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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE tD/srG.COMMENTS OITNIR BIIILDIJR Dl'I,CARATIoN <br />I hcrcby lmrm loder p.MIiy of D.rju.y lh.l I m .iempl lmm rh. (onl..clors Lic.nse La* lor rhc nnbwnf Bsn (ss ?0] l 5 <br />B$in.sr nnd Profcsion Cdc)r Any Ciry.r aoudy which r.qntcs . n€rm ro con{rucl tlrs. imFrovr, d.n hih o! RNt 0try <br />,ru.rurc. nrsr lo its issuad..l$ rcqutr.r lhc .rnlcinl fo. suct pem i{' nLd sisftd skrc Enr rhtl h..r $. h lic.n*d puts.nl <br />ro rh. nmvNons oarh. Conrhrroas Lic.n$d Ijs (Ch.nro q. ComnEmins {dh s.ctio 700t) of DilirNn I of(he Busines ond <br />tmfesiions Cod.) or rhar h. or sh. k cxcmpr thcr.fmm 5nd lhc hrt nr rh. illcs.d .xempri.n Anyvi,n.rionolS(lon?0:ll5ltv.nv <br />l'tlicnd lor a pmn subr{li rh. a0thc,nr ro i crv il lr.ml'y n f no( nDr. rhan lik hundr.d dolltrs (5500) <br />-1, <br />s owftr of $. pFp.ny. or my .q,lortd eilh *!rd 4 th.ir $L shF6rioc sill <b ttt vqt td llE ldturc ii Dr <br />inrdd.d or o{f.rd lor el. (se.?044, Bsikt Md Pmf*hB Cod.: Ti!. codrocldt Lb.e L.v do.i ml opplv $ !n o9G ol <br />th. |'mFrty *4D hil& or inFoB rtE@.. ..d who .lH Mh wd( hid*lfii h.elfor thmush hh or lrr 6M .nplov.6. <br />p6!id.d rhar sch i,emwr'ls c bl !!qd.d otu ftr sk. l( tFilE. dE hrildins M inpmw, i. sld wih'. om ,4, <br />of6sp!.ii,4lh. owB BuiH.r will l{E tlr bud.. otpov!ts ilE tE or !h. did d htild or illImw lt r,olrry 6r E puposof <br />-l..somrofrfi. <br />pmpeny. d.xclusiEly cohlh.lins eirh lic.lltd c.nldcroBto mnslruct lh.Imj..r (Se. 7044. Aurrncsr <br />And PFlsri.. c.d.: Th. Conlacloas Li..nsc l,w dG Bn alplyro m oqn.r ofpFp.nywno builds or inpmc. 'h...on.and wno cohtBcts lbr such !oj6h wirh o Conrmclo(t licdrd pueant lo th. Conlocloas Lic.n.. Llw) <br />I rnexcopl undcr secr D. & P.C. tr lhr reason. <br />!!aEE8!lO!r&dSAllA! <br />l2ECtAEArp! <br />I h.r.bylltrrnlndcr,.nahy6f Dojlry.n .f fi. louoqinl d(lmlio.s: <br />-l <br />h.vc ud wilt @i.r0ins C.nificrlcofconE ro s.lt l.sE for sorkdt @npnelior as ,mvid.d for bv Sftrirn J70o of th. <br />Lator Cod.. Ior th. pdo.mam. o fth. *orL tor {hich rh. tdnn ii ks.d <br />-lhrv.rndwill@inlainwo.B@mnBarioniroEm.,nrtqundbysc(ionl?ooofth.bhotCorh,lorlh.dfoMcoftll. *brt lor vhicn ihis p.mi ir i.!u.d My work6 onp.nsdion im.@. ffi.r trd nolicy tumb., e: <br />PolNyNumbcr-[xlnes <br />-l <br />c.rlrty th{ rfie !.rf.rroNc of th. oo* f.r which thi. Frmil i! irsocd. I shall ml.mnlov lnvl.mn in tnv nnnrc. <br />s I to becom. iubj.cl lo lhc wodd @n ,..slion hws of C.lifohit dd t8E rhal if I stFud tldom 3ubjd lo lh. <br />uork(C comp.nsolion penitBofs.ction l?00 oflh.lihor Codc,l rhall. fo.lhwilh oiDly eth rl$*Pmvisio.3 <br />IIARNINC fa'lu.c10scctrrcworkerconpensxr(nrcor.$x.'ttrnh!ri'|.xnddhllsubJe.rrn.mt'lrtycrhcnrnol ntllE,rr! <br />Sc.rn r lllT6oil[cl-ihtr(.nc, inlercsnDdorfitrq s n.s <br />Dri.:_ APPl,..ntr- <br />uclll[LQNrlAcra8 <br />DICI48AUAN <br />I hcEby.mrm und.r D€nahyotp.riuty rhd I m li..tr*d undcr DDvir'o.ofch.nl6 q(sllweirg wtrh Setion ?qll))olDNnioh I <br />of !h. B!ri6. ahd P6a*sio$ Cod.. and fty li..nrc ir in tull forcc ffn .f€cr <br />LieBCLs: Lh.M NuEb.r: <br />CoNS'TTIICf ION LENDING AC}'NCY <br />th.Ehy.mrmu.d.rFmllyofp.rjuryfidrh.r.iaonn.tonLndin!as.eyfotth.,.rformnccofrh.*brkfor,hichthrodndI <br />ms.d (Src. 1097, Civ. C ). <br />ll[llcltrLllliclAaarlo! <br />I lEr$y nfllm undcr pcnally ofperjury om ofnE aollolin8 d.cladri,)ns' <br />Demohion !.rmn*Asbesros Notincalion rjcdcrtl R.8ul,lions ( l nle 40. Pan6) <br />-R.qumd <br />Lett.r of Norifi canon <br />-l <br />ceaity lhd lh. t{.61 rcsllal inN tn ding dsncno. Em\51 sr. nor .pdi.abl. ro rhis pm"i.{r. <br />I c6rr,rrh.r I have Ead rhh dnrlcariondi nd.Ilsr lhc aln!. infomrio. is coE cr. I a!,a ro 6mrly*ilh lll Clv..d Counlv <br />odl'Mm4 and Slar. lj*i Fldiie to tdildins .onrrucl ion, ad hr.l,y t!fionz rq,rc*,!d'vd ofrhis Citv ltd C.lorv ro ..!6 unon lh. <br />0tnv. Gorio..d pmp.ny for in!&rion purFs <br />Appll.,nt or Agrnl SifnNlure: <br />Pcrnnt.c ncn. (prlnl)l <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOUSPA <br />P{rap/Drain 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 i/t0/n )['y4 ) <br />Notes Remarks Etc.