />Lrnd. r'. Addms: <br />- <br />- <br />o",2-d-tE