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PLUMBING-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent ela/n 7il44) <br />Waler-Under floor <br />Gas-Underfloor alw tr r^)?Y <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent ailM 1}lr,@ k]'V l)Water Piping e.)iln 7:il."D <br />Gas Piping It <br />Roof Drain <br />Tub/Shower Test <br />Rouoh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL toltPltni "vv^Wlc4UNo(es, RemarkS, Etc.rL <br />leY,*tt-.i.l.* oU-glbltg 'itr(w) <br />U a.-., <br />OIINER BUILDER DELCARATION <br />I hercby artrm undcr Fnahy of lcrjlry Ihst I d denfl ft.m Ihe C.nr&rm Lienc Lrw fo.lh. followh8 Eesn (5€.7031 , <br />Brsin ss and Prcfcsion Cndc): Any Cny or Counry whi.h rquires ! pomir to ondrct. all6. inpbv.. &mliih or Gpdt any <br />sru.r@, p.ior i6 ns isUa., also Equircs thc arpltd aor scl Fmil lo fiL ! skmn n!tc* thll h. or sh. h lkcn$d pum,rl| <br />!o thc pmli.ions ot rk Conrreror's Lienscd Llw (Chrlr..9. CommEing wilh S.clion 7000 of Dilki.n I of llt Buinc$.nd <br />Profcssions C.d.) o. ih.t tE or sh. L\ cr.ryll $@fren ud rhc basis tor lh. slhEcd ci.npdon. Any viohlk n of Strdion 7031.5 by any <br />lor ! Fmil subjels lhc aplrliclnl ro 0 civilpcmhyofnol mrc lhan livc hlndEr! doll$ (l5m) <br />owncr orrhc pmFny, or my cmpk,rrrs vilh w,8.s as th.ir slc conDcnsdion. $illd.lrr *Mk atul rh. {mrurc is ml <br />nd.n o, o,Icrd l'or slc (Sd ?044. Busifts Md Phressionr Cod.: Th. Conrelols l-iccnsc LI, .locs nor nnply ro an orftr or <br />thc popcny eho blldr 6r inp6B ilrotr o,rd who d.d *h w* htnsclf or hcelf or ifiDgn his or htr osn .nplolG. <br />providcd rl'!t such ihpmrmn$ e er htcd.d or oflcrn fo, sL. If. thg*i ttE t{ilditr8 d itrpr.wEnl h $ld *idtin orc tw <br />ofcon/cliorl ltbOwn.r auii.. B hlr llf hrd.n oapmving llEl lE or slE dU mI biiiB or irprDE dt poFly lor dE 0u{bc ot <br />I.6sow.ciorrh. Eor.ny. mr.xclusivclyconratin8 wnh li.cnsd .o.trrcroF ro onrltucr rlt Imj<r (Scc.7Ot4, 8!src$ <br />und Pnl6sion Codc:1hc Conrracttrt Licc.\e Law docs nor appltro.nownfi ,m!.ny *ho blilds or imprcvcs lhocon. <br />0nd who omMB lor such Imi{ls wnh a Co mro(s) lictrsd puner <br />I hcrcby,mrmu.d.r pcnolryoiFrjuryoncof ltufollow <br />-l <br />luve &d sill @i.r0ii s Ccnifr.rc of ConFnr to SclalnsuE for work6 dtrpcnsdrior a Fovidcd for by Se.lion l70O ol dE <br />bbor Codc. lor lhc |)6roffi of lte rc* tor which lhc l)cmi i. issu.d. <br />*l h.vc and will m.imain wnrkcn ompcnsltion inslBncc. ns rcquncd by SLrrion 1700 ol rhc Ljbor Codc. ror rh. Fformncc ol <br />thc No* ror snich lhis pcmit is tsucd. My uork6 .omFnsrion insurancc .Mtr 6nd Flicy numb$ ml <br />TVARNING: F ilurc k, KUrc $orkcri .om!.n\rri{,,cmploy.r ro dninllpc'uhic\ Md <br />cilil finc\ up lo orc hundrcd rnou\,nd dollutr ($l <br />I h.nby ilfr6 xndfi Fnully of p.rjury <br />'h,t <br />I am li.cn*d u vision olChlp16 9(commncnrs silh <br />of lh. Busircss and Pmfesions Cdq ,nd my liccnrc is ii flu lod el cttccr <br />QNSIBIIqIIANIENIIIIG.EGI!!:X <br />I hcmby rfllnn undcr F trdry of pcrjury thot rhqc is r (mlrudion hMing ascn(y ntr lhc pcrtonurft or rh. *oik for which rin pcnnir h <br />i*u.d (S.. .1097, Civ C ) <br />AIII.IEIIITLDECI,ABAII1)N <br />I rrRtry nlitrn unds pcnrxy oi f.rlury onc ol rhc l.,lowir8 dc.lnrlridrl <br />Drmoliiion Pcnnirs Ashc\ros Norific ion Fcd.ral R.!ulrrii,n\ lTnlt {).I,an6) <br />Rcqundd k(cr ol M,rifi rarion <br />c.n iay rhar rhc fcd.ral rc8ulrr ions Esardnr8 esbcslos rcrmlul e mt lprlicuhlc ro rht toFcr <br />rhrr lhf,vcrcrd rhnrpplicrrnnmJ {arcrtur r is..trccr. I 4@ loo,q,lywilh lll Cirya <br />.bovc mnriomd pmp.ny for in <br />rD!rcscnra'ivcs of lhh Cny and <br />APPROVALS <br />Policy Nunb$: ExdB <br />- <br />-l <br />anifyrn in rhc pcrforturc of rhe worl f.r ehththh pcinn ! iisxcd.l sh0ll nor cmlloy ony IErstr in rnydontu. <br />$ N ro lx.om subjcd ro rh. wdnl shpcnsrion L*s of Califomi!, ad a8N ltat if I slblld ttcoe sub.iccr to rtE <br />w.rk.r( Nn{rnsrion lmvishnsoiSccrion l?m oath. blrr Codc.l ndl f.nfi*irn omply $irh rtns povhions. <br />:::ql&il <br />ttr.nJc,'. <br />^,td,"* <br />= <br />= <br />I <br />I <br />I <br />=