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PLUMBING-INSPECTOR BECORD <br />APPROVALS tD/stG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Test <br />Bough Water Heater <br />POOL/SPA <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 />e .16Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing ?/tut/z 5b%, <br />Final Gas Test <br />Meter Release <br />FINAL 6/ufic SN8'6 <br />Notes, Remarks, Etc <br />( <br />OWNER NUILDER DELCAI'ATION <br />I hctuhy rfilnn undcr pcnrlry ol t rjury rhrr I dr.rcmpr Innn rht Coikr.trJ Lic.n{ Irw for rhc lol,ovin8 rcuynr IScc r0ll 5 <br />Burimss itrd Pdcssbn Codc) Any Cily or County qhi.h rL\tunc{ r F_nnir h c1,nslrucl. .lter, iarprcvc, dumlnh or Eprn rny <br />\lru.turc. l)nnlo ns Gsu cc. ako rcquncs lhc {rli.anl lor su.h n nn b nbn \i8ncd nal.,L-nl rh.rhcorshc n li(cNcd ,'!rsunr <br />ro rlr pmvi\n'n\ or rlr G tucnr'{l.icc\cdL.rs(Ch{nrcr9-ConnNici',9qirhS$inJn70(DofDivi\i.nIolthcBtrsirc$ind <br />Prol'.$iotrs Cnd.,.rrh.t hcorshc ircxcrnnr rhcrcfionr.lldrhr hsii f(trthcnllcpcd.rcn{'rio. AtryrioldionolSedionTl).ll5byloy <br />rppli.r nr !lcrnrir\ubj.clsrhc unplicanr ro oci!ilpc.alryolnolaErcrhln fivc htndrcd doll"rs(1500). <br />-1. <br />s owF of lht !m!EIly. or m, cmpk'res wilh *ae!s !s lhcn $t mq*nsaron. willr,o dE qdk !d tlt nnEl@ ie Dl <br />i.rcd.n o. of.rcd ro. sb (Sd.7044. Bu.ircs d, Profcsrion! Co{tq Th. Co.rErors Lien* llw dms nor $ply ro rn owmr oa <br />rh. rmrEny eto hrilds or nqmB tutun. dld who.t*s sEh *o himsclt or tNlf or lllDugh hii or h6 own cnplor6. <br />,,rovid.d lhai su.h itpmEEils m mr intcd.d or oftr.d ror $r.. ll holffi. tlE hilding or inpmwmnl t $ld *hhin orc FU <br />of.oru,htioi, llt Owr Blih€r wiu haw tlE b!d.n ol pmling lhar lE or str did tur build or irprew thc pNFly for $a ptrrFs of <br />l. trs ovftr or rh.lepcny, mcx.llsivcly.on,rernrg wnh li.co$n corrDd.n roconsh.t <br />'tE lrojet (Scc. ?044. Busms3 <br />!,n hD6isin Cod.: Ttu Conrracrols Liccns Llw docs nor 4ply ro an ovnd of po!.rry sho blildi or inporcs th.ron. <br />lnd *ho onrsdr lor su.h pmj.lk wnh r Contuio(t lhcn.cd prlsnr b rhc ConrF.lm . LiNns l,*). <br />llantrliBstl.:aufl,Ns ro <br />DLCrdntrIllN <br />! hcr.bynifi ihundcr p.nalr, of p.rjuryoncof Ih. rollo*in8 dcclrrdions <br />IhxrrIxlsillDrinr]inrCcni[rn.olCon\ctrrn,Sclfln\ur.i\trrkrkc^'..n!t^-\di({,r\prtrlcdhrhrSccri,)r.17(xrol'rhc <br />lrtxtr Codc.lnrrhc Frn)nn]occollh. *ork iirs,hi.h rhc pcanir i\ isu.{l <br />_l holc ond will m0i.loin *oltcB compcnsalion insuranc., as L'qlicd by SNrion 3?0O oflhe Libor Codc. for rh. F,rornEnc. ol <br />thc solk for *hich lhis pcmil is hsucd M, vorlcs cotrrFn$lion insrrare cadcr and pli.y nuhbd e: <br />h ns <br />c0l$0 <br />-l <br />ccrrily rhlr in lhc D.rlormftc ofrhc Dork for which rhh r.rmit i iss!.d. I rh,ll @r employany nci$n in any mnmr <br />s I to h.com subjc.r ro rhc wlk6r onpcneiion laws ol Crlifomie. and a8c lnlt if I shuld bccoft $hjt l lo ll'. <br />workcs onlcnsorion pbvirions of Scclion 3?00 ofrhc L{ho! Codc. l shlll. forltvilt conply *ith rho$ poviFions., <br />.z -18 <br />I hcrc$y dlinn u Jcr pcnrlry .l Frrury rhd I n |i..tr{d uM.r rro\ iri(Jn oi Chrnrcr q (comrrcrcing wirh Sccriiu 7(n0 ) ol Oirnim .l <br />oI rhc au\incs !.d ltolcsions Codc. ud nyli.ctr{ is in full incc rl cffccr <br />1 <br />( (r\st'Rl(1't(rN t,t.tNt)lN(L\(;D\( r' <br />I ncrcny ilinm und.r l]cnrllyolp.rjurr rlmt l,'sc h i connrudion Lnding aScncy in rhc pcrrir.nuncc oarhc w.rk r.r which rhis Frnir is <br />isurd rsc. :1097. Civ C ) <br />AEELICANI.IECIdEAIAA <br />I hd$y atrm undo pcmhy of perjEy oe ot lh. tollovirs de.lfarionll <br />D.mohion Permib.Asksros Notificarion FcdcBl Rceularions (Tnb 40. P.n6) <br />-Rcquied <br />kncr ol Norifratirn <br />-l <br />cdify thd th. fcdcrol rcEulario"s rcgslding lstEstos rcmvd aic nol amliclbk r{, lhis Imitr <br />ify th.r I hlvc Erd $h applicution lnd (arc rfi!| rhc abole informtion t <br />and Stsll txws rcbrin8 ro $! ilding coNdcrioa. urd tErcby ofrhis Cnyaod Coury lo.rler uFrn dr <br />a 4s <br />*.L.t0 <br />.1. <br />WARNINC: hitu.c ro wlrc qorkc^ comFnsarion c.vcmsc is unhwtul. und \hqll sDbict an cmploycr r. lnmiml pcmhi.s ond <br />ciril fincs up lo om hundrcn lnouss.d doll{s (SI0O.O0O). itr rddirn,tr to rhc.osl ol.or'Fnerioo. d,.Egcs 3s trovt.d lor rhc <br />Sdion 3076oalhc tibor Codc. inlcrcs Bnd otlomy'sfes. <br />btrdn . Ad rr( <br />DATE