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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS oI\ NTJR BTJ!I-DI:N DTI,CA IA'I'IoN <br />I h.r.hy Jfiirn undcr pc.,hy of lcrjury rh,r I m cxcm!'l from rtu clnlmcron l-i..nse Lat a{tr rhc follo*its r'&r (Sa 70'l l 5 <br />Busnrc$ 0nd Prolc$tun Corlc): Any Ciry or Counry which rcquircs u pcnnt t, con(tuct. 'h'r. nn[ovc dcmlish or rcFt anv <br />srruclfe-ririoirshsutc.rkorcqutcsrhcnppli.rlorsuchl)cndrrofileusisncdslDrcnrnrrhrrhorshctliccn\cdrununnr <br />ro !h. poisn,n\ 6r rhc Conlracrq s Li.e.eJ L,s (Chnpr.r 9. Conn,cE-in! wirh Sccrnrn 7(lx) of Dienion I ofthc Bu\incs rnd <br />l,macssioi\Grlc)orrharhcorrhciscxcmpllhcr.fro,ndrhchosist,rhcJk8edcicDri.n. nvviobrnrnofsari']n?0:ll5brrflv <br />(prii.,trr lor r |rc rnir subjc.hrhc stplic$tro d.ivilPcnolry.i.or @rcrnrn ivc hu ndrcd dollr\ (S5m) <br />l. 0s oNn* of rhc tmpcn y. or 'ny <br />c,nPlolccs $irh w4c\ as rhci s'lc coqf,trs0r ion. *ill d. rlf wdk sd ihc *fldurc is nn <br />inlcndcn d orhrcd itr ;b (so.7oi4. B;sinc$ snd Pn,fcsrions cdc 'l h. G,ntrrcr.as Li(.ns Llw doc\ tror rp,rlv lo r' owncr of <br />ih. pmF*dy wh.l{ilds.r iifm\$ lhcdn. sxl wh, des \eh {.rl himsclior lrt{U or rhrcu3h hic or h'r osn cnployccs' <br />p-"ta rrr* *.rr imprcrc'EnN m mr inlc(k{l offcEd ror {lc. ll ho$d.r. rhc huildiry or inumrcntnr i\ $lt wifiin ond Fi <br />;f(nDlcrion. rh. o,nc. Buiud will tn( ll* budcn or povin8 lhd h.ordt did nor huiil or int,m\t fic Pop'iv lnr rhc Pqntor <br />-1. <br />Nnvnfol rhc prcI'cny, rm.xclusivclyconrracrint *nh liccnscd conttnns l. cnr{dcr rtE rmJcd (s"' 701'1. llu\i"" <br />&rl Profssim Onlc Thc Cotrracror's Licc.r lrw docs Dor aml, !o on owtrcr of fotcnv $ho l'uilds or imProv'l thcr$tr' <br />ann sh. mnlmcrsaor srch tml.{rsuirh d Coftncro(s} liccnscd Pursutnl Io llrGn racrols Liccn{ hw)' <br />_l rr.xcmfl under Sdr <br />vl}8EE&:lrau$NsalloN <br />DECTAEAtrqN <br />I hcrcby rfirolndcr p.nllry.lp.riurroncof lhc ftrbsi.S dcchllions: <br />-lhavc0ndwillnrinldintccrlificolcolcon{firosclllnsurcli]rwort6canrptnr <br />hn. as Itrolidcd lor bv S(ii'n 17In nr ih' <br />Llbor Cod.. ror rhe pcnomwc olrh. sork for ehkh lhc r.nnit ii i\rucd. <br />lm*and wrilm0inrrin so .r\' .oarPcn\rriln, n!'urrh.-c. \EquiEd hy Sdlion 3700 of lht bbor Codc. for lhc pqfoll]rfu or <br />ion insumre cetr ed lblicy tumber 4:ir$hi.hrht pcnrii is isucd Myworkc.\ <br />-I <br />ccniiy lhrl in rhe pototroncc o{ rh. work for which rhn Frn h hsued. l rhnll nol cmplor snv pcr$n in anv mlnrcr <br />* * r. ttcom *4*i r" rt " "orloc comPcnsd ion lnws ol Carifornic, dnd agrcc Ind if I $ould t coflt sub.iecl lo thc <br />m cr' onp.nsalion pr,{rions of Sc.lion l7(D of lhc tjhot Codc. I rhdl. fotlhwifi d,mplv *ith thos lovhions' <br />WARNINC ljlillrc b scurc s.rkcn <br />civil tincs u0 ro onc hundr.i tkt$id <br />n unhsa!|, ,nd shull subjNt e c'ryloFr ro dininll Fn.lra.. a .l <br />lddirion ro rhc.o( of omrENtion. &tuges N providcd tot th. <br />Y::5WW-^ <br />DECIdEAITON <br />I I'c(hybilnnunJcr ncdl,y.lf. ruD thol I nn,l'..tr<l ualcr nn,ttrrtr3lchrFr,r <br />.,r rhc BuqF{ord Pmic\nn.C,dr. ond nD l(n\'r <br />'n <br />rulllhr( xl1ff(t. <br />9 tco,trmrcins *irnScclion 7O0o) ofDivhion 3 <br />c9G ze6 <br />coNi[EucIraltI[lDINcaGENcr <br />I hcrcby smnn !n<ld tE.tlry oa rcrj!ry rhd rturc is onn dirn Lndins arcmv lor lhc Pcrtornuncc of rhc work forsttnrhh Fnn <br />'sns!.d (sc.l0e'7. civ c). <br />L.ndc' r Nam <br />IrF&' s AddE$. <br />APILICANLDECLABAIIO! <br />I lsr'6y nifim undcr pcnahyorpcrjur) orc orrhc aollowins dcclulli.ns: <br />Dcmolirn,n PcrmirsAshcslos Nolifi cation Fcdcrul R.Sulations (Tirl€ 40. Pon6) <br />-R.quncd <br />t1llcr of Norill.dion <br />I cenify rlar rhc f.dcml rcgulalions r8&dins asbcnos rcmv0l src ml aldkahlc to lhis pejd <br />I ccniiyrhJr I hrlc rctd ll,i\sDPt i.arion lnl (arcrhll rhc abovc infomarion h cotrccl.I llIe lo ('hPlv wiih oll Cil] and Cou.tv <br />oilinaNcs nd Si,rc tiws rcht bu ildirg c.tr(rucrion. !d hcrcl,y !urlt)dr rc!rcscnrd i!.. ofrnk (--nv rd Counl! <br />ahnc mnrioncd pnipcny lot <br />*-s <br />3 <br />UNDER GROUND <br />Waste & Vent <br />Waler-Under f loor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release -7zt\ <br />FINAL Q.t.u 47<*-' <br />Notes, Remarks, Etc.