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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE rD/stG.COMMENTS O*nd-Buil.!.r Dcclaaion <br />I h*by sfim undd pd.lty ofpajury th, I e cx@fl fm li. Contr&loE' Lic.nr. Lrw for $€ followiig 166 (G.7031.5 Buind <br />sd Prcf*i@ Cod.) Any City orcouty which Equird. pdnir to @!t ud. slt6. improv., d.'lroliih or r.plir oy sEucltuc p.id to iE <br />i$@e. riio egliB rhc rpplicer fd ruch psmr to fiI. . si$.d 5l!166r thar hc or shc i! li63od puE@r ro 6. provisioN of lh. <br />C6!icld'3 Licc.5!.t !.w (Cn Pla 9, Cotudn{ wilh sdri6 7000 of Dvisio. I of thc Bsi.d dd lrofaioN Cod.) d 0!.t hc or <br />sh. is cxnpr rh@frw {d th! bnit fc U. allcScd dnptiotr .Any viohi@ ol Setion 703 I 5 by d, appliot fd . pc6ir tubjd. 0r. <br />appliot to a cieil p@.lty of no. D@ ttx fiv. hu&!d &lle (ljoo). <br />_1, 6 (Ma of th. Fop.rty, or ny @ployq6 with w.acs s th.t lolc @npcnsation, rill do $c *ot &d d. sructurc i5 nor intdd.d <br />or otrd.d f6 !.ll ( Sa 7044, Buine ed Prcfai@ Cod. Itu Conrr&rols Lilsc kw dG ror spply lo u @na of 6c propdty <br />who buil& m inFDc t?!@, &d vho &q &ch rdk hiBrlf q hd.lf a drcu8h htu d td oM mdoy6, lnovi&d th.l luch <br />improvmols e nor irEndcd or oflBld ad s.lc. If. howoa, U. bqildiD8 or inprovm@r is 3old withh d. re ofcdpldi@, thc <br />OwD6.Bdld6 wiu hav. 0!c hrd6 of pNins $.t h. or lnq rci build or ioprov. ror rtc plrrosc of !al4 <br />_1, 6 (Ma of $. p.oFriy, e aclEivlly @nEscii!8 wiin li@nrcd cdtulo* 10 conlEucr rh. poj.ct ( S.c 70!4, Suin63 an.l <br />Prof@ion Cod.r Tn? CdEeiol! Li@. L.w .b6 nor +ply 10 s owDB of prepdry who builds d inprcvB ln.rs , ed *ho <br />@nr.d! for such Droj4ts wilh a cott lo(, li@cd p6@t to 6. Conterors Li@s L:w.) <br />_l o cxaF od.r Sc.ii6 <br />-8. <br />& !.C. fq 0ri. @q <br />WORIGRS COMPENSATION DECLARATION <br />I hd.by aflim uod.. pa.lty of pajury o.c of $c fouopins dalritions <br />_l h.v. 6d will @iDllii r Carif..r. of Cftcnr to Sdf.IE@ atr wort6' c@pa!.ri6. a providcd f6 by Seti6l70O of$c <br />L6or Co&, ftr 0E ,<fdmal)c. of$c ao* for *hic[ th. pdmr i. is.d <br />_I hav. dd qillmjntdn *dtd' cmFBatim inrum@, a Equircd by S.dlor 3700 of tltc L.bo Co<tc, for thq pafomuc. of ln. <br />wd( lor whici {i! p6nit i i&ru.4 My *dt n' c6po3ade im!m@ @id ud policy numbo e <br />(Thb !eri6 ncd nor b. c@plctcd if rh. pdmit is fo, Or. hedr.d &llB {1100, d 16) <br />,A*6..,,i,;rh.r ii th. pdfmo@ ollhc wod( fo. wiich n\i! ponir ir i$u..l, I <br />ccl to $c wqkd ' Mpolad@ l!e! of Crlilmia &d asc <br />cmFNadotr proviiioN of Scli6 1700 of U:. L5br Cod., t rhsll. <br />-3-o <br />WARNING I.il@ to r.ce wdkm' cdp.tuadon @vdag.e mployd ro gininal pcnallie dd civil <br />find up 10 onc he&.d dio!!&d dolle (t lO0,O00),h lddirio <br />Uc l3bor Cod.. irlaBr od fioBcy s 16. <br />thc @sr of corpdation, ddrA6 6 providcd r* th. Sction 3076 oa <br />IJCB!.EDIONIIAqAS!.DECI4BAII9N <br />I h6aby amm rda p..rhy of pc.jq.y r.\al I o li@r.d uid.r prcvirio. of Chaptd 9 ( <br />lhc Buins od Prclsiont Codc, ud ny licms. ic in full lnc. ud.f.ct <br />I heby !ffim un<!.r pcr.lty of pdjury ttar th@ i, . coisEu.tio <br />i$u.d (Se. 3097, Civ. C). <br />aA.ncy fd lh. p.rfome@ of th. wo* ior which $is pmn is <br />arEucANLt.prc!aB4!aN <br />D@olirin Pmi$-tubetG Nolific.tion F.dd.l R.rrl.tioft (Tid. 40. Pln 6) <br />_R.+ircd t na ofNodfi@iio <br />iot Aplic.blc lo rhi! proj6-t. <br />Cily sd Counry lo ald uDe $c <br />abov. mfltion.d prop.rry aor inspc.'ion <br />o. <br />UNDER GROUND <br />Waste & Vent <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />P{raplDrain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing EXptPt h <br />Final Gas Test <br />Meter Release FEBrlI ,r,3 <br />FINAL c5t, 667 <br />Notes, Remarks, Etc. <br />Water-Underfloor <br />Misc <br />D.tc _Own6 _ <br />Lada! Adtq: _ <br />tl <br />I <br />ffi <br />I <br />= <br />=