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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GBOUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier bn,,.*
<br />TOP OUT <.-l
<br />Waste & Vent
<br />Water Pipinq S2<
<br />,L t-,-
<br />Gas Piping Gz-- q t\r \
<br />Roof Drain )
<br />a E
<br />Tub/Shower Test t daf+r..
<br />Rough Water Heater
<br />-)
<br />POOL/SPA
<br />P{raplDrain Line
<br />Main Drain/Pool Pipinq 1
<br />I
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line I
<br />I
<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
<br />FINAL lAs ln *Ei-.\D I
<br />Notes, Bemarks, Etcl t | -wopyl ZON-r
<br />OIVNER BT]ILD!R DELCATLT''ION
<br />I h.'chy rllirm uDrcr pcmlrt or Frjury rhrr I rm cxcmnr tonr rhc Gnnrr.t6 l,iccn\c li* lu rhc lollosiry tN,n (s(.?o.ll 5
<br />ausirc$ trdP(n.si(,nC({.):,4dyCiryorCounryqhichrc{loncsrfrnnirt,cdi{tu.r..hdr.nnpruvc,..nni\horrcf'trnriy
<br />nfldurc. nridr. irs t\uin.c. aho rclunc\ th. i|rlicinr ld\u.h Fnnir ro filca silncd n,tnrtrr rh lf,or shc is li.cnwl pursurtrr
<br />Io rtu pmvntuns.f rh. C.itd.nr's l-iccn\.d t1w (Clh|]icr ,. Crnnncn.ils wirh S.crioi ?(xx) oi Divnnnr .l of'hc Bu\i r\r, d
<br />Pmfc$i.n( (-odc)orrhar,*orshc iscx.nDi rhcrdionrr lrhchr\i\ fi* rltr rllrgrd drc rflioi AiyvxnrtuiofSNr6nT0]l5byii]
<br />ppll.rtrlli,r rpcn!il suhjccr\ rhc anrlicinrhtrcivilpcn0llyolmrm'crh{nliy.hundrcddolhm(|t500)
<br />-1.
<br />a owmr oa lnc pbFny, or oy eoplorrcs w,lh waec! $ Uct sh mn ..suio( will do 0E wolt nld Esf,rrwkmr
<br />iorcndcd or otr rcd for slc (Se.?044. Bleincss lnd ProLrsioN Codc: Th. Conlrrcror's Liccns Llw dds ml lrply lo m o*mr of
<br />thc pstEry who hoilds or niproB ih.6n, ard slb ddi skh Mrt hisslr or hcMlf or rhmugh hi. or lEr own.mpLy.6.
<br />provid.d rh,r slcn ihpb*EDls @ ml inrc'dcd or otu fd slc. li, hoM. ih. huildins or i'prcrcmrl i md whhin om yla
<br />of.orrplelio( ltr O*rcr Auibd will haE tlE budcn of pmving lhal lE or slr dA d brild or inprow lhc I,DFry for llE purpo$ of
<br />I. Bo*Mof rhc ltroIcny, Mcx.hsiElyconllsrins *nh lkcn$n conrrerm ro onrrud rh. pmjcr (sN. ?o14. Bulim$
<br />art hDG$ir Cod. Th. Conrrcrols Licc.sc L.w do.s not rt ply lo m owncr of rrcr.ny wls huilds or inlmrcs rhvmn,
<br />,nd eho mnrea for such pr.lxts wnh ! Co m.ror{r} ticcnrcd lJlB@r ro rnc C.nu!dor'. Lic..e ttw)
<br />-l
<br />am.rcmfl lndf Sccrion-, B. & P.C. forthh rcasn
<br />I)nrr
<br />WOnKFRS, COMPETISATION
<br />DECI,AEAIIOtr
