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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />t hftby ,md undd Denalry of p.riury fiar t m cxcnDt fiom rlE Co.tdoB Ltcnr tiw for th. fouowing rdsn (Sc. 70:l l 5 <br />ausin8s ond Pmfe*ion Cod.): Any City or Counly vhich Equtcs a pcmil lo onsrtu( ahd. inlpetc daoo&h or Epot .ny <br />srtucruG prior ro irs ksum.. !l$ Eilircs rhc trrpltdl for such r.mi lo nb a 3i8ncd sl&rcm.l rh{l lE or stF is lic.kn lrrslnl <br />ro rhc !rcvisions olrlE Conrturoa: Lhc.{d Lj} (Chaflq 9. ComftNi.8 w n S.clion ?000 of Diltion 3 ofrhc arsincar md <br />Pmfcsiois C.dc, orthar tE orsn b crcnpt llEErron.d ino boi. ror rnc.Ic8cd ercm ion. An, violaraonofs4rbn ?0:!l.5 by"ny <br />applicrnl for a Fmil subiels thc lpplic! lo r civil pcn.lly of ml mre lhM fiec hud.n doUB ($too). <br />_1. ds owM orrhc troFny. or ny.mphFr with w.E . ri llEt slc ompcnslion. wil do|lr m* un th. sltuiE ir ml <br />inrendcd or ofimn fc sh (Se.7044. Bosi*ss snd Pmassions Codc Tt Conrr&|oil Lic.nc t w .ro.r Nr lpply lo an owM of <br />rh.F.F ty atb buikk or inlmE rrEmtr !i *ho dfts *h mrk himFll o lEelf or lhrcusn his or hc. oq cq'loy*s. <br />l,Iovitq, rh,l skh ihpiolft s e rcl inicnd.d or oFoid for $lc. t( hosffr, rtE hilding tr inprwmnl is sld *hnin om y@ <br />of conplction. rlE Owmr Buili$ *ill hsr rlr bltttn of!rclin8 $.r h. or sh. dil ftr ltrild tr inqroE $c pDFry fcr dE ltrrpos of <br />-1. <br />&s owncr of rte pnpcdy. ad eiclusivcly .oorrcclirtB sirn Iccn*d .onr|.b6 ro co.shd rlf prcicr (Se .7Ot4. Bbinc$ <br />ard hftssbn Codc: Thc Conhcrols Li.crsc tiw doc$ nor trptly ro m owncr ofprorcn, who builds.r inprorc* rh.,con. <br />and who co mcc for such Drojccis uirh e Conro.ro(r) liccnscd puBuni ro rhc C.ntlclocs Liens tlw). <br />-l <br />rncxcdpt undcr Sd <br />D.ter- oencr:., <br />DIiCIABAtr!]N <br />I hcrchy amm under p.nnlry of pdlury onc oldc follo*in8 drlrlrnnr: <br />-l <br />har snd sill minrain a C.diar.rc or Con!..r b scll lNurc lu uork.6- c.nD.ns,rion. ,s rovidcd lbr hy Sdt,n ]7fi) o I rhc <br />l-'ho! Codc. lo. rhc F lormncc oi rhc q.,k nn *hth lhc Fnnil n nsucd <br />-l havc srd will tuinrain sorlcF comFnr.lio. iBunrcc. &r r.quiEd by Sc! hn l7m of lhc tjt or Codc. for lh p.t(o@ac 6f <br />tlE erk for ehkh rhi. pcm! t i.srd. My wdt6 @mFnslhn in.uBnc. cmi6 $n Foky numbcr e: <br />l.cniryrh,r in rhc p.rror@ncc orrtu work for whi.h rhn Frmh n nsu.n.l shlll ml cmployany peMn in any manmr <br />s us to tEom sul,j.rr ro rh€ uortcs' comF.s.lion la* ofcalifornia. and ae@ lhd ifl shouh tf,.o,E subirl to llrc <br />woltcn conrpcnslion potsionsofSdi.n 1700oflhc Llhor Codc.l shnll. lodhwnh .onply wirh tl[s pmvlsions.. <br />WARNIN(i: FriluE ro su. wortcn onFnsolion .ov.n8. k unlawlul. and shall subj(l u mnlote, ro diniml lEnlllts rnd <br />.iril nn.r up to.nc hundrcd lhousrtrd dolh6 (3100.0(x)) <br />Scdi 1076 orrh. tltnr Codc, intercst and lllorncy\ fccs <br />nPcnslrion. dafrrlc\ rs r'ovdcd i rhc <br />ol rlt IlusiN.!\nnd Pnnis\i{rrCon.. rnd n,r" ]i(1rNc l\ in,'ill1itr.. xn,lcll.(r <br />Lisns. Classi-Licnsc Numbd: <br />Dd.: Contmtor <br />IONEITUCIIONIENDII$IAENCI <br />Ihcftby11616lidcr t,cnalry.fp.rlxrtthd 'hcr. <br />isa.onitu.rion Lndine rC.,Ey lor lhc Itr o,nEncc orrhc {.rk nrBhichr[n Frnrit h <br />isstcd (Scc 3ID?. Civ C ) <br />APII.ICANIDECI,AMIO! <br />I ffiy ofrm lndcr !.nolly of Frjury orc of $c followinS d(l@lionsr <br />Dcmolnio. Pcrmirs-Asb.sos Noti6.ation Fcd.Bl RcSulalions (Tillc,l0. Pan6) <br />Rcquncd bttcr of Noili.alhn <br />-l <br />a iry filr rhc fedeEl E8llltlions Eedding sbciros rm$l @ nor 0pdklbk lo lhis poirl <br />_l cn'lrrhrr I tuw,cad rh'\afllrrrnn.id$!r.rhd rh.rion ircorer.l age tocomrly*irbdt Ciryond Counly <br />ordi'u ..\ rnd srsrc lr*{ mlaring ro huildioSconnru.r &rtnrtercflesnt livcs ofthis Ciryaod Cour] r..nld ufx)n lhc <br />dx,vc mnrioncd popcn, f.r inrpccrion tuqs\cs <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 Pipino <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />P-trap/Drain Line <br />lVlain 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 />Rough Plumbing <br />Final Gas Test l <br />Meter Release I <br />FINAL Y/zht'.4ffif-q) <br />Notes, Remarks, Etc./-4/ <br />Roof Drain <br />Lrnd.is N!tu: <br />P€mir&MnetDnnO:\ef o ^,., l f zlltL <br />f------T------