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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ollNl]i AUII-DtiR DI]I,CARATION
<br />I hcrchy rfirm u cr pcnrlry ol p.rjurr rhar I anr cxcnrnr lior rhc Conrado6 l-iccn* ljw turhc folh*ins rca$n (sdi'71,:ll5
<br />Ilurirrc\\ rM Pn,Lssn CGlc) Any C[y or C(,unry sh'ch rcqotdl , ltm h .on{n,.r. alr.a, imfr.vc. dc xrnh .{ RnJn .try
<br />(rucxrc. priorro ils is oncc- ol$ rcqutcs rhc lpllicr hr such lj.nnit ro rilca vrtren sldcNnr rh hco! shc t liccn\.d pur\rnr
<br />ro rhc ,rftJvti.ns orrhc Conrnc(r\ Li.cn*d Lj* (Ch.pr$ 9. Co mrking wir[ Sccti T(X[ of Divisiotr ] oflhc Busincsr aDd
<br />Itora$i,rs Codc) .r rhd h. or rhc is cxcnDt lhcrcr'm rMrhchr(isn
<br />'hc
<br />rllcscd crcnDtion. Any vnnnlifl ol'Sccri'n 70.rI 5h,nDy
<br />rmlicxnr n,:Frn,ir suhJ.crsrhc nprlicanrt,!civil,,.nalryolnornrErh tivc hundrcddoll0rslSt00)
<br />-1.
<br />as o*rer of lhc !troFny. or my cnplo)tcs vith M8es s lh.ir solc snlcnsolion, will do ltE m !d!h.stnflEisml
<br />ifl.M.n o. ofrcEn for sk {Ss.7044. Businc$ lnd Plofcssions Cod€: Tfu Conrrrcrols Li.en* Lrw do.r ml atply !o M ovm of
<br />lhcpmp.ny wbo builds m inpmws thcmtr .d wh. d6 sh srk hirelt ( h.mlf or thouSn hG or h.r own.nploy..r,
<br />,rovidcd rhai such idloeMls e mr inicd.{ q oficrcd ror slc. ll howw. r}E buildiry m iqmwmnr is sld wirhin ohc y@
<br />of.orqllcriotr rh. Oqcr D!i!L, sill h.E rn hrdcn olprevins rh lE or dE dil mr tiild o, tqmrc rh. r,otEry for r,E DUrF$of
<br />-1.
<br />as owM ofrhc prcn nr. @ .r.lusiv.ly .onlr.cri.8 wirh lie.sed connadoN ro onsmd rhe r.ei.rl (S(. 7O4a, Eusiics
<br />dnd Phftarbn Codc: Thc Conlrlcloas Liccnsc Law d@s nol .pply io M o*ner of prcpcny who builds or improvcs lhcr.on.and who co 6crs lor ilch Fo.iEk sirt { Co 6.10($) lixnscd ,u6wr 16 rhc C6 reroas Lt ns t!e),
<br />-l
<br />{m.xcmpr u.dcr serion ,B.&P.C for rhilr.f,s.n
<br />UABf,EXS:.COMTEIIIAIIO!
<br />DECI"AIAIIO!
<br />I lEEby lrfm un&r Fnrlry of pcjury oE of Uc followinS rk l&!rioG:
<br />l;rhtr Codc. lnr rltr prroflnnkc of rh. sork ktr trh'.h rfu ,[mir i\ n\u.(l
<br />_l nrvc lnd will minlain work.s compcnsrliln insuftmc.,s rcluircd by Sdion 1700 oalhc tiho. Codc, for $e pcrfomcc of
<br />lhc Bort lor vhich lhn pemil is hsuod. My qorknl snpcn$tion i.rudm ceicr lrd polty numb.! uc:lNc{-D Lt-"-186C33
<br />-l.cnity
<br />fi{ in rhe p.rlormec ofrhc worh for whichthir psmn n iselcn. I shlll nol cnploy an, pcso. i! aoy DMn6
<br />$ a\ lo tE om subirt to th. wortd ompcrsllaon laws ol C"lif6me md a81E lhat if I snould hcom subirl lo tlE
<br />vor*6.ompcDeliontovisioDsofS.dion3r0ooflhchborCodc.Ishil.fonhwilh.omrlywilnlho*pDvisions.
<br />wAnNIN(;: Frilurc lo scurc *orlcrr
<br />.ivil 6tr.\ xp ro on. hrodrd thonsBnd
<br />Sc.rn,n 1076 ofrhc titx)r Codc, inrcrud
<br />utrl wtul- ud \hull \ubrccr rn cnrloycr b cnni,rl ,rdrlri\ rid
<br />ion, .hm8cs d pmvidcd tor rh.
<br />DECI.AXA.I&N
<br />I hcrb, afitrm !adc! lcnully of p€rjurr lhul I an liccnsn u.dcr povnion orChoprcr9 (commncins wnh Scdion 70OO).r Divisi.i l
<br />ol th. Busircss alld Pmfcssiotrs Codc. nrd my liccnsc is in lull roB dd cficct:
<br />q5 bsz
<br />l7*
<br />!aNEIBqGUONI!NIIS$.&OEN!1
<br />I h.rby .flnn undcr lE.lhy of pcrjury lhsl rhcrc is a .on(dction !:Ddnr8 uscncy for thc pcrl'onmncc of rhc *orl ror which rhh Fnnii ir
<br />ksucd lScc. 3t197- civ. C.).
<br />AT8UCAII.PECLA&IIION
<br />I tmby adnm u .r pcn.lry of FrjDry oDc of rhc follo*ing dNl0arions
<br />O.ifr,l[ion P.rfrns Arbcnor Norifi.arion Fcd.ial Rcgrhrn,ns (Tirlc 10, Pan6)
<br />Rcrtun d brr$of NotitudDn
<br />_l .enify rhar rh. fcncBl rcBulalions resardins a\hcsros rcmval rrc not .t'Iltablc ro rhis pmr.r
<br />l.cdilyrhd I havc rcddthi\ dmltrrr i,,nr.d{ric rhxrrhrhilr ,ntrtr ri(trr n.orc.r I r8B ro ofl/y wnh.l Cnyand Counly
<br />ordinmcs $d Srsrc L,ws EbrinS mFcsntuliv.sofrhn Cilyed Coutrl, to cnls uton llf,
<br />bv. tuhriUn d pnrFn, for in\A?-tt
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underf loor
<br />Buildino Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool HeateriGas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />"/Dl't
<br />sDs
<br />Final Gas Test
<br />Meler Release
<br />FINAL Wb/rt aN\<3
<br />Notes, Remarks, Etc
<br />Area,/Storm Drain
<br />Roof Drain
<br />^, 1-q'17
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