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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG,COMMENTS OWNER trt'ILDER DELCANATION
<br />I hcEh, ilfim odr peely of pcrju.y lhtr t 6 cx.nq from th€ Co r&16 Uens Lr* for llE tolloqilg @s. (S.i.7011,5
<br />Busin.ss md Pmf*sion Codc): Any Cny or Co$ry wii.h Eqtrircs . Fni' lo 6.rtMl. allr. inpb( d.mliih or EFi ey
<br />!rw.lw. prior ro ir, issuffi, ako cquiEi rh. ll)pli.sr for such Fmi ro 6lc ! sigmn srdcd $!r lt d dE ir lt6tu nusrd
<br />to rh. prclisions of rrE CorrE rols Liansd L!* (Ch!pr.. 9. Co,|mEing wilh Scrion ,m0 of Division 3 or rl. Baituss and
<br />P,bLs.ions Cr<tc) or thli h. o, rhe ls crcnpl thetfren ond dE tosb for rn alh8cd crcnpdon. Any viollriopf Shrioo 7011 5 by lny
<br />lpplicant for a lemil subjcls lhc lpt,ldnt ro r civil Fmlty of not mE $ fivc hudrcn dolG (1500).
<br />-1.
<br />!s owrcr oithc pmp.dy, or fty cnplorEs wnn va8cs a rlFn sb smp€nelion. will do ll* *mt ard dr srnEl@ is mt
<br />ii{cndcd or otrcred fd slc (Se.?O14. Bliituss and Ptoitsions Codd 'thc Conracrols Liccnrc Llw docs nor apply to an owftr of
<br />rh. pmFdy qho boild! o, itreows tlEbn od who dftr s@fi s* himsclf or heMltor fibuBh hh or her own empLr!.!.
<br />providcd rhll such imF.rcmnls m mt inl.nd.d orotrcrEl for eb.If, h.wM. tlE t{ildinS or inprMmd t sld *itnin on. rs
<br />oforplcrion, rlr Ownr B!il!. wiu har tE bu!d4. of Ebviis tiar lr or she dij tur lriu d in{lor rh. pmpdly fo. tlE plrrDc of
<br />-1.
<br />s owrc. of lhc p,oFJly, m crclusivcly conrelir8 shn lened coI tr'o6 lo snslNcl llE pojel (Se. 7014. BEircs
<br />aid Prsturam Codcl Thc Comreroar Liccnsc Lra dNs mr smly r. !n 6qG of lropcfly who blilds or ioprcEr ih.rcon.
<br />and who ontmrs fm sah ,rcj.srF with ! Cor E ro(s) liccn*d pu6wr ro rhc Codr.crols Ltcn$ L3*).
<br />-l
<br />M cxcopl undcr Scclio,-. B & P.C. for rhis rcMtr
<br />Drr. o*n.r:
<br />]1OBf,EELCAMPjNSAIION
<br />DECIAf,AIIQ!
<br />I hcrcby !fitn undcrycnahy of psjul} orc o, lhc folbwinS delmliotrs:
<br />-l
<br />havc nnd qill ,Mitrr.in a CcniaK c of Con*n'
<br />'o
<br />Sclrlnsue for mrkns- .onDcns0rion. .s lmvidcd ior by Salion l?00 of lhc
<br />t hor Codc. for rh. r.rfom.cc of lhc work for whkh rhc JFmn i\ is$dd.
<br />_l h!!c ood Bill maintain workcr' coq'cnsol ion insuEmc. !s rcquircd t y Ssl ion l7m ol lfic bbor Codc. lor tt p$aomncc ol
<br />i. nscq. My*o*er a'mpcnd,un rnumxc tsic, &nFlry Nnbc,m:tul
<br />7
<br />-l.cnilyrh{l
<br />inrhe perfortutue ol lnc work lor w,rich lhh pcrmil is nslcd- I shallnot cmplo, !n, pcson inany@ncr
<br />s as ro h.com subjc! to thc wrkcn omp.n*,rion hws oaCalilnmia, md aBrc rh,r irl should tx.om subrer lo lhc
<br />workcB drnpcnrdlion tmvision\ of Serion l70O of rhc Ljhlr C.dc, I shdl. rodhwilh .dmtly wilh lh.s pmrbions .
<br />WARNINC: Failnrc ro sctrrc worketr $q)cndnrn .ov.Bsc is lnldsful. Md shru {brc.l m .n{'lo}er lo siminrl ,cMxhs and
<br />.ivil itr.s up r. onc hu.drcd rhonqnd dolldrs ($l ).i ion, damgcs as pmrAcd for lh.
<br />S..rn :1076 ol rhc trbr CoJc. inrcicsrutrd.iiom!\
<br />^.,9-3a-t{
<br />DECI,AB6.TON
<br />I hcEhy ualir undcrr.n.hyofpcrjurrrhir I lrn h..n{i undcr pbvision of ( hrrrn 9 (comnrmin8 sirh S.dhn 7(l()O)ofl)ivtt'n l
<br />of rhr Bo{mssnnd Pbt rsnrnJ Cdd.. md my li.cn\. ir in tullf(nenddcfir.r
<br />./ a-?.-taf-'7:-'rV
<br />g}NIiIX.IICIOITIENIAJ;.AGENCI,
<br />I hcEhy trlftr undcr lEntrlly of pcrjury lhll rhnc h a.on$ru.rion Lnding a8cncy for rlE Fslhmnce oflhc solt tor whi.h lhh Ilcmil i\
<br />issucd(Scc. :1097.Civ. C ).
<br />AP&IJITNU,ECI.AMIIO]!
<br />I hoEiy lnim undcr ,.oalry or pcrjury un. .r rhc followine dsl@rions:
<br />Dcnblirii,n Pcrnirs Asbcsros Norificarion lrcdcralRcEuhtions(litlc 40, Pea6)
<br />-Rcrt!ircd
<br />Lcrrcr of Norilica!ion
<br />I ccn tt rhrr rhcfcdcrrlrrlrhri,,i\rsdin! r\1.{o\r.nxtrnlxrd nor npplica6lc h rhl\ F,,jccl
<br />-l
<br />ccnify rhll I havc rcld thG appl
<br />odinuc$ ond Sralc L,*s relarios ro
<br />!d sr.rc rhor rhc ow i.fomEtion t corsr. l a8rc ro comply wilh all Cny lnd Counry
<br />ion. !d hcrcby ourtnriz rc!rcsnhriEs of thh Cny and Colnry ro cnrs llnn rhc
<br />rn,vc mnln,ncd lop.ny for 4 7-3o-r{
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area,/Storm Drarn
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Mai n Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanita ry SeweriCap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL
<br />Notes, Remarks, Etc
<br />Miscellaneous
<br />tfldd 3 Ad&B*
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