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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS (rwNr,iR B(ILDER Dtl,(.ARA',t.tON <br />I hcrchy r litm u M.r lf,nJlry or Frjury rhd I nm cx.mpr rio r rhc G,nrr.r)^ Lic.n\c I.!w lnr rhc tulhwn'! rcr$ir( src 70.1 t 5 <br />8u\in.s ud Prolc$ir r Codc): Atr! Ciry or (iunry whi(h r.qtrircs . ,.nnir b .oiitu.r, llrcr- ifrp('vc. dcmoli\h f rc],r, urv <br />{rucrurc. pri(tr b irs i\suan.c. rho rcltuir.s rhc lllplicnnr itr n'.h N.nnr ro li.n e!trcd ftrcrf,.r rhi h. or \h. i\ liccn\cd 0u6nr.rt, rh. pn,vi\i,nN ol rh. C.nrr.htr s Li.cn{d Ii* tchrDrcr q. Co rnrn.nrA Nirh S..rnnr 7Ux) of Divi\ii'n I o, rhc ttu\ilcs rtrd <br />P(ncssnn\ Codc)or rhrr hror\hc i\cxcnDl rhcrcliunand rhc h i\ l'or lhc dllcgcd cxcnDrion An!!6hri.dofSrcrionT0.ll5hyrny <br />applicanrlnrrp.iinirnrblcrhrhc.On'ranrt,J.ivilt.n.lryolnornrrcd[nfiv.hrndrcddolltr^($5(x)). <br />La\osftrofrhc,r'rcny.ornrycmployccswirhw8.\{\rhcnqncconlPcnslxi(nr.uilldorh.*orkd rh.{turhisrk <br />ilrcndcd orotltrcd n, {rc lsc 7Ol{. Busincss lnd ProLsnon( C.d.r'l hc Conk{rtr s Liccnsc ltrrwdocs.or npply r, uowncror <br />rhc lftTcn, $h) builds or ilrlm)lcs rlrR,n, s.d *ho dcs $.h wof* hnnsclf.r hrrrltur rlB,rgh hi\ or hcr own umlkryccs. <br />provi(lcd rhd nkh i'npmvcnrnr\ a.c m, i cftlL{ orolT.Rl ftf qk li ho*c\ u. rlrc t{ildir! or imflovcnrnr is wnd $irhinoDc r!.rol.otrDlcri,[rhcOsn.rBuiklcrwillhovcrhcburdcn.fpn]lingihdh.o,shcd or buikt .r in m!. l}E pmpcny tor rhc purlDs of <br />-1. <br />!s owner of th. pNp€ly, an crclu.ilcly.ontrlclir8 wirn lieBcd .om.rcroN to co.strud thc pmiccl 1S(. ?044. Blsinc$ <br />.nd Aot!$io. Codc: Thc Conrmtoas Lk.nsc ks d@s not.pplylo oowmr oap.oFny who blitds or imprcEi thcrcon.a.d *ho .o.ln.k for tuh toj6$ wilh s Contftro(s) lk.ied puft@l to rhc Co relots Lirrs tjw). <br />WORI(ERS' COIIIPFNSATI(TN <br />DECIJ.SAII!}N <br />I turcby lffirmundcr p..!lly of p.rjury onc orrh. tollowins delararhns <br />I hlvc ud will trrinr0nr ! Ccnirrarc or C.nE ro Sclf,lNurc ror sork s comr.is n{.ns fmlidcd tor hy Saltun 1700 of th. <br />trh.r (fdc. for lhc t).rromftc ol rhc so,k nn shich tne Fmir h issucd. <br />I hrlc lid qill'ntrint0in workcrl conrr..sdi.n insuraicc. ss rcquircd by SNion lroo olrhc tibor C6dc. aor thc pertormMc ot <br />lhis p.mir is isscd My w6.kcr' compcnslriotr inruramc odi.r nnl rtli.y numb.r sc <br />c l.\.\ar. <br />-l <br />enify lhal in lh. p.rformE of lh. w.rk a6r ahich lhh pcrmil is tsucd. I shnll mr cnpLy any tser in lny dMrr$ as io bc.om slbjccr ro rlE sorksl o'nFnsarion hwr 6f CaliforniL ud sgE lhat if I should h..od suhier lo rlE <br />wolknc omrc.sarion pnvisions of Setion 3?00 of lh. Ldnr Codc. I stull, forrh*nn conply with lnos pfl,visbos.. <br />WARNING: Fuilurc lo surc srlcrs' omp.trerbn ovensc is unlevtul. snd sn! $bi$ m cnployr. ro diminal FnalriB and <br />.ivil fincr uI ro ok hhdEd thousnd dollrB ($100,000), in addition ro lhc msl ofco i.n. dntugc\ nr proridcrl lb. thc <br />:."ltuilT"f?0Tu': <br />I hiEb, affrh udcr pmlry of pdjury rhd L.n povkion oich{prd 9(conmrcing wiih Sdion ?000) orDilhion l <br />l.toa?t-- ? <br />CONSTRU(:TI(}N I FNITIN(I A(iFNCV <br />IhcEbyllttnrutrdcrtE0lltofrcrjuryrhtrrrh.retaco.(ructionbdi.8agcndyrorrh.p.rrortun.cotrlrwortrorshichrhisne.nrilh <br />isx.ed (Sa.3097, Civ. C.) <br />APPLICANT NFCI ARdT!(IN <br />I hc,.ty 3,Ion undcr pcnohy olp.riuryom orthd adllowins dcclulrions: <br />Dtholirio. Pe nn$Asb.{os NorincrriDn FcdcEl Rcsulorions (Tirlcr{}, Pd6) <br />-Rcquncd <br />tlncr o, Nolif$lirn <br />l.enitrrhlr rhc lcdcrolrc8ulorions rcSarnirgasb.dosrcme0lnrc nor 0pllicrblc lo rhn pmj.rr. <br />qll.cniry rhar I iavcrc(lrin !,'rlicdbn aflt ar. rhar lnc atntc inr(trmarion cofu I a8m ro..mpt, *irh atl Cny snd coun,y <br />ordn',nccs md srlre L,vs ELlitrslo huildi ofrhil Ciry dJ Counry h enrcr !F)! rlr <br />ab.vc tunriurd poFny <br />d"pt'[ I 1 2018Apt,llcanl or AEenl Sillnnluro: <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Building Sewer <br />AreaL/Storm Drain <br />lnterc tor/ Clarilier <br />TOP OUT <br />Tub/Shower Test <br />Rou h Water Heater <br />POOL/SPA <br />P-traplDrain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool HeateriGas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Sanita Sewer/C <br />Back Flow Device <br />Rough Plumbing h ztlty',il491 / <br />Final Gas Test <br />Meter Release <br />FINAL qq< <br />Notes Remarks Etc. <br />Gas-Underfloor <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Rool Drain <br />Lawn Sprinkler <br />V4trlr <br />of thc BusiNs and Prolcsrion. Cdc. ad ny liccns h in tull lorcc ond cficcr. <br />Lrndd s Ad&ess: _ <br />?-