|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNEI AUILDER DELCARATION
<br />I ncRby alftm uld.r ncndty of pcdury lhal I m cx.mfl amn rlE Co.rrarm' Licf,F t v fo. thc fouowing Grsn (56.7011.5
<br />Busincss lnd Pmfcssior Codc)r A.y Ciry or Counry *hkh EquiEs a IEmn ro on$rucr. slrq. inpmr. dcmlish o, Ep{r {t
<br />nru.turc, Fiot ro irs i$uare, alro rcquircs rhc r,,ii.er lor s.h ttmi $ lik. sign.d .ieft.( th.t lE or rlE iq lier*d plNlnl
<br />ro rt rorisions of rlB Co.tr!.rois Liccncd tlo (Ch.flcr L Conmmin8 qirn Sccrion 7000 of Dilision 3 of Oc Au.in..i rnd
<br />Prelc$ions Codcl o. rh{r lE or ihc n cxcdpr rhcoliondd rh. hsis for lh. llh*ed ex.mpion. Any violarion ofsdio.703l-5 by My
<br />app,icd for r Fm subrek the +pli.. lo . civil p.Blry of trr rcrc lho ,iv. hu.dEd dol-s ($5m)
<br />l.,sosD.roilhcto|tny.orarrrn,Illrrycrssiihsa!c\!srhcn$Lconrpcn\arion,trilldorhcsoir rh( ituturc i\ Nr
<br />idxlcd uiollar.d ntr srlu (S$7(X4. aDriDcsr itrd P'.fc\\i,{s Co'lc lhd (irnrodois L.i.ctr* L.w docs nor lol)ly ro rn osncr o!
<br />rhcpmtdy \yho buildi or iq,n)vcs rltu)n. drd $ho d{xs st.h {ork him\clfor hcrsclfor rhn'uth hi\ or h$ own.nd.tcos.
<br />proriJcd rhJr nrh irnlntturnh,m rkn i cfllrloronir.i lnr sxL lih.sclar.rh.huildingorinrplNcnr r i\ $tl enhironc tt,t
<br />oiconqrbridr,rh. Oan.r auikln wrlLh$crh( hx cnolphvnB rlhrltrornr drl nn huikl.rinpm\t dr l](,Fny hr rh.Iru{n{ oi
<br />p$r.
<br />"*
<br />.**' .r rt p-p"ny. am ciclusivcly conr.acr ils ,irh liccnscd .onrB.ro6 ro consre{ rhc rrerd (se 7044. Busin.$
<br />und EDf.sirn Codcr Th. Conhclo. s Liccnsc liw dcs .or rprly io M owrcr of prcpcrty who builds or inpmts lhc.eon.ond who .ontn.k fo, 5u.n rftirl. wirh ! Conr6cr6(s) li.cncd l)usranl ro rhc ConrE roas Lic..s Ljw)
<br />I h.rcby rllirdrndcr ptNlry of f.rjury onc ofrhc lolkr{iig d.clidio.\:
<br />-lhaN{'dwillD[nlin0CcniftrlrcofCon\rfrl{iScllrlnsurci,*orlcnro'npcn!i,trr,r\rrovid.dntrbysc.'i,nr3700olrh-uha! ( ulc, ld lhc pcrhnMrcc ol rhc uort li,r *hi(h lhc rcnnir is issucd.
<br />I hak and will orin[in vorkrc .on{r.sn'ion inixmncc, as r.!xi6d b, Sftrion ]70o of rlE t:bor Codc. lor lhc pcrtommc of
<br />$. Mr* rDr whkh rhir Fmii ir i.sad. My eo.k n co,rpc.erbn iosura*. Mar drd poli.y nunhd m:
<br />Poli.rNuaDe Fgitr;
<br />?!!r -nlry 'n , ln,r," p.t,nun.c orrhc worlt for whi.h ihis ncnnir tr istr.d. I lhrLlnor.dpl,,v rny pcrwlr n' trfy mMrcr
<br />s) r\ h h.rortu ruhircr t) rhr wo*cts' .nnDctr\ tir lrB{orcllitunr Md(lrrccih r iiI should b(om suhiccr hrlf,
<br />$orkcr\.un!r.urn'il)(vnioNolScclio.lT([)ollhcut!,Qx]c,l\hr!l.li,nhs,ilh.on{'lyrilhrb\cpmrisi,nr\
<br />WARNINC: Failurc lo seurc mrlcn s,npcnsarion otcmgc h lnhwful, ond stoll subrccr !n cmtlor$ ro oininal Igdrar lnrl
<br />civil nncs ut ro on. hundrcd rhouslnd dolltrs (t100,00o), in lddirion ro rhc cosr nf cohte.srion. damges.s providcd ro. thc
<br />S.dion :1076 .l rhc t. xtr (-odc. inrcrcd
<br />DISAAAIOX
<br />I h.rbt rfinnrndcr I.nrlryofF.rpry rhd I.n h.cn{rl uid.r tbri\n,n ol Chr|,d 9 rcomnf,ncir8 rith S.clirn 7{Xx)) ot Dirtion:l
<br />of rho Inli'!.\sr l'tr,Lsi{n*Codc, ,rl ,y li.rnsc i\ i'r rull lnrc. r clTNt
<br />q)Nflag-rloNln uNli-aliErrr
<br />AITLICANLDISdNAIIQ!
<br />I hmlry aliifrt u nd$ l.nolry ot pcrut onc of lhc folbsin! dcclerr n,.r:
<br />Dcmlit,n Pc.nih Aslxnos Notificarn,n Fcdchl RcsLhiions (Tirlc.l0. Pln6)
<br />-Rcqltcd
<br />lrllcr.f Notiliclrbn
<br />-l
<br />cnlify lh{ ln. f.dcrsl rcgulalions E36ling a\bestos rcmvrl N ml q,pliclblc ro lhh pmjer.
<br />oRlilrE--c\ rtrd Srurc l,u*\ rcl ingro buikli'rg con{ru.ri{'n. !frlhcrch,orlhii CnyaDd Counlylo cnlc, ll'.n lhe
<br />obovs mntiomd pmt,(ny for
<br />Appli.u or A,l€nl Si8mlr
<br />UL
<br />,>)
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Buildinq Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<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 ,IF|NAL /obz//tr -#a ?//
<br />Notes, Remarks, Etc 7-- V
<br />ID/SIG.
<br />Gas-Underfloor
<br />TOP OUT
<br />. l n(tcrnfl um,cr Sslion-.11. & PC liirrhnRa\nn (-**-lfultK ""."., -D-r.qr,\\r[oRKcm coMPlrNsarxrN
<br />D!CI,I.B6.IION
<br />Liens Class:-Liansc Numtf, r
<br />D.l€: Co d.lo.
<br />kn&t r Ad&6!
<br />=
|