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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GHOUND
<br />Waste & Vent
<br />WaterUnder Iloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL tn6hs Sl sv
<br />Notes, Remarks, Etc.
<br />OII'NER BUILDER DELCAIATION
<br />I hccby a,Ii.n u.d$ Foalry ol pcrjury rhll I u .x.npr tom dE ConlmloE LLtn* k* for llE tollo*ina eatn (Ss.70:r1.5
<br />Busine$ ad Pof.ssion Co{te): Aiy Cn, or Coltny *hich r€qlircs r IEmi lo coo{n(t. !ltc, inflovc. dc@lish or qrat any
<br />srocl@. !rio, ro irs tsuec, sls ,cquiEs rh. arpliclnr ro, such Fmir to ,ilc a si8md srtrtcwnr rhal h. or shc is li.cnsd pu^ua
<br />ro rhc l,Bvhhns of ItE Conmcrols Liens.d tiq (Chq,rcr 9. Conftnchg wilh Se.lion 7000 of Division 3 of lne Busincss ed
<br />Prcfessh.. Codc) or rh6r lE o, rhc i5 .r.qr lhqetom od Oc b{ri! for ft. rlh8 d .x.trrption. Any viohlion of S.nion T0l l .5 by any
<br />rppli.a.l for ! Fmi subj.ds rlf, ll,plio lo!civilF llyolno! mElhln fivc hundEddou&s (55@).
<br />-,.
<br />N o*tr.r of ih. lmpcrry. or my .mploy.cs wilt waScs as rh.ir Fl. comt)cnsrion, sill do th. qot ud $c rhdG is mt
<br />i cn t€d tro0crcd rn sle (56.7044, Btrsi,.s a.d Ptbf.$ions Corlq Thc Cont!.loas LicDk l,w do$ ml q,!ly h.n awrcr of
<br />rhc rolrcny who buil.ls or nr{,ors rh.mn. aid who dirs skh s* tinlscll or hcuclf or thmueh his or hn ow. .mrhroi
<br />l,rcvided rh0r och imrmwmnls m ml hl.ti.d orofcEd Lr eL. Ii hoEt.r. thc buildinB or iry,ffift neUsnhinon.Fd
<br />ofon?klh'! rlr o'xrcr BuilLr w nlw fi. hltlen of tDtanE thar hcd sh. dit mr hlld or ilproE O. pmFny for dE FrFos of
<br />-1.
<br />as owrcr of rhc Ino06ry, am cx.hiirly conmcrins snh licensd co.rie!.n tr onnrud rh. pmiel (S.c. 7041. Busims
<br />0nd fiDfc$in Codc: Thc Conlrelor's Liccn$ tiw docs nor,pplyb eowncr ofrmpcnyuho builds or iml,rows rhcrcon.
<br />lid qho @ntrucrstbr such pmjets sirh d ConrturodI lkensed !!Bun rorhcCoorrcbis Li$nsc tlw).
<br />-l
<br />am cicn hdo Scct B & P.C. {orrhh rcuson.
<br />Dere' Orner
<br />llaf,E8S:!0M?ASArIllN
<br />DEC!.A8AIIOX
<br />I h.rcby afljrm undcr Fnrliy of reiury on. of thc tollowing dccl,ralions:
<br />Ihrwr willrMinuinrCcnrfl.orcofCons bSclr-lnsuref.rworkcs.onrfc.srlion,rs povidcn lor b, S.crn,n:1700 olrhc
<br />l*or Codc. nn rhc ll.nbrmnce of rh. uo* r..which rhc prmir is h\xcd
<br />,fn* ,".r " '
<br />rr ."*,
<br />' ".rrc^' cornncn{rr r.tr in{urrncc. ,N rcqutcd hy Scclion l?OO ol ltc ljhor Code. for rh. l)crrrmnlnc. or-rhcwo n{whEhth'sncmurtrr*udM)wqls.cnn'I)cn.rrionir\d'Jn.".Jnidr'lp.li.J umhlr r.
<br />Sacu&, rz l)t* rztpa t
<br />zo o
<br />-l
<br />ccnify lh.r in fi. lcrlormrc oflhe work lor qnich lhis lElmn is issucn.l sh.ll tur corloyany pc&n in ony manrc.
<br />$ ai ro h.otu slbjed ro rhc wrl6r' oftpcnelion Lwr 6l Calilomia &d a8m rhd if I should tEiom subjecl lo thc
<br />wo,ke6'onFcnsorionpDlisions.fScd .lT00.rrhc Lnbor Codc.l dEll. forthwithmmply *ilhlhos lmvisions..
<br />WARNINC: F.ilurc ro sw so c6 .onqrnsalion o!cr!8! is unhwtul- ! l shall slbixl !n Bployr ro aimiMl lrMhis ond
<br />civil fircs up ro o* nundEn rhouslnd dnllas (5100.000), ii lddirion ro rhc.osr oa conFnr.iio.. d!.88.s as povilcd for lhc
<br />,a
<br />L&DNI&OJONINACIOB
<br />DI;CIABAI,I!.}N
<br />I h.{byarfirmuidcr p.nJrloftr.lu.yrhd I anlicctrql undcr pmvisio.olChlprcr9lro rmncin8wirhsNr n T(xn)ol Dilhion.1
<br />df rhc ll!\inc$ r.d ftofcsb.r Codc. ind myli.rn* ic ir lullfor.c exl clficr
<br />?A 6{7
<br />I t-
<br />CAIEIBII{JIONIENDIITCAGENCI
<br />I hmby I"n uhdo Fnally of Fiury thd dsc ir 0 oi(ruclion lcndnE {Bcncy n{ rhe F,fortui.c nr thc *or* ro. which lth lcmil it
<br />iisu.d (Scc 1017, Civ C.).
<br />AE&&ANLDETLABTII)N
<br />Ilrt6yr,)nr tulrrn.trrlrloll,crjury.ncof rhclnlk)s ltdc.hrlnrn\:
<br />Dcnnlirio. l,cnnirs-Ashcslos Norificrrion FcJ.rrl Rc8 Ltn,,s l'rith 40. Pnn6)
<br />Rcquncd lr(cr.f Norillcrhon
<br />-l
<br />cea if, lhat rhc fcdcEl rcs!!,!ionr egrJdiig a\bdsroi rmval ft nor ,lrli.rbk ro rhn Pmjcd
<br />Water Service
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