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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.OWNER BUILDER DELCARATION
<br />I h.rcby aftm undcr ,.mhy of !,cdury rhot I m qcopr noD th. Conrdclou Li.en* Llw for 0r hllosing @$n (SE 703 I.t
<br />Bu,inc* rd Pmf.*sion Cod.): Any City or Colllry which rquiH o lqdii ro 6n!tdcl, .kd, impmvq &mlih or rqEir any
<br />nocr@, pri)r io ni ise.,.&o EluiR rh. lpplicmr fo, $ch !.mi ro fik 6 ut..d sllt.ffir th.r lE or s& b lic..sd nulsM
<br />ro rh. pmvisions oltr Co.[sloa3 l-icnGd Lew lchatlc.9, ConGminS with S.clion 7000 ofDivirion ] of lk Blincss and
<br />PoEsi.N cod.) o, rh,t 1l. or !h. ir d.m9l tha.f6m ..d rh. b8t fr'r rh. .ll.scd cxdprion. A.y laobtion ol Sdion 701L5 by any
<br />apDli€! aor ! Fmn sbjari lh. .pFli@ roa.ivilp.Mlryolml tuerha. nvc huo&.d dollN ($500).
<br />_1, s oqF olrh. r,mp..ry, or my.mplotrg wirt E8d e th.n sk .omr'(Mrioa *ill.h tL work dd t t.Elw i! ml
<br />idcrd.d or ofrcr.d lor slc (s6.?04{. B@i6s a.d PmfesioN cod.r Th. conrEcrols Licds l,w &rd ml Ddy ro !. ollM of
<br />rh. pmrsly who bonds or nom6 lhc6n &'d wbo *B Nch slt hims.lfor h.elfor rhhu8h ht or h.. om cmrl.y..t.
<br />lmvid.d lhll $ch orbwnh! c mt hl.nLd dotr rEd 6r eL. It hor!6, ttE ltildiry or i'rrreEttr! i3 $E wnhi. oE Fr
<br />oaotrplcrioll. th. o*ncr Builld eill h6!t rlE hlddr ofpoving tlw h. or rh. did ml build or irpmw lhc poFly for $c pu4De of
<br />-1,
<br />alown.rofrhc tDldy. m .x.l[iv.ly co,r6crine wirh lic.n€d corlmdoF ro oNdct lh. pmjal (Src. ?044, Busind
<br />afl! Pbtsird cod.r 'rn. Conlr.cror's tic.nsc Llw doB mlopplyto eo*8. oftrop.nywho $nil& or inpors th.roa
<br />5nd wlx) conrEcl3 6r ruch rmj..ts wirh a C6r bclo(i) lkdnd tlnuafl lo rh. ( o'nrccld', Lic.nF L!q).
<br />-l
<br />dn crcnDt und.r 56l
<br />!408tr88s..CA!ItEdlArO!
<br />0[CLA8ADA!
<br />I h...by amm !ndc. ,.n.hy ofpaju.y onc .fth. hllowiru .ic.b6tn,B:
<br />lhr\cx'xl$rlltrrim3hiCcnrfi. (.1'(,rNcrrn)S.lllrnkcli)r\rork.6(nnf.trsarurNpn,vtlc{liarhvS(fotl?l)oolrhc
<br />I rhor ande. ltr rhr f.rfir'n]ncc., rhr *ork li)r (lncl, rh. teirnir ,s N\rLd
<br />I h.v. .hd sill n!i.(ai. $'orkcr3 comn.nsatk n insuE.c., ss r.qliEd by Sd ion 1700 ot lh. l,tlhr codc, for rh. Dofomrce of
<br />lh. wo.k for vhich thh p.mit is bN.d. M, eort.B comFcr€rion inN6k. ori.r .d poli.y nnnbd &el
<br />Ca J
<br />vty' cD r I /./",
<br />I c.nify lhat in lh. p.rformrc otlh.wo for vti€h this Fmit h ktu rL l.tsll mi.mrloyanyp.Mn in if,y m.nn.r
<br />$ as to t@ft lubFr ro rhc md(n onqEnerion Lws otcolihm'r. dnd 33r lhar if I should tE otu sbjct ro rrE
<br />mrk n' coqi.nerion povisi.nr of Sdlion 3700 ol lha rjbor Cod., I shall, ionhwilh mnrly anh lhr. revhione
<br />WARNING: !:silu.. to *cur. wo .rC mmlcns bn ov.nsc is unlar'tuI. ond .htll .n dnnloycr to oinnnal Imrlr's and
<br />cilil fin.s up to om hundEd rhousnd dollar (S100,000), in addnon ro r n, d.mracs !s pmvid.d ftr rhr
<br />::jrqyildl_"Iffi1,
<br />I narcby.mrm und.r p€nahyofp..jurylh.t I am licenEd und.r pmvsn..lCharls 9(mmfttuinr B h sdri.n 7000) of Division l
<br />of rhc Blrin* and Pef.rsios c.d., rti ny lic.ns. ir in tull aom ard effer
<br />t<
<br />Li.ctu€ Chs:-Lj*nrc N!nb.r://>o|q <n
<br />,,.,"Nov t 5 20t8
<br />cQ irauclloNLlrlDlrc-&Gl;lcl
<br />I h.Ehy a,l'rrnr llxlcr p€nnlty o t perjury Oar lh@ ir ! 6$rrud ion L.dins ns.n y fo. rh. prnrm.cc of rhe *ork fot q hi.h rhr p.dir is
<br />[sed (Sa. ]097. Civ C.).
<br />AITLICANLIICLAIAIIA!
<br />I hgltiy amn' unds p.nalty orr.rjtryoh..lnE rol[rwins dcc16r,r'oni'
<br />D.molilion Permire'Asb.slN Notificarn,n l:.n.rol lte$larions ( l irl. 40, Pin6)
<br />-Requn.d
<br />Leu.r olNorifi orioo
<br />-l
<br />c.tli8 fid th. Hc6l c8trlarioB E8ardin8 h.dos ..mEl .rc mr E rlicabl. lo thh pmj..I
<br />-rCEr!+thnt
<br />I h,v. 6d rhhrnnli(al
<br />odiMnc.c Mrl srr(. rlssEldhxto hui
<br />io. on er.t. th"t rhc obov. informlrion n cor6t.I arrc ro@mplywirh rllCiryand Counly.{ihr. rcrrcEnEYri rhN crry a.d counry r. .nr.r uF.n rh.
<br />l{},V r 5 zore
<br />ih.v. menrnncd pmpcny for rnspd'onnuoorcs
<br />ADDlicrnl or A*.nl Signalur.:
<br />UNDER GROUND
<br />Waste & Vent
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piplng
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{raplDrain Line
<br />Main 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
<br />Meter Release
<br />FINAL rr-\4 rB b.- q. (l.t ,^ ,'U,Lqfu/
<br />Notes, Remarks, Etc I
<br />COMMENTS
<br />Water-Under floor
<br />P.'
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