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PLUMBINGNNSPECTOR RECORD
<br />APPROVALS OATE ID/SIG.COMMENTS Owo.narild$ D.cleation
<br />I h@by clfid und.r pdalry of p.rjury $rl I d cxdpt fm $. ColtetoE' Licas. Law fot rh. followinS rson hd 701 I 5 BGinBs
<br />dd P.ot6io Cod.) Ary Cily 6 C4,ty which rc4uiB t Fmil lo @slt!d. alG, imPtov.. dholish or Eplr ay srrulrur., Pnm b ilr
<br />isru&cc, ako rcquiB $. applic l lor such pmn lo fiI. . sign.d tl.l.h€d $al hc or shc is li@srd PuRUel lo $. piovhitu ol t'!
<br />Conr@td! Lic@€d tlw (ch.flo q Comocing with S.clid 7oo0 of Diviliof, I of lh. BusiiB &d Prcasio.s cod.) d fia Ic d
<br />shc is dmpt rh@flm &d lh. bsiE fd 0E sll.scd .xoFioD .any eioladon of Sation ,031 5 bv ev aptli@l fd B pc6n tubJ@tt thr
<br />.pplimt o eqivil p.nslty otnotmoc th fiv. hun.lr.d &rll4 (S500)
<br />-1,E
<br />owrd oi$. ptopcny. orn, @doyd with w.s6 s $. iol. cmP.$alion, eilldotl. Bort dd t.,h.lu. i5 nol inl6d.rl
<br />*lt.df63.lc(S@704a,Bcineudlrcf*i@Cod.rTh.C.nl'lcl6'3Licftcl,wdGnotr9Pl,lodMdofrh.PDpdtv
<br />pno buil& or imr.ovs th.@n, dd *ho dB such wdk hinlllf or hdclf r dircusn hi5 d h.r owr dploy6, Prolid.d fi such
<br />inDrd ar. e nor in16d.d or offd.d fd ialc If, how.vq, t. building or improvmol it sold witirii oic y.& of complaio, dc
<br />O$i(ruldd will h.vc $. budci ofpovinS$ h. or ih. nor build o mProvc for $. purPs. oi salc)
<br />4, e o*"*.r tr,. p-pcny, *.rcl6rvcl, cmtmsnt with lidrcd conl@tos to coNrru.t lhc pq*l ( se 7044, BBinG 6d
<br />Prcfqrio Codo Th. Cdtr&toi! Li@* llw do6 not +ply to & oMd of prop.dy wno blilds d ihProv6 ,'.r@n . ud who
<br />cdE&t, ror such Fojett with . cmtero(, li@cd Poslut ro dq Co.tuwt Lie6. L.* )
<br />Del Q.n"u
<br />!-sE{l85!SUrE!SA!9!!rCl48drO!
<br />I hd.by nlfim undcr pcn.lty ol pnjury on. of rh. followinS delaEdons:
<br />_l h.vc ed *illnliilli, !C.ni,i.c!ofcoE! bS.ll-ltuuc ldso*@'@nP.n$ri6. a Prcvid.d fdby S@don l70o ofth!
<br />L&or Cd., fd $. p{dmnc. ofth. wort fm *hich fi. pdmh i! is@d
<br />_l hrlc dd *iU m{nldn wd(cR' conposaiioi ituuecq s rcqliEd by s.clion l70o olth. Labs Codc. for th. P.domecc ot$c
<br />*o.t lo which lnis pahn is i$ucd My wdk4' c@Fs.lio iNllruc. clnd 4d policy nunb.r .
<br />Policy Nunb..-ExPtcs
<br />(This $clioi nc.d hor bc compldcd rifi. pomit tr for On. hundrcd doll s l$lo0lorl6s)
<br />1Gadfiy U,al i^$c wronse or th. sort ls sh'ch tl'E p.mtr E ,su?d, I
<br />lich. suble o th. *ork.E cor.!.n$rion las3 ol Calrfomr.. ed.8re fiar
<br />shall nol dploy uy paon in 6y ,M.o ro q ro
<br />if I should b.@m. subjd ro $c wort!6
<br />l7o0 of d!.I$d Cod.. I rhall. ld0tsi$.ompl, wirh
<br />WARNING FailoE ro s.cu!. qork.ls comp.nsarion coloas. is unl,wiul. d shailsubJc€l .mPlo).t to Bminrl p.ntni6and civil
<br />6n.s up ro onc hun&cd $o6dd dotl6 (l l oo,ooo),in rddition lo . c6t of compcnsdion. dmaBes s provid.d fd fic S.clio. 1076 of
<br />thc Labor Cod., inr.lcsr md.noh.,\ ac6
<br />LICENSED CONTRACTORS OECLARATION
<br />I hcr.b, afllm undd p.nlhy of p.rtury rhd I o lic.nscd und.r protision ot Chaprcr I (cmmcncins *ilh S.ction 70cr0)ol Diviiioi.r of
<br />rh. Busin.s d Prof.$ions Co'd!, md my lie.ns.ls in iulladcc dd.ft cl
<br />CONST'RT'CTION LENDING AGENCY
<br />I hdcb, .flim ud.r p.nalty oa pdury thar rhd. i! a coislructioi lc.din! .s.ncy ror rhc Frfom&c. of $. work lo, wiich $i5 pcmn ii
<br />issu.d (S* 1097, ci! C)
<br />APILICANT'S DECLARATION
<br />Dcmolilion Pmils'tub6r6 NotfiQli@ F.d.r.l R.suldim (TnL 40. P.n 6)
<br />-
<br />&cquircd Lrn.r of Notificdd
<br />I ccniry llat fi. r.ddlr.8lratims !.adina sb6!s rmovdu! nor applicablc 'o{hk
<br />prol.cr
<br />-/lAify dlr I havc csd rhis .prl'cario. Md n . thd (h. abov. i.fmlrion n cor.cr I.gt.. to 6mdy wnh nllCnyandCourry
<br />ordinoco ed Srar Lnws rclat,nB ro buildi.g comlfudion, and h.&by $one rcp.dcnrarivd of thi! City dd Couiry ro .ird upoi $.
<br />,bovc Mion.d prop.ny for insp.crion purFs.i
<br />h,^*r*,*&,
<br />"^*.yd,,
<br />t7-? Qd
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Underfloor
<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 />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main DrainiPool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Misc
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing I Z-t a-. L)
<br />Final Gas Test 5o\r;:rwtH. -
<br />Meter Release 7)
<br />FINAL z/zz/sr / 09il12 7
<br />Notes, Remarks, Etc
<br />Roof Drain
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