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PLUMBING.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent 7-Z+1v X-E- n-W gat,1oB @l!.xwxti
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent tl>iltr -'r,- t ll
<br />Water Pipino '1 ha\ i*/t" (/
<br />Gas Pipino I' I
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain 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 />Rouqh Plumbing lMlt?lJttn)
<br />Final Gas Test I
<br />Meter Release ,a.\
<br />FINAL zlplrS lllolW/2A/V
<br />Notes, Remarks, Etc.IJ tt
<br />A// gMl0rAA A\l e/rv,
<br />OWNER BUILDER DELCARATION
<br />I ncrcby.mrm lndcr tculty of rcrrury lhor I m.xcnnt 6$m rh. Co ncroF Li{rre tjw tor llE followin8 rcasn (36.7031.5
<br />Blsioes !d Profcsbn Codc): Ary Cny or Coniry vhict r.quir8 a Imi! lo on.ltu l. u[d. iml,otc. &mliih or 6Fir &y
<br />suucruE. prbr lo irs irsu.re, ako rglircs rhc lpplicant for $ch !.mn lo fib , 3igncd rrarctrnt rh,r lE or 3h. is liccn$n puNrnl . "
<br />io dr t/ovisionc of
<br />'h. Conrmlor's Liccn$d tzw (Cn:p'd 9. Com.min8 wilt S.clhtr 7000 ot Dieieion I of lhc Buitrss tnd
<br />Pofc$ions Codc) o. thrr lE or shc Ls cxcq,r lhcrctoD srd rlE b6sn tor ihc elhgcdcrcrflbn. Any viobrhn of Serbn 7o31.5 by r.y
<br />aptlicrnl lor a p.m sutirts lhc llplionl lo a civil pon.lly of ml mrc than fivc nrodtd dollur {$500).
<br />-1.
<br />&s ower of th. pnlFny. or ny crlploF. wirh eaeet 6 |hcir $h onpenslrbn. wil rlo itr wrt dn dE sErE ir ml
<br />iflc.dcd o..nc6i for $L 1sa.?o44, BusiBss .rn Prof4sioN Cod.: Thc Conrh.rols Li.cn$ kq des er lpply lo N owM oa
<br />rh. pmld, wk' bnlds or inp6B rtEotr dld qho &$ skh us* him.ll or h.r*lf or lhDu8h his or lEr oq chrloy..s.
<br />prorid.{ rhat soch inqroEcnB@ m i cflhd dofEnd ror sh. If. ho*E, rh. l[ildiry or ir{rNmn! is sld *inh oN }et
<br />ofotrpkriotr thc OwEr Bui!:lcr *ill hrE dr tnE&n of nsvins fisr h. or ihc did ml boald or ir{,bw dE pmFiry for llt !q!e of
<br />_1. {s orvncr olrh.Jl)fu'ry. rncrcluslclyc.nrrrrri',9 $irl' liccn\rd.ortx.tn\k,..rsrr.rrhc fojccl (Scc 7l]r4. Bu{nrs
<br />rki l\nrssir(,)Jc-lh.Cotrrr.roirl.i.ctr\cLdvdrc!trorrf!lthrtrostr.rolnm|Eny*h.6uiUsornrpn)lcsrhcrcui.
<br />xnd $l,o..dricr\li,r$.hpftUccr\uithrC.ntrctn(9li.co\.dpr'\udt)rhcCotrLr.ttrsl-i.cnscLi*)
<br />-l
<br />d cr.nIl undcr s..1ion- B. & P.c. for lhi! EMn.
<br />-l
<br />taw ud *ill Einllin ! Ccnirrlrc oa C.trsfl ro Sclf lBurc fd worlcB .ompcnslion. as previdcd for t y SNion 1700 of rhe
<br />L o Cod.. for rhc lErfomftc of rlr *o* fn whi.h rh. Fmn b irsucd.
<br />-l hlr aod will roinllan wort(6 .on{rBalion irouEN.. !r Equhd by SNlion 1700 of ths ljl,or tudc, fo. lh. pqaol|l@. of
<br />rh. *ork lor which rhk pcml is issEd. My wq*6 .onwosarion insurm 6hr on plicy .!hbd &:
<br />Poli., Nuhh.r:
<br />-rtn'rcr
<br />-l
<br />cdifyrh{r ii rhc n d.rmanccorrhc work ror which thk ltrnir h isucd. r shrll ior cmployanypeBon inu, B,nn$
<br />s s io tEcom uhjccl ro lhc wortc,l corynnsdion laws of Californi( und a-!e rhll if I slk)uld b.co,E subjccl to llE
<br />wo (tr sn .nsarion provisions of Salion 3?00 of lhc Lrtnr C.dc. I shlll, aonhsith cdndy wirh rhos pmvl\ions..
<br />WARNINC: Failurc ro $curc sorkc^ .omr.isdnrn covchts. is utrlnpful. rtrd $rll \uhjccr sn cmDloycr t di riml lEnukts,nd
<br />ciyil rin.\ up kJ oft hundri lhousand dollss (Sloo.troo). in lddil rhc cosr ofcohpcn$trion. d,nugcs os provilcd ihr thc
<br />Cdc. inlcEsl lnd ormy s
<br />DICIJBAIIAN
<br />I hcrcby afitm un cr p(nnlrr of p.rjurr rhd I am li.cnrd rnJcr thvision .l Chtrnrq 9 (.ommn.inA sirh Sccrion 7ffX)) .r Divhbn -1
<br />or rh, Busin.ss aM Pmrc$hns Code, !d mr liccnrc h in lull forec ann c,Lcr.
<br />C0!illI&IrlJliI!NIUNii-[0[N!1
<br />I hcrcb x,nirnunds Fnilryorp.rluryrh0! rhcr. is r connrudion Lndi.8 trscncy fn lhc rcrturro.c. ofrh. work aot whi.h rhn Fanir is
<br />h{ucdlsa :l0r7,Civ C)
<br />a.ttuc6 fD[cldxalll]N
<br />llmhy imxtuhr Fnrlry ortrrjury om of rlE iolb{nre dc-ldnrn,rr
<br />Dcnn,lirion Pcrnrils Asll(\los Noriticarn,n F.ddrd R.SUhri,n\ (Tirl.Jll,I'd6)
<br />-R.qun
<br />d Lcrtcror Nolifuli0r
<br />-l
<br />en jf, rhrr rhc Ldqd ,cgnl,rions rcE.rdi.e asbcslos Emld -c ml olpligblc lo lhii ptuitl
<br />l..dilyrhrt I tu\c rc0d rhh lpplicnrn,n and starerh.r rhc nvc infnMrt'n i\ cotrc.r I agr@ to .onDly * irh all Cil, lnd G,lnty
<br />ordinutucs and srlrc liB Elaling r. buildirg consr dd hcrchyourhori4 El'rcscnrltivcs ofrhh Ciry a.d Counlylo cnlc! upon th.
<br />ahvc rmtrriorcd floncny io. inspccrion Dlrr,oscs
<br />*,., 7/2/zr,\ppliunl trr,\[.nl Silnnr r.2
<br />lC/-a-
<br />II
<br />APPROVALS
<br />I)ule ()$ner:
<br />ll}BlilrBiraurursrllQ!
<br />Df,Tl/l.B,IIll)!
<br />I h.rchr_ rllrn, n,l.r Nmlrvoltrru.yfnrol rhc ln1[i$i',g,tu.lrrrrnr
<br />Lcndclc Nam:
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