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PLUMBING.INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS OWNEN BUILDER DELCAR TION <br />I h.rchy dtrEm !nd.r ,.nahy oa I'ci!ry rhd I d excdd tum rh. Co 6.loN Lscos L5w lor rlE followirB t4en (Se.7!1 1.5 <br />ausinc$ ard Profcssion Codc)r Aoy Ciry or Cou y whhh tcquics . Fmil lo onntuc( 0llcr. nt{mvc, demlish or rcFtr ;y <br />studurc. rbio il3 ilsu.re, slso reqlircs ln a?pli! ror such Fmi kr lilc t sieicd 3ttl.m lhal hcor drc a lien$n plMaln <br />ro rh€ Dmvisio.r of rhc ConrEcroii Lieiscn t,w (Ch!plc.9. Commncing wilh Sftrion 7000 of Dirkhn 3 oalh. Alsincss a.d <br />Pefcsrh ns Codc ) o! | hai h. or shc is .r.nq,l lhcrciio m lnd I hc hosis for t hc ,lkgcn cxctrpr io.. Any viold io. o a Sc.rion 701 L 5 by dny <br />0mlka.r for a pcmir sb.iels rlE aprlic.trr ro . civil pcnahy of nol rcrc t . iv. hu.drcd dolles (t50O). <br />-1. <br />.r owrcr oarhc p6Fnt or m, cmplottcs silh BaSca ar rhcn sb @nF.s8l ion. eill do llE wnk !d llE nntl@ b Dr <br />inrclrH or oficEd for sle (Se.7(x4, Burin.ss ind PFf.si.ns Cd. Th. Conlroclols Licn* Llw docs nor .pply ro an owftt of <br />rh. ppcny who hfirr or if,pmws tlEmn. od wto d6 sh qorl hihscll or ncef or dmu8l nh or n r oqn .nployce\. <br />nrovidcd rnd such itrllmrftirs d hr inlc.d.rl rlrcnn for sL. la thww. UE tridnB m iqrcrcm is eld ehhin om Fe <br />of.oq,lciotr t}r O*n r Buildd wiu hlw tlr bhhn ol ptuvins ${l hc or lhe dt d build or impDrc tnc I,oIEly for tu pu.Ibk ol <br />-1, <br />as owrc! of rhc FmFnr. rn cxclusivcly .onrscting wirh lis.scd conto.toF to consttucl llt poj.cl (Se 7044. BusiN$ <br />lnd P,tLsin Codc: Thc ConrBclols Lhcnsc ti* des nor apnly b an own( or prorEriy who builds or imptuEs rh$.on. <br />lnd who @ ad. ao, su.h FDj.ds ailh ! Conlrsclo(s) lkcnkn pus@nl lo thc Contrdors Lic.M trw). <br />-l <br />mcrcilpr undd S6tioo - B. & P.C for this Mon <br />laBtrE8c-cl}MPilsAtrox <br />DESdAAII!}N <br />I hcrcby aflirm und( p.mlry of p.rury om of lh. followir8 dc.LElhnsl <br />-lhivcmduillnr.irrli'raCcfliticarcofc.nktrrnrsclflnsurcturwolkc6 <br />c.trrj--n\nrion. s\ Pruridcd fitr hy Scdion 17m ol l hc <br />fah.r (i{lc. io hc rc '()nuncc olrhc trork ftrwhich rhL pcrn r k tsucd <br />-lhrlc <br />andsiilmainllio sork.A $np.nsalio nrsurnnc.. !s rcquncd bySccrionlTfilorrhc l-$or Codc. lor rhc lqfo,mon.c ot <br />pcmlil ir hsu.d. My wori.m .omlB.saiion inslnrcc wic, and Fliy nunbd @: <br />( <br />co\?r \.\.\1 <br />-l.cdifr <br />rh.r in rh. Frformre of lhc,ort for which lhh pcnnit is Lisn d. I shlll nol.nPhy lny FMn in any @m, <br />so as to hc.otu slbjccr ro rhc eortdc oDl,.nsd6n lows .f Cllifomi,. and asEc lhar if I should h.rom sub.iel to th. <br />wo*si ompcnsarion pDri3ions or ssrion 1700 of lh. tibor Codc. l sn ll fonheirh @mply *nh lhos pmvirions.. <br />WARNIN(;] Fnilurc ro *.uc qorkc,l conrpcnqrlbn srvcr4c <br />.ivil fi.ci up to oc hun&.d llEusnd doll6 ($IOO,O00). in lddi <br />$"IilU.": <br />DEEIABAII9! <br />I h.rby rfatrflr undcr Nnllryofpcrlnry nrd I rn lic..s.d u dcr lovhionol Chprcr 9 (conn.ncina wirhsccrion7m0) otDivisinr:l <br />or rhc Busin ss md Pmlcssionr (odc. aftl my liccnsc t in tull til'tu rnd cficcls lcd,arq <br />colilallclroN.LENluNctqllcr <br />I hcEby trlftrm lnds p.nalty of |)cdury lhal rhft h s onnrucii,n lcnding ogcey aor lhc pfifo@Ec oa lhc woIk for qticn rhh IEmI ir <br />is\x.d (Sc.. 1097, Civ. C.) <br />AIPIIQINLIIEIIAM.IION <br />I lErc6y dtm undcr p.nrlry orr.rjury onc ofrhe lhllowin8 dslnftrions: <br />DcnFlnion Pcrnirs-Asbc(os Nori6.n!ion Fcdcrrl RcBulrrions lTnlc 40, P0n6) <br />-Rcquned <br />Lrrcrof M ifi.,rirn <br />I ccniay rhrr rhc rcdcml rcBulorions rcssdinB lsbcslosrcmrvalrrc nor trollh,th lo thh pmirl <br />-.1tsi .dify rhar I h.rc rcad tNs E dhdion rrd narc rhd lhc abh inaormrbn is coret. I ssE lo onl9ly sirh .ll Cily .nd Counly <br />ordiMtrccs snd Srarc lj*s dlarins io buildir8const <br />lborc mflioncd p$,)crry lor inrtNrion <br />Applic.nl or Agent Signalue: <br />P€mltellm.(prhl):Y <br />,*"*.*,,*,.$UG,, <br />ff E' Il,,l t <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <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 -d/,</lt ,\w <br />Final Gas Test <br />Meler Release <br />FINAL I T/blie =[1qNotes, Remarks, Etc. <br />APPROVALS <br />Tub/Shower Test <br />.AUG <br />,.^,*,". Y4+r€ <br />f------T------