<br />I hcrcby amrm u.dor ,.n!h, of p.rj!ry onc of lhc followi.S dcclMtioN:
<br />-lharc
<br />dsilltrui am0Ccnificatcofcons.nrrosclrlnsurcnrwork.'.ollcn\!rio..,sprolid.JlirhrSccrio.lT(Dorrhe
<br />I-rh, Cnlc.lnr rhc lorf.nnocc.l rlr wo* toiwhi.hrlE ncrmir i\ i\skd
<br />_l h,vc and e ill 'n.inlrin *ork B .omp.nsation in{arcq as Equircd by Serion l?0o of rh. t bor Codc. for lh. ,'crfotmre of
<br />rhc work rorwhEhrha Ermt i\ nsucd Mvwor[cF conNo{arbn insurrrccJEf,rud p.lky numbcrm
<br />.,",", - 9l<. \e t-.,n|
<br />1l o2 9rl tc -j\-
<br />-l.crlily
<br />lh in rhc p.rlo,frftc of lh. wor* ro. *hkh rhk p.rnl is iqrucd.l shnll mrempLy ry pd$n inanymnrcr
<br />s * lo trcom subi lo ltc workcB conrEnsalion kws of Califomk. and if,rc lhar if I sholld bccom subj6l lo dt
<br />wortn' odpcnsrrion ,mvisio.s of S6tion l7m of rhc Lltnr Cod.. I shrll. fonhqi$ oq)!, airh $s tbvilions..
<br />WARNINC: liihtrc ro s.urc qortcn' d,mpcnsol io. svcr,B. is unllwiul. and shall s,hjccl arr c'q,loycr to nin]indl lEmhics $d
<br />cnil fitrc{ ut tu !rc hundr.d th,usand dolle( rtl(,r.o iJ), in ddnion lo 'h..on of co'rpcnsorio.. drnE8ca as pnrvilcd tu rfic
<br />Sdi'n llo7a.f rh.lf,tbrCod. inrcrc{!nl, o.ruvr{c(
<br />".,.
<br />-l lLl l8 ^,,,i L.', L Cr-' cr
<br />LICINSEDJONIIACIA&
<br />DECIAMIION
<br />I hctsb, llfirm und.r !.n!hy ol pcrjury lhlr I am liNnsl undcr Imvisn,n olChuprcr 9 (mmtuftinE wnh Seri.,n T()(xJ) dfoivhio! l
<br />of lnc Busincss u.n Pmbsions Codc. and nry lt.ns is in tull tuc. trrd cqFr
<br />A L7-("*5-l tqt (
<br />ct b raD
<br />CQNIIAIEEONIEIIIICjIi&NS
<br />I hcehy uflirm u c. p.nblly of pcrjury rtul thcrc is i o.slru.tion hnditrE uecrey ror thc I'crformnc{ ol rh. krk lor {hi.h rhh Frtur ir
<br />issucd (Scc. 1097. Civ. C ).
<br />AfIIICAII.DESLASAIIIIN
<br />I hsd', !ftinn urdcr F.ally of lErjury om of lhc folhwing ddlsmrions:
<br />D.mlnio. Pcrnn* Arlxsor Nor irjcaiion FcdcBl Relllarions (Tirlc:t{), Pan6)
<br />-Rcquircd
<br />btrdof trorilkalhn
<br />-lccnifyrhur
<br />rh. fcd.6l rdglhrions nldding a\h.{o\ rcfr)vrl*. nor apduhlc ro rhi{ pm$i.
<br />-l
<br />ccni,r rhdr I h!rc rad rhn a0rlia starcrhal rhc al,vc infomrion is corer I llIe h onpl, onh all Cny
<br />ordi'riccs aiJ Srrr.ljw! rclxri,,g t,
<br />llbov. 'ncnrnnrd propcn, lbr iisprcr
<br />n- ond hcrchy aurhorizc rcprcsnllrnc ot',rn Cirrand
<br />ovla
<br />,\pplicnnl or.\srnl Siqnatum
<br /><t C oa.?
<br />1 ct
<br />IIII
<br />Gas Service
<br />}B
<br />Pemlr4unr(pntrO:
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