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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNER Btl!r-tlER DELC,IRATION <br />I hcrchy rflnor u cr lcn0lry oi pcrjury rhir I rm cxcnDl tiom rhc ContracloK Licnsc L!$ for rhc hlbring rcnn,n (scc70.115 <br />Businc\s and Pn,f.s*,n Cltc) Any Ciry or Couniy shich rcquirtr r ltrnnr i, .un{ru.r. .lrc!. impntrc. dcnn,lish or Epoi rny <br />{rucrurc. plitrr) ns nsulncc. aho Equncsrhc applir.nr lor \u.h txrnril h [h. ri[ncd srnlcm"! rhll hcor shc n liccn\L\r pursurnr <br />ro lhc pn,visiotrs ol rhc Conrructtr\ l,iccn\cd lr{ (Chlprcr i). CoNncncnr! wirh sc.ri.n ?OtD of Divhion I ofthc Busincs\ otrd <br />l'mL$n,ns Conc ) or rhrr hc orshc t.icnDr rhcrerronr narh.tlsirinrrhcallcscdcxcmfli.n Any vol[on or SNtion 70ll I 5byun! <br />q'tlicrnrrdaFrnircuhjccr\rhd,tpli.a.rroa.nilp.tuhy.lnorntrcrll firc hundrcddolld( (550) <br />_1. as ower of rh. FDFny. d nr.nqlolcs wirh *as$ N rlEt ele @mlEneion. wi[.lo rh &it arn {E mdw b mr <br />in.d.d trofi.Ed le $lc (Sc.?o44. Busimss snd PbfcsbN Codc: Tn ConlrcldsLiNMljvddsmlalplrlomovBol <br />thc lNrEny who build. or inprews th@n dd ehd dB $.n elt hinklf or hdsclf 01 6mugh hh o, hcr own .mployes. <br />prcvi&d lh.r $ch inpmEmds e ml id.ftkd orotr rcd lor sh.Ii homE.lh. t{iht'8 or in9rwmni is Fld wniin om y@ <br />ofonpkraotr ln. Owmr Builder will h!v. l}l birftkn of prlvin8 hd hc 6, rlE did 6t tdjld d irrmw df, pstEny aor tho pulFlr of <br />-1. <br />as owmr of rhc pq,cny, um erclusiwly conrrmrinS eirh li.cnsd conh.ro6 ro onsrtocr rhc Fojccr lsd. 7044, Bu{ircs <br />r.d Proi:sba Coihr Thc Conrtulor's Licen$ bs des mr Eiply ro dn o*no ol ntup€ny wh. builds or imt,mv.s lt Nn. <br />lnd {ho @nrmls for sEh projsrs wirh s Conrr.cro(, ltrNd l,!rsu.r lo rh. ConEdoli U.etrc Ljw}, <br />I nmcrcrnpr utrdcr Sccl S. & P.C. iorlhn rcason. <br />!O8f,!BI:I]O!IIDNIAIIQ! <br />DECI.AXAII]N <br />I lErcby aifirm undcr F.dly of Fjury om of ltE follositrg dc.ldlions: <br />I j,hrr (i u.turrhclrrli,nMrcorrhcs.rk rnrwhichrh.p.nnir i\ isurl <br />-l <br />hrvc lnd will minllin wor*cB .ohlEnsalion iNuEmq as EquiEd by Sccrion lTm of ll.l t lh. Cod., fo. rte F.lo,.ec ol <br />bn iNurunce caricr od Fric, nu mb.r e: <br />I <br />_l.cniry thar in rhc p.raornBn.c ofrh. sork lor uhich rhh lErnn is i\sncd.l sh0ll nor cnrploy rny ptMn ifl My mantr <br />s a r. h..o'ru subj(l b fic wofics' ontrrelion l,ws ol Californi.. and o8Ec llEl if I sholld ttc6m suhjel 16 rlE <br />*orkcs omrcns0rion nmlisn,nsofScclion 3?morlhc L orCodc.I sh,ll, ionhwnh omply tilh lhos rmvtiohr. <br />WARNINC: Fdilurc ro surc w.rkcs convrnsarion .ovcm8c is unl0w6rl. ond \hrll subFl on o,ploycr <br />'o <br />qiniMl pcnalrics ud <br />ro orc hundrcd rhousand doll0ls (SloO.!)()0). in .ddirion ro rhc cosr of cohpenetion. d!tuBcs !r [ovid.d ror rh. <br />\q.\s As <br />I hcrcl,y rfiln udcr pcmlry or Frrurr rhd I rm liccn\.d ion of Chlo6 9(commncing wnh Selion ?00o) ofDivht'n 3 <br />of rtc Busincs ond Pmfcsions Codc, lnd my licetrs n in tull ,hc otd ctfccr. <br />3 <br />I h.(hyrnir u.der rctrrlryofFruryrhnr rh.to i\ a.on{ru.ri(,n lcndnrg alc,rcy ror rhc p.rrumun.c oflhc work nx shi(hrhi\ pcnli n <br />i$ucd (Scc 1097. (i! C ). <br />AIEIICANI.I}ES.AAAII!]N <br />I h.Eay arim undc. rctulry of p.rju.y oe df rh. lolli,sini dehor ioorl <br />Dcanlirion Pcmits.AstEstos Norificoriotr Fcdcr0l Rcslldions ( l'irlc 40, Panr) <br />-RcquiEn <br />1.rrcr ol Norifi cllbn <br />-l <br />cdify rhd I how rc.d rht aprlicorion ond shrc thar rhc ot v. infomrion h cotut. I agr ro.omtlysirh.ll Ciry rnd Counry <br />ordiMnccs llld Sllrc liws rcbl ing tNildi.E consrrucrioG urn ficrcby lurhornc rclrc*nrlrivcs olrhis Cirydd Counryro cnrd uF)n rlr <br />!ho!€ mcnriorcd psrcny lor <br />UNDER GROUND <br />Waste & Vent <br />Gas-Underfloor <br />Building Sewer <br />Area./Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouoh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Ivlain Drain/Pool Pipino <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />I <br />Rough Plumbing (?/, <br />Final Gas Test rI <br />Meter Release <br />FINAL 'tln l*Anoib-/o- <br />Notes, Remarks, Etc <br />Water-Under floor <br />Gas Service <br />l <br />I ccaify rhd ih. fcdcal nlllations rcSarding asb. r.mv{l e not +pltlbh lo thn poFl. <br />' ,,," Y tY-lf <br />f------T------ <br />= <br />rn^@. <br />I <br />=