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APPROVALS DATE rD/stG.COMMENTS Old-Buildd D@L ioi
<br />I icrcby .frm undd D.Dlry of pdjury tl|ll I m d.mPi fo,6 lh. Coffraor' Li..M L.w for th. followiq t..otr G.. 703 1.5 Buhd
<br />.id Piofdioa Cod.) Any City or Couty sticn Gquna r Pahn !o @EEud, .xa. ,nPrcE, dcmlilh or t.P.t mv truduc Prior i, il!
<br />i.!u.ic., dro rcqu,rc di.ppiiont for.!ci pmit to ftl. r 3gBd loror.d th.r h! o, !b. ! Ii@M.d Puu b dE ProvitbD ofthc
<br />Conndoar Li@8..1t w (Chrpt.l 9, Coh6.mi.g wlh S.dion Tooo ofDivnion I ol th! Buin .. .nd PtofalioB Cod.) or thn h. or
<br />rh. it q.h rlE.&oh .nd ttr. h..ir for th. rlLg.d d.nPtioa .Ary vioLrion of s..rion 701I 5 by .ny.PPIio![ for. Pmn tubj.crt th.
<br />.pplie.r ro I civil p.dry of not moE th& fivc hlndt d dolbf, (i500)
<br />-I,
<br />s owr of th. popdly, or ey Gnployd with s8d s rlBi, rcL onp.urlion, wiu do rlE mrt.d rh. rr'lram b rcr iilcnd.d
<br />;trs.d lor rL ( s; ?oaa, Bu.in.r .nd Profsri.tu Conc: Th. Cont cM'r Lie& k! doo ml .PPly l! & owM 011h. Prop.nv
<br />who hildt or ihprova rhq@n, rd s,,!o dod rucn *ort himclf or n!B.lf6t ttuollh hit o. ha oM.nPlova. p.ovid.d dul.!oh
<br />inpiov.hoit! r. mt hr..dcd or of6r.d for !ll.. If, howdc, d!. buildmg or inPrownd it .old wntii oio yd of@6Pl.ciot\ thG
<br />omd.Euildd {iU h.E th. bIrd.i of provin8 th.t h. or rh. nol blild or imPlow for th. PurPot oft h)
<br />_I, s owr of ril. prop.ny, rm dcluriv.ly @atndirs w,rt lic<t!.d @nlr&L6 1o coNtru<r rh. P@j61 ( Se. 7044. Burift., lnd
<br />PefqlioiCod. Th. Conhdofr Licdrc rrw dod iot .PPly lo s oE.i of Propdty *ho buil0 or inPiovd r,h.roi , .nd who
<br />@im.i! fo, ruch proidn whn r cotn rct (, li4.$d puru to th. Coit[doC. Li:.n& r.u)
<br />_I m ampt !.dq S*tion
<br />-B
<br />& P.C. for thit r6$i.
<br />Dlr.: O*N:
<br />UOBXIA!@IEII{TAIIAU.UPCIASAIIAN
<br />t hd.by .flrh rnd6 pdlty of pdjur/ @ of6. JllL*ing d.cL!.rbE:
<br />-l
<br />hrv. rnd eill i in . Cqtifiet ofcolralt to S.lf-louo fot $iort.rr' conp.ixtioq u PrcvitLd fot Dy S.crioi 3700 oftl'.
<br />trborCodc fo!th.,qforhrnc.of D.{{)rkforstich6.D{DhL i .d.
<br />-l
<br />hNG !6 wilt inoii m*o' @Epssliotr in unt&.t r. r.q Gd by Sldion 3700 ofde hbor Cod., for tt. P..bfttnc. olth
<br />mll lor {hich thi p@! i, i8ucd. My eortd' on @.tios i u 0. cari6 &d Policy Nllbt( r.:
<br />(Thi! lc.lion n..d rcr b. @mDl.tcd ifrh. DsBi i! for Oe hundr.d dolhrt {ll0o) or hs)
<br />_I cdiry th in th. p.rfo@ of th! work aor shich thn Pdmit it n u.4 I tU mr 6Ploy .ay p@on in uy tunnq ro B ro
<br />b.c.m. subj@! & 6. mlkd! @sD.urio. Lwt of qufom4 rnd.8tE dll iII rnodd b-on..!bj@t to th. worret
<br />ompcostion proviriotu of Sdion ,?oo of dF Lbo. Codc I rhrll, fonhwilh otply wi$ r[.e ptovitbn!
<br />D{?
<br />-ADph6n!
<br />-
<br />WARNING: IriluE lc, !.cur. *orl@' .oep.Mdon @v6r8! i! urLwtul, &d thlll !ubj!.t & .nPlolt ro cimiBl ,.ultic .nd ciril
<br />fua up ro oE hundr.d thoumd doll.u (ll m,ooo),h .ddnioi 10 1[. @.t of osp.N.tiot\ d.mgci ! ptovidd for !h. Scrior 3076 of
<br />rh. Lrbor Cod., intdd.nd.t!h.y! f€.
<br />LICENTEDIANIEACIABIi.PECLIEAU9X
<br />I lEr.by !fftr6 undc plEty of pdJ!.y tlltt I d li4i!.d $da Povidoa ofchr a 9 (6m.nciag wilh SElbr 7000) ofDivitioi ] of
<br />thc Buin{ rnd Proft*lioB Co&, rnd my li@i& !
<br />'n
<br />tull fo@ ed.fr*r:
<br />CONTIBIICUAN.I,INDBC.AGENC(
<br />I h@by fflm unds FDIy of pajsy d[. td. it. @Ntirctio" hnding r8.my fo! thc FrbD.nc. of th. *olt for sl ch thit Fbn it
<br />nru.d (S*. 3097, Civ C.)
<br />L..d. Addrdr _
<br />AIII.ICANT!.DICI,AE6:IIAN
<br />D.nolhion P6il."Arbslo! Notifiotion F.ddl R.slLtjoir Gnb 40, P.n 6)
<br />_ Rlqun.d t4rtd of Norifiqrion
<br />_l cqtiry dll lh! f.d6l r.luhriou rcs!.ltu rbdtor laiohl a. nor .gPlioblc to lnit poj..t
<br />-I
<br />c.nif, dlr I hrv. rad th,t .pr lic.lion .nd tlrr. th.t tlF.bov. in&rDt|iion b cor.c( I.gtdto cooPly eiut rllCiy.d Cou Y
<br />ordi n6 sd S|.r. lls .rl1m8 ro buildi.S @snuctior! .d hooby .u6ori:. r.Prc..d.tiilt of thi Cny nd Cosdy ro a[.t ulon th.
<br />rbow h. bid propcrty for iirpG.ll,a purpord
<br />Pdnllla um. (p'id
<br />UNDER GROUND
<br />Water-Underfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipeing
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Misc
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing E,J \TIn(E.U
<br />Final Gas Test EE
<br />Meter Release I al,t,J
<br />SAMC &43, 290, 55t 6A7
<br />FINAL
<br />Notes, Remarks, Etc.
<br />PLUMBING-INSPECTOR RECORD
<br />Waste & Vent
<br />Gas Service
<br />Back Flow Device
<br />Li@Dt Ch.!:- Lirsk Numba
<br />-
<br />Di. Conlaaori
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<br />_T
<br />I
<br />[T
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