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APPROVALS DATE IDiSIG.COMMENTS Omd-Buildcr D6l&ti6
<br />I h@by !ffin uidq padty of Fjury $1I o !x pt fm $. C6t &tor'' Li6rc lrw ad lh. follow'nB,am (E ?03t.5 Bcin6
<br />&d P6fE id Cod!): Aiy Ciry dcoury {hich,.qtiE t pann b cd&L! rlr!', inFov., dddiih d r.p.ir &y n'udurq F,o ro irt
<br />isud@, 3lso qlia lh. applic$t for 3uctt Fnit ro fiI. r si8n.d narMr lhar h. or.hc ir li6i.d puGqsr ro 0E prcvi.id of {rc
<br />C@tadd's Liorld ttw (Crrlr{cr 9, Co'llMcin8 with S.djq 7000 of Divtio I of 6. Buina dd Prof6.iN Codd or rhar h. or
<br />rh. k dmpi thefrn &d th. br.i fc dlc.ll.s.d qapdon Any tddd of Serid 7031 J by uy spplior f6. Fnn subjfts lh.
<br />epplidr r, ! civil pa.lry ohot lte thM liw h6&cd .tolld {3500).
<br />_1, s om6 of th. pr@6!y, *my mploye wnh *ra6.s t.t 3ol. @F.5rion, eill .lo $. wort ed $. rEucr@ it rcr inr.ndcdq otrs.d fd in. ( Sa.70a:1, Baind ed PEf6i@ C.d.: Tt. CdE .r6't UcqE t w <!06 nol +ply 10 E oM.r ofdlc propqt
<br />vho buil& o, imFovd OCffi, &d who ilo6 $d wdt hift.lf d hdclf 6 $Ngh hn d h6 own .mdoyd. Fovidc<t rhd luch
<br />inprcv.lMlr 4 nor id.nd.d d of6.d fo. r.l.. lf, howcva, rh. boildjtrs d ihprcvmdl h lold wi$in onc yry of cmptctio, ri.
<br />Omd-Buildd will h.E dr. hr&' ofproyint th.t hG d 3h. nor build n improv. for $c purpo6c of s.l.)
<br />_1, a oua of lll. pmpay,6 qclGi*ly @ttsir8 *ith lic@rd onalds to 6srud lh. pbjd ( S@ ?04a. A6in6i &d
<br />rrcr6ion Codq Th. Cdl.!cq! Li6$ lip do.! nor .pply ro r omd of roFq vho buil.b B imFov6 !i@n , ed ,ho
<br />cotrla. fo tuh projcq, *irt ! C6tud(3) licd.d Fd!@r ro rh. c6lrr.ro* Ucle L.w. )
<br />_l u d6F sdasad@
<br />-B
<br />&PC.fdl.hirllad
<br />WOEXERS COMPENSAIION Df,CLARATTON
<br />I hftby .flim und.. F.alty of pdjlry o. of $. follwinS d..l!r.li@:
<br />_l h!v! ud wiu frli.dn sC.njlid.of Cd!t. roS€lf-InlE fd w6to,cmFm.lon. s Fovidcd fc. by Sc.tjo. lroo of lh.
<br />Latu Cod., f6lt. Ffoi@cc of thc rdl fdshicn In. Fhn ir iec4
<br />_l hav? ad will oainl3in *dtd' @hFsdo icuru.c s r.q!ir.d by S€lior 3700 of rt. Lsbs Coa., fo. 6. p.rfolfuc. oi rh.
<br />work fo which ihis po it it isucd My worl.s' comF.s.rio iiruro@ @i6 ad policy nuhb.r r.:
<br />Policy Numts_
<br />,{^t*.^^t^G"-.,,6*,,.
<br />not b. Mplcr.d ia lhc Fnir i! atr On. hundrcd dolld It l00l
<br />ltc p€fomecc of th. w r id which rhis pmn i3 isuc4 I shsil
<br />6c wdtd ' c6p6!did I!w! of C.lifmi!, ud .s.a 6!! if I
<br />comPc6ltio. provisidi of Seion of $. L.bG Codr, I shall, fd$wilh
<br /><,o
<br />WARNING: F.ile to Ge wort6' mFliariN @vaagc ndoyd ro eimind p.dlri6ddcivil
<br />fin!' up 10 @. hs&.d 6ouud d.ll8 (ll0O.0O0).ii oddirio lo
<br />ti. Lbor Co&, i.rE6l ed .t!ooq't f6.E p!ovid.! f6 lhc S@ds 3076 of
<br />LICENSED CONfRACTORS DECI TRATION
<br />I hdaby snim udd Fnalty of pdjury $ar I 6 lidscd undd provitio. ol Claprd 9 (
<br />fi. B6ind ad P.ofsiw Cod., Dd liry lic4c is in full fdE m.l .f..r
<br />rnh Sario 7000) of Divi
<br />Li..@ Cler_ Li@c NMbqQo-L
<br />I h4by imm und.r p6:1ry of Frju.y lnat rh6. is ..ffidcr,o. todina .!6cy tn rhc Fraomdisswd(S.c 3097, Civ C)
<br />APDLICANI\S DICLAR,.\TtON
<br />Donolnio. lmill,A$drG No.inqid
<br />Rcqlt d r,tld orNodfqrio
<br />F.d.r!l Rc8uldiont (Tnlc 40,
<br />-6l, *0,,
<br />th.t rh. f.ddl rcgll8rim EgEilir8 sbc5r6
<br />thd I h!rc rad lhii.pdicdidr sd sBr.ro mmply vi$.ll Ciry ed Coury
<br />ordino.6 ed Shr. L.ws Elalirg ro buildi.g
<br />UNDER GROUND
<br />Water-Underfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifler
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipein g
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipi ng
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn S rinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />lggg! Plumbing trYpll Itrrl
<br />Final Gas Test
<br />trRn-l ?nlq
<br />FINAL SAMC 0-43, 2!o, 556, 667
<br />Notes, Remarks, Etc.
<br />PLUMBING.INSPECTOR RECORD
<br />Waste & Vent
<br />Misc
<br />Meter Release
<br />-o
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