|
PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTI,IiER BUILDER DELCARAITON
<br />I heE6y 8'ftrn undcr pcnllry of n dury rhar I @ crcopr tDm rhc conr.eroR Lbcns t s for fte folowi.g EMi (sa.?031.5
<br />ausiEis ad PofcBsion Codc): Any Cny or Counry anth Equift . Fmh ro snslru.r. alrr, inprcrc. dcmlth or Ep& uy
<br />docha. pthr Io nr isswc. .ho requic! rlE lpplicet for reh IRnn lo fih e si8i.d srar.trnr rhlt h. or shc is lien*d p!r$!,
<br />to lhe povisios of thc Conlreto s Li..nsd L3w (Ch!F.r 9. ComminS wnn S.ction ?000 of Divisiof, 3 of th€ Busimss lnd
<br />Pefe$io$ Codc) or rhll tE o ihe Lr ercau rh.rciom ltd rlE bdis for lhe !ll.g.n ercmption. ADy viobtionofS6rbn 7031.5 bt an!
<br />lpplha for . pcmit subjal3 llE {ppli.dl lo . civil pc@lty of not mE thd frve hundrrl dollr! ($500),
<br />l. ss osrr ol rhc polrny. .r ny cmplors eirh wascs as rtuir sh onp.nsario,. will do llr w{,rt art dE nrarft i( mt
<br />inlcnd oro,f.Ed for sk (S{.7O14, Busircs md PrcLssi'ns Codcr ThcConrdor's Lkcns t w dms no! q,/y lo m ownr ol
<br />lh. pqEny who boildr or inlhEs lhcMn. ard who dms sEh wort himsclf or h.rslf or thmu8h his or h.r own cEploy.cs.
<br />providcn thll such impmEnEnh m nor inrcnd.n d oficad for slc. la tF{rn tlE lnildins tr itr mwmnt is sU *ithh otu y@
<br />ofonpldiotr il* O*mr anikkr will lur rlr htr&n o, pnvirs rhd h. or shc dil hl tuild or nr{,or rhc ,,oFny for r,r I'uqn* of
<br />-1.
<br />as o*rcr of lhc t otcny, trm .xclusiwly contracring wirh liccn*d confuroN lo snsrud rE rrcirl (Ss. 7(J44, Busms(n Prnl6sii Codc: The Coor6rols Liccnrc Law des nor a[,lyio mowns ofpmr.rry who builds or imprcvcs rlErcoi.and eho onrrucB for $ch pmiEls vhh. cr @ro(s) liccised l,!6uur ro E Contilcro s Liens. kw).
<br />-l
<br />unrcrcmtr und.r S€rio
<br />trQf,(ESltroMfENsArrox
<br />DICIdEAIION
<br />I l*r.by dffi.n undc. F.dry6flcrjlryonc6frhe lollowins dcchrari.ns:
<br />I hawanruiu @inl.i! a Ceniacare ol Consnr ro S.lf'lnsur€ lor *o*sl coml.nsalion, os nmyidcdforbySNrionlT00oirhc
<br />tjhor Codc. for rhc ll.rformncc o, lhc wolt tor which lhe Dcrnil is issucd.
<br />_l n!v. ,rd wiu Miilli. wo*cE @npcn.alion i.s!6m€. e rluirEd by S€rion 3700 of rlr Lrld Cod.. for tlE !.rfo,r1ec of
<br />llE mrk for which thi! p.mn & ii$ed. My s6k6 @npctrqlio. insllle @icr and plicy nunbd el.4alp Co.M Pe n sctl;on
<br />ol3ctlit
<br />-l.diay
<br />rhd i. rhc p.rformrcc of ll* Mrk fo. *hich this rcml i. ir$ert.l3hall rer.npLy my lcBon inay @net$ .s lo lE om subj.rl to lhc rod(m enF"elion Lw* of Califomi!. .d s8m lhal if I stFUB b.com subjccl to tlE
<br />wortcts' oh,,cnsllion tovnions of Setion 3?00 of thc t 60r Codc. I sh.ll fonnvilt omply wilh lhoF l,ovnions..
<br />WARNINC: Flilurc to surc wortc6' compcnsolion .ormec n unhwful. md sh.ll suhjer 3n cmplortr to simiMl pcEhbs .nd
<br />civi, fincs !p to oflc hlndrcd lholRnd dolls (Slm,uD), in.ddnion lo ihc.o{ olconpcrqlion. dom8 s as Imvidcd hr lhc
<br />Scclion .1076 of thc Ldor Codc, inlcrc( .nd lllorrcy s fes
<br />*,",- *lztlit
<br />llEclllaar,ltN
<br />I hcruby dirn uM.r lcnnltyofNrjury rhar I n lidnsil undcr F,vnion ol Chaptc! 9 (cootuno ing wirh Sccrbn 7000) df Dilisioh l
<br />of rhc B!\imsr aid lroLssnns Codc. !d nry licen{ h in full fttrcc md cltLrl.
<br />P)./ot455\
<br />^'' .8 l7\li8
<br />rcNt:tr!!1t0rL[Il)lNt;ilixxlr
<br />i\uci lS.. llr97.(-rv C )
<br />d.Plltc NfD[cL atruoN
<br />I tmtry dtinn u ndc, !cn!lr, ol!.rju,y om afthc loln'$nr8 dc.lffiln'ns
<br />Dcnoliriotr Pc.nrs Ashcstx Norill.arn r Fcdcrrl Rcgrhrnnr (l'nb .tlJ, Iran6)
<br />-Rcquircd
<br />l.rlcr or Ndifi .orion
<br />l.rnrf_r)rr rhc ltd.fultuguldions rlrdiig n\h.nos rrnniul rr. nor rfplicxhfu !, rhn fnl.rt
<br />oilirrtrcc\rid srrrc Ls\tolrrin3tr huildnr! c.n{n(nnr. lxl hcrcbyr lxtrirc rcprc\. rrl!c\()frhi\cir,mdcounryrornrfutainrhr
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Building Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq l4t IclB'l'ile>
<br />Gas Piping I
<br />Roof Drain
<br />Tub/Shower Test 1 rltl 'ril ty
<br />Rough Water Heater tt
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Healer/Gas Line
<br />Miscellaneous
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />-ai|
<br />Bough Plumbing I $.n rr-rrJU
<br />Final Gas Test t I ur
<br />FINAL q >l |^-n*a&r">)urc-Notes, Remarks , Etc.I
<br />-+
<br />ab.vc nrnrinncd potcn, for jnsp(rion purlxacs. ,-.- -_-,---)
<br />Appr.. orAsqrsis iurc:^ {-42:' o^,.,'l/2lli,
<br />""-u**."rrn*r K DiAla She.lrot-i
<br />Area,/Storm Drain
<br />Gas Service
<br />Water Service
<br />Back Flow Device
<br />Meter Release
<br />;tw I,
|