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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OlVNI]R ITUII
<br />'NT
<br />DEI,CARATIoN
<br />I hc.chy rll]lnr xftlcr 0cnrky.n Nrury rhir I r .xc U ft,n rhc C.itri.hr l-i.cn{ l-rr tor rh. lirll"$irg rclsn lsN 70.11.5
<br />Btr\nrs aftl l\olc$t'n (ixh), Anv Ciry or (irnry *hich rcqnir.\ r n rmir ro.on{tucr. rlrd, impn,vc. dcnmlnh rrcFttrrv
<br />lppli.a ror r pc.n r {!rjd.r\rhc alplicanr h acililncialryofnor nrncrhrn fii hundrrldolhBrS5({))
<br />-l.rsowmrollhc|n)r,.riy.rtrnrrcmli'yees*ilhsngcsrrrh.tr*'lcclrDpcnsnrtnr.trilldolhework
<br />xl ilE sruldE i\ nor
<br />i'n.ftl.al orolltrditrslclS.{7(,4.,1,Burinc\\andltolir\tntr(int:lhcConr.ch\l-iccnsclj$doc{Doi,Jrnlylomo*mr.l
<br />rhcpmpcny who build{ or inlpmrc rh.r6tr. lRl $lD nocs su.h w* hiDrclt.r h^clror rhou8i his or hcr.uncmph}rcs-
<br />p()rnlrd r hnr srh iopnntE s re nn iddx,cJ G olltEd for $k lt lxr!$rr. rhc hrildirS or inlpnrEnrN i1 $lt wnhnr .tr )!o
<br />of.on{lrr io rh. ONtur Bu'kiy *rll hrv. tlf hurd.n .f nflJlin8 rnri tf, or \tu dil 'sr buikl or nqnow rhc pn,Fny for rhc Fuqn\c ol
<br />I. asowmrofthc p6Fnr. m.xclusivclycoorr&ring wirh tien$d conird.rG ro consrud rlE poiet (Ss. ?041. Bu\i,Es
<br />ad Aohsi, Cod.: Th. Co rmloas Liccnsc L{w dcs nor allly lo orE of l,roFny who builds or Inprovcs lhcrq'tr.
<br />md {no conrers fo .Eh prbj.fr. w,th r conrrcro(s) liftned ,!ur ur 16 rh. coni@roas Lkxn* Lrw).
<br />l rmcrcmfl undd Sftrt
<br />]I!}8trE8S:I;OMEENSAII0!
<br />DEcl,/tf,AI10!
<br />I lscby alTirm undcr Fnnl'y or pd,llry om ol rh. following deldorioN:
<br />-l
<br />h.vcudwill mi.rain 0Cd'ificoreof Cons ro S.lf.l.suB for qorkst oqM$ri{'n, 0s providrd for by SNiion 1700 o( rhc
<br />LltFr Cd., fff $. p.rfirnEncc of nE w.rt for whi.h r hc ldnir ir i$\ncd.
<br />aZ m'c qra *itt ruinruin *orlcB .omllcnsrnon usur,rcc. trs rcqu'rcd h, ssl ion r 7(r0 !l th€ Lsbor (idc. ror rh. ,trLrtuN o!-\+.titI.iitr *hi'h rhi.ncrmi! ^ *s{d li,tyBDloi omnctr{rnn 'n\ur,rc.cffi' md nnlr} numhc, dc
<br />la/ Ven Svr<
<br />A <o z\ I lz 2aZo
<br />-l
<br />ccnifylhil inrhcF fornunc.oflhcwork for whi.h rhi\ pcrnrir i\ is\ncd,I sh,rl nor .ntloy any Frsn in onymnrc.
<br />$ a\ ro bcoft sut'jsl ro rhc *o.tcn'ompcisrrion l.qs of Cilitonio. m<l rAE rhor if I s,Fuld hcrom suhjd lo rrE
<br />soflds.o'nF.sarionnrorishnsotSecrion:170(,oflhcL,horCode,lsh.ll.lonhsithshrlywilnrho{po6ions.
<br />WARNTNC: Failurc lo pcurc sorkcm o'rycns(n'n .ovcnec is rnhwtll. d sh0l1 suhFcl on cmploFr lo oimiNl pcNhies ond
<br />civil ftts !! to onc hldrcd rfiousand dollars ($
<br />SErion 1076 ofrnc l,lnr Cd. inrcEn addrmr
<br />thc cost ofcompctrstion. dlmscs as pov
<br />l'*", ' l'j l'2"2"
<br />I hcEhy o(inn undcr pcnalty of D.rtury lh.l I an liccn$d vision of Chaplcr 9 lcommrcin8 wilh Selion 7000) oi Divkion l
<br />of thc Burirc$ rnd Prof.s.io.3 Co.L. srn my lhc.r is io full loc a'd .Oc.l.
<br />.t7 ?o0reg
<br />Cva 9 t'o,r., z'J-:-LL' L9 eo
<br />IANJiIBIEIIANIINDINg-ACE!.qI
<br />I hcrb,arft xndcr Fnahyolt.rjury rhd rnc,c i\ ! conrrtucrion lcndi'lg sg.m! lorrnc pcrlortuEc orrhc $dk ror {hi.h rhi\ Fmir k
<br />hsued (Scc :109?. Civ C.l.
<br />ATPIICANI.DEII,ABAIIO!
<br />I hod,y itrm u.do p€nrlryorp€riuryorc ofrhc folloein* dccldsrions:
<br />Dcmlilion P.rhils-AslEslos Noli,ication Fcdcral Rclulation! (Till. tlo. P!n6)
<br />R.qui'c lxrrcrof Norili.rri,n
<br />-l
<br />e'rilylhnlrhc ndcnlrcsul{lions rcsmli.[ rstE{or rcn('vil lic noi rrplicnhlc k' rhisrnx.l.
<br />--Tilrntrhx lhiLu rciJ rh^rIfiJJr tr fJ !rh.rl-r rt1c rh\c i'ir,trr rir,1 r.,nrfl IxF.rL.r,ft,
<br />trtrd Qrunryro cntcr qrotr rhc
<br />7- J1 - zozo
<br />rurlbriT.'rtrcsc0ruhB of rhis Ciry
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceplor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />It/ain Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />La wn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Belease I I I /rA
<br />FINAL lil{wk IWWU WltNotesRemarks, Etc.
<br />,.
<br />nrdinan.cs Md Slorc kws rlalirg
<br />.b.ft mdr io.cd ,r.Fny aor
<br />*!?!!.t"e
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