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PLUMBING-INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.
<br />UNDEB GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release I -l n \\
<br />FINAL qm U
<br />Notes, Remarks, Etc. -7 J I-
<br />OWNER BUTLDEI DEI,CATATION
<br />I hceby rttur lndd FMlry of pcrjury thal I d crcmpr frlm lnc Conrra.roB LtflE L€q for rhc fotlowing rcMi (5*,70315
<br />Busincss .rd PEf.ssion Co<t )i Aoy Cny o, Counry ahich EquiEs a Fmi ro con$ru.r alto. jnpFlc, dcmlieh or qrn My
<br />srtururc ltrior ro irs issumc. !l$ requircs thc opplkanr for such lEmjt ro fih a si8f,.n slal.mnr thlr n or llp is lktnFd l,umut
<br />lo thc prcwnions of de Conlmtols Lic.ncd t2w (Chaptcr 9. Conmcmi.B wilh Sccliof, 7000 of Divisiof, 3 of th€ Busin.ss rnd
<br />Prolcsrionr Cod.) or lhar hc or slE i. crcq,l rh.rcfren !.d rlE bcsis for lhc dbg€n.rcrynion. Any iiobrion ofScdio.703l.5 by rny
<br />lppliqil for 3 ,.mi subjftri rhc sppli.anr to a civil pcolry of mr m,c rhd frv. hu.<,r.d dollai (5500).
<br />-1.
<br />as owB ofrhc FeFny. u n, ..OlorE\ wnh vagca !s rlEn $k @dpcnrdion, wiu do llr h ( ,rd tlr s!!Er@ b nor
<br />inrqd.d or ofi.red for sh {SB.?M4. Buim$ d Pmlcsions Cod.: Th. Co.r$clols Ltcns Lnw do.s not a!'ply to owncr of
<br />th.p'oFny olh hilds d i.lhes rh€@i. ot {ho des Mh mrt himsclf or hdelf or rhou8h his or ho own.mrlorrci
<br />prcvid.d rh{( sucn inlpmftmnk ft @r hr..did ordFdld aorsh.l[ lE*6.0E lnildiig or irtErmfl t $ld eirthom )e.ofonplclkrl tc Owrcr Buildo will hE th. h!&. ofrrcvinS rhll lE or $c di1 rcr hild or iqmr llE FlrEiy f.r tlE l{rro* of
<br />-1.
<br />$ owrcr oi rhc pmp.ny. .'n crclusivcly cont,sling snh lienscrj conracroF ro consruci rlE nh.iccl (S(. 7044. Bunrc$
<br />lrd hnlt{sion Codc: Thc Conlrrcrols Liccnsc Low do.s nol apply ro .n owncr of pml,crly *ho builds or iq,mlei lhdcon.
<br />lnd wh. ontEcB for s!.h pmids wiln n Conr6.ror(9 lieNd punour lo rtc C.n!turoar Licns tlw).
<br />flz-'tz-\g ULt t,t-c,
<br />!2t!!.!a^l!!)l
<br />I hcrcby llfirm undcr IEMlly of lrtury onc ol ihc lollowinB del-srio.r
<br />-lh.v.dllwilln$intlir0CcnificrrcolCons.nrhS.lllnsxrclnrsolkclr.otrrp.trsrtiotr,.srrovidcdl'orbySdion.lTlloolrhcljlnr Crdc.lor rh. pcrlirnrnccofrhc *or* lir which rhr nd'nir is t\u.d
<br />_l hav. and will mainhin *orleB coopcosniion ins!'ancc. !\ rcqliEd 5y S(lion 1700 ot th. rjbor C.de. tor thc pcrromffic of
<br />rhc wor* tu wnichrhi{!.mn ir hsocd My work6 compcnsrrion insururc cldirr lrl p.licy nu'nb.r uc:
<br />-l
<br />ccnify lhar in rh. Frfonruncc olfic wort for which rhh p.rnit is isrud. I shrllnot cnploy n.y p.*on i.0.y mmncr
<br />s erlo bcee subjcd to rhc *o cF comDctr$rion hws .f California. and,EEcth ifI slhuld ktom suhjcl rollE
<br />wortdl conrEnsari.n Dnvhioni ot Sccrnrn l7{lo of rfic ljhr Ax,c, , slEll. fonhwith cohply Dnh ft,* povisi.ns .
<br />WARNIN(;: Fiiluru h s.ur. workcd ii unl,wtul. &J shall strbj.lt d e,ployrr lo aiminll F Elli.s ad
<br />.ivil li.c\ !p k, .nc hun rltl ,. in addirn,. lo rhc.o.r ofonFn$lior, da@g.s as lolilcd for lh.
<br />LtVa c.
<br />l)lr( 1,,\ll/l I loN
<br />I hcEly i,rrm ui&r p.nalry of }.rjury th,r I ao lietrid und piDvision of Chqr6 9 (@mrcing sin Scrion 7000) of Division 3
<br />of thc B6incss and P,rf.ssions Cod.. dn my lb.nF is in tull foe .d efr6t.
<br />CON AUCUI]NI,ENDIIIi.AGDNCT
<br />I ncrcby ortrm und$ Fnalty of p.4ury tl'or rhsc is a consddbo Lndi.8 a8cmy for lhc Ffoflmmc of tht sort for which lht Ixmi is
<br />i4\xcd (sN,109?, civ, c ).
<br />AIIIIIANLDECLIBATIIIN
<br />I h.'rhv alllnn u nd.r pctr.lry ul prrJUry.nc ol rhc tulk,wn,! d..lrrrions
<br />D.n8lirbn PcrmiG Ashc(o\ Norilicrrion rcdcrol Rceuhriors{l irlc 40. Prn6)
<br />tuquncd I cncrorNorilidirn
<br />_l ccnify thtrr lh.tucmlrc8uhtions EsardinB a$cstosremovalrc not ryplicabh ro thh pojccr
<br />l(ailv rhi I hf,vc rurd rhi\apn .gm
<br />'o.on{,ly
<br />wirh.ll Cnyrnd Counry
<br />i.s coinrudt,n. 0d hcrcby kahovc mnrioned tmFny for
<br />A pplicant or AEenl Sigmtu
<br />t4-C{(-{"s
<br />uilti]tu
<br />COMMENTS
<br />Cor(nctor
<br />onlinrnc.s rnd St c L,r*sruldiDg(,
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