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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE rD/srQ\COMMENTS
<br />UNDER GROUND
<br />Waste & Vent 1*q-ttr 1"ttP4,I
<br />1 -5 _ttr \J,{,IL tL* er\tagg"
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain A
<br />lnterceptor/ Clarilier 1-z1r V,W)h ve.-l. "?Ae-b
<br />TOP OUT
<br />Waste & Vent 1-Z,t-ly V.IYA
<br />Water Pipino 1-"!-tY
<br />Gas Pipinq 1-7e8 tS)
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/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/Mp IJ. I 6.t.n-!Ltpa.,.
<br />Back Flow DeviCe -a4.
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL ll- lr- t1
<br />Notes, Remarks, Etc N7
<br />rE$ uzipl auyscQD
<br />-9
<br />OWN [:R Ii TIILDI]R DI'LCARATION
<br />I hcrcbyllfir und€r Ptnrlrv ofFrrury rhar I d.i.frp! lmnr rhc C,n a.t)R Licctr{ ljw lirr thc i)U.wir! r.rv lS&70115
<br />Bu\iricsl rnd Ptufc\\ion Codr): Any Ciry or Cootrrr_ shf,h rrquirc\ r Fnnir ro mtr{rxcr, !lr.r, inuor, dcnni\h or rcBrir rn"
<br />{n.ttrc. tnorr) \ ir!uM.c. JsJ rcqun.\ rhc rrpli.ld n* {.h Fmir b lih! \i8trcd {rrcNnl r( fuorshc t licrn'..| r ^urn '.
<br />n, rlN p'ovntnN .i rhc Conrrrctr's l.i.cn\cd lls (ChrDrcr r). (innnrmnrg *irh Sc.rn 7(XX) .f Division I oi rh. llhtr,c$ rnJ
<br />!pIli.ullnr a |rilnil su6jccr\ rhc rpplicanr ro a.i!ilprn!lry.lD.rnnnc rhrn fivc hrndrcd doUr^(S5m).
<br />-1,
<br />ac ownf of tlE prcpcny. or my G,rploylca *irh ws8lr &\ rh.t soh otrp.nsdion. qiu do tlE qdk old tlE sLr.r@ i! mr
<br />intql(hd troficEd lor sk (Sd.?(x4. ausies aM Ptuf.$io8 Cod.iTIE Co dtols Llrn* tjw do.s rcr qlply lo sowmrof
<br />th.ImFny wls ti{ildr or iqmB llEmn. r,n vho dfts Mh vort hiru.lf or lENlf or llmus} hii or ltr om cnploy.<.
<br />proviicd rh.r sh inipreltmnlr e mr ,{c.iLd domsEd f.r{lc.l( lbM. dE trililin8 q inFlvmnl it $ld -nhin orc )M
<br />of.on?kioo tlE 0*6 Blild will haw th. br&n of leving lhd lE .r stE da d hrild or iqmr thc FoFry for dE puryos of
<br />-l,.sownd
<br />oirhctnicdy, amdclusivclyc.nrEcrirg wirh liocnscd .o.racroN ro condrucl rhc pmr.t (Scc. ?044, Businss
<br />nd PiDfc\sion Codc: Thc Contraclols Liccnsc La* d.cs nol applylo anowrc! otpmrcrrywno huilds or ioproks rho@n.
<br />snd eho .onrEcrs fo, {ch poier wirh a coire'o(9 liccisc{ nuNMr ro rhc conradois Licctre L!w).
<br />-l
<br />amcrcn undcr S(lio B. & P.C forrhi\ Er$n
<br />wonxFxs, coMpENsaTroN
<br />DECL/ISAIIO!
<br />I hcEbt arfim undf p.Mxy of Frrury.rc of the lollowir8 d(Iffllio.s:
<br />I rhor ao,l.. ntrrll p.rlomrmrolrlr unk |,tr Nl],.I, rtu ltnn '\ a{ial
<br />-l
<br />havc rnd will nBiflltrifl wortcrs comp.nsalion insur!rcc. 0s rcqlncd by Sd io. l7O0 o, rlE Libor Code. lo, rh. Idloruftc oI
<br />rhc *ork for qhich rnis pcflnit t tsucd My*ork6 smrtnqtion in\urarcc kr
<br />.^J^.{c.-J 6s,5&*C,O
<br />.lVhX - o8;) - oo3l ' oo t I /8
<br />-lenilyrhqr
<br />in thc te1forourcc ol Uc work tor whi.h lhk p$eir is issu.d.l sh l.ol employa.yF6on inrnytunmt
<br />s ns h h.sm subFct lo dr worl@R omlcns ion laws ofc.lifomi.. da8slh if I should h.foft subjd 16rh.
<br />wollcm snqEnerion pmvisions ol SNion lTO0 of rhc lltm Codc. l nD[. fonhwith omply *irh rhos povtions.,
<br />WARNINO: tuihre ro sc!rc {orkr^ compcnsaln,n co{risc is !trhsfxl znd shrll \ubl.cr 0n cmtlo}tr ro dmiml p.mllics and
<br />hudrcn rhoosrnd dolle {5100,000). in ldd aon ro rlr @st ot.omFnerion, dame.s 3s providcd for lhc
<br />inlcrc( and alromy\ lce\.
<br />rB
<br />PEII,AAAII!'N
<br />I hc,cl,y ltltm uder pcnllry ol pcrjury rn l m lie.sd lndcr po!i\b. oachxrrr 9 l.onnkn.ing *irh se'iotr ?our) ol Divirion .l
<br />of lhc BusiR$rnd Prclcsions Cndc- ond nry liccnr n in lulll'oremlcl cr
<br />7?? )?e
<br />COISI8ICITONIENDEG.{CENJJ
<br />I hcrcby efiirn und., F.rlry of p.rjury lnar r|..rc t a co.ndcrio. !.ndi.g agcncy tbr tlE pnformncc of lhc worl lor which lhir Frmil is
<br />isucd (se.1097. civ. c.).
<br />EflTADI)
<br />5;7!,
<br />Water-Under lloor
<br />/r\\
<br />h,%t)
<br />XNrt)
<br />I c.,n*r.,tL
<br />*
<br />L.ndcls Ad<l,es:
<br />-
<br />APILICANI.DECLAAAII(IN
<br />I ffiy alltrm uftdcr pcnahy of pcrjury otu of thc lbllosing dccleorions:
<br />D.rmlirion Pcirnn$Ash.stos Nolificslion Fcdcral Rc8ulllions (Tillc 4n). Pfln6)
<br />-R.qun
<br />d kner of Mrificalion
<br />_l ccnir, rhd rh.fcdflrlrgulartr,n\ NCrdihB 6b.{o\to'mrrlr( nor lfplrJblc brhBpmFtt.
<br />KLEnrfy thot lhovc rcrd rhF lFllicari.tr ad {arc rhar thc atnvc rtrrnrrurion h comcr I aslrhmnlly
<br />^rdmunccs
<br />and Sl{c L!* s Fld ins t, hurldrtrE con\rructiotr ond hcrchrlurEnie r|tr*nhrt.( ol 'haC y
<br />,r!tr'\ r !,1 rL,|a \rr rrr,!,{rtintri1^-
<br />\rDrrnn,i .rrH,,si! r,tr,.: *
<br />''y'(-'.'f,(,n,i,(nnrr,l,nnl, x' -/ 'J11t.r/ U)t lllt
<br />W;
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