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PLUMBING.INSPECTOR RECORO
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq 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 />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 />/.^..\
<br />Rouqh Plumbinq 7'zo-{g k"tJ]a)
<br />Final Gas Test
<br />Meter Release
<br />FINAL 7-71-14.,Vkr.*rt/.az)
<br />a1Notes, Remarks, Etc
<br />OWNER BUILDEf, DELCAIATTON
<br />I lErcb, alItrn undcr F.llry ol Frjury $.1 I m d.ml'l tls rhc C.nlracro6 LiitrE t e for lhe follosirg rc&. (Sc.7031.5
<br />Businc.s and Prof6sion Cod.l: Any Cily or Ciunry ehth rcqlircs . FrnI lo 6iir d. aXa. anprec. &mt!h o. EFn 6y
<br />soucrG€. Fir ro lrs irslad. .&o FquiEi lh. .}?tican fo, sh pcml ro fd. . sigmn 3r.l.m th.t lE or slE b lkctu d puMar,
<br />ro rhc povhionr of dE Conh.rols Liansd k* (Chsprd 9, Commeine wth S*rior 7000 ot Divishn 3 of llE Blsircss and
<br />PrDfci.io8 Codc) or Ud lE o, .h. b €kmpl thcrenon nd llE ho.n fo.0E .lL8cd .xctrplion. Any lioblion olsc.ibn ?011.5 6y uy
<br />lPplkanl for a p.mit subtrlr llE al,plicanl lo s.ivilp.nallyofmt mE lna. fitG hordcd dollrs ($500).
<br />-1.
<br />a o*n6 of thc potEdy, or my cn:ploles wnh wagca a ltF! $lc codFnsslion, *iI do ln tult &d rlt lttlM h mt
<br />idcDdcd or oficEd for sl. (Scc.7044. Busiftrs and PrefcsBions Codc Th. Conr.etn s Licc.* t v d*s nol lpply to an owNr of
<br />lh. poFny who hiildsor in{,brcsd*mr eln who do.s sh m hiruclf orhemlf or llNlsh hn u ho own.8plor.s.
<br />pro,idcd rh.r su.h in{roEmnr. @ rci i.larded dolEfd f6r elc. !f, hoemi ttE hildinS or ihpmrcEnl hsUqi$inon Fe
<br />ofcotrpLlion. rhc Own.r Buithr will hlw rtE hr&n of pmvir8 tnlt IE or slE dit m! tdild q inpmE ihc prcpqly lor dE l,qns of
<br />_1. as osncr or rhc lmpcny, d .xclu.ivcl, .o.r&rins wirh li.rn{d .odlncros ro onsldcl rh. pmjccr (Ss 7044. B6imrs
<br />sd Pistssion Codcr Th. Conl@tols Licctrsc Li{ docs nor a!,Ily ro onnwn.r olnnFn, who blildr or iipmrcs rhcrsn.
<br />rnd qlF conlmds for such poj.rts wnh ! Conthcro(s) lkcnsd plFunl ro ih. Cont.ciols Li..ne Lnw).
<br />-l
<br />om crcmpl uidcr S.ctio ll &PC aor lhn rcaso.
<br />II}Bf,EEI: TMIENSAIIAN
<br />DEII.ABAIIqN
<br />, hercby Nfirn und.r Fmhy ol Frjury onc of th. followinS dchnlions
<br />l.rlu (n,[. hr lh. pdtunmncc olrhc \o* lnr lvhich rh. j]cnnir n nn(d
<br />I h*. and willnoinlain worlcB coq,cnsalion insurotr.. as r.quncd byScctioi 3700 of rh. Llhot tuc, fo. rlE Frfomrc of
<br />n nsucd My *trtm' compc$dion insurofle catrir and Iiolicy ,!mbc, el
<br />1\\\t
<br />-l
<br />ccnify rhul in rhc ltrformrc. of rh. eork lo, *hth rhir FrmI h i!su.d, I sh.ll nol cmtloylny p.Mn in ay n&ocr
<br />$ a3b tB.o'm subi..llo llE worl6! oqrcnsdion hws ofclliforni0, and asd tlur if| sholu h..om bj(tr lo lh.
<br />workdc sFpcnsarion pmvLions.f Scction 3?00 of lnc LdDr Codc. I dEll. fonhwirh oduly *irh lk,E lovi\ions..
<br />WARNINC: Fuiltrrc lo $urc work tr .onD.nsalion svcd8c is unhwtul. {.d shall subjccl an cnpl.,rer fir ciminal FMlriec tnd
<br />.ivil rinc! ul, h on. hunded lhousrnd doll0rs ($l00.uD), in oddilhn lo lhc cosl of.ompcn$tbi. damgcs as Providd for thc
<br />Sc.riM 3076 orthc bhorcodc. i crcsl nnd
<br />'1 \\.)
<br />DECIABAIION
<br />I hcEby 0fiiirn undfi pculty of leriurt lhar I dm laen*n ondcr pmvi\ion orChdflr 9(.onihnc,r8 *nh Seli,fl'7000) ofDilii.n:l
<br />of rh. Busin.$ 0nd Prolcsshns Cod.. !n my li.cn$ is in full loN nnd cfid
<br />c<L \62 \Io!
<br />b *"*""
<br />CONS1BI]CI]IJNIENDINC-&qENSI,
<br />I hcrch, aflnd undci Fnslrrorp.ijury rhd rhcrc k 0 consrucrion Lndin8 l8ctrcy for rhc pcdommc.trhc sor* tbt whicn rhn Fr.ril k
<br />ks'cd (Scc .109?. Civ. C.).
<br />AIPII{:ANLDECI.AMII$i
<br />I H,,atrmundcr pcnlhyolpcrjury o@ orrh. followine d l& iohsl
<br />Dcm,nion Pcirnn$Asb(slos Nolificalion Federol RcBuhlions frnt 40. P!d6)
<br />-Rcquircd
<br />t llcrof Ndirrc i,n
<br />-l
<br />Nniryrhrr rhc tud.rillcruhrt'ff r[ddiic ,sh({o{ rm)vrl rc ior trtfli.lbl orhr pmjNr
<br />l.cnily rhtl I h,vc Ead rhis appli.alion and stnlc lhll thc,how inlnndion h corel. I rle ro.orrfly wnh illCi'y snd County
<br />ordinatucs onil sr,rc tlws Bhrir8 ro buildinB.onnrudion. ond hcrcby 0urhoria rcprcsenistivcs ofrhir Ciry rnd C.unlyto cnis upon the
<br />hrrc nrnrnn,cd lx,|tny nr
<br />lpplirutrl or '\t.nr SisnElu 1. \\' \t
<br />I
<br />I
<br />II
<br />Lcndciq Addrc$
<br />lem lmnrmc(rrinl):
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