|
APPROVALS DATE ID/SIG.COMMENTS OWNI]R Bt'II,DER DEI-CA RA'TI('N
<br />I hcrchy allnD urdcr lcnolry ,,t pcrjur, rhd I Jn.rc.ltr li$n rhd Codmrlorf t-icctrs l,w tu rhc nnhwmS rc$nn (Sr...7011 5
<br />0u\ine\s onrl Pr'ac$ion Codc) Any ciry or counry whkh reqrnus ! pcanir n' con{tucr. ,lrcr, nnr.vc, dcnrlnh o, rcDrn any
<br />ntudor. prid b n\ i\{Dtr(., !l$ rcqui.cs rh. apdicanr ior such tl(nni k, nb n riSndl {atDrnl rhlr lrcot shc i\ licdn{d dursu r
<br />b rk. pmvisii,n\ ol rlf Conti.ntr\ I-i.cn*d tnw lch0prcr 'J. ConrnEn.il8 wilh Sccrhn 7fiD of Divisiotr I ol'lhc lllsinc$ and
<br />ftofrsn,n\Codc)orrhlrh.orrhckcxcmplrh.rclionrlndrhctxr\i\tnlhcallclcdcxcnr|,ion.AtryriolllionotSsti,nT0ll5byrtry
<br />rrtli.rnr l.r p.nnn suhjLrIs rhc opplicanr h !.i!ilpcnatrtofnor 'flrcrhrn livc hundrcddollssl$5lx))
<br />-1.
<br />.r owrcr ol thc preFnr. or my cmployes wilh *ds.s .s thcn sb conFnsrhn, will & lhc wrt {d Efirl@iimr
<br />inrcdcd or ofi.Ed for sle (Se.rO{4. Bnsift.s aid Prolcqsio.s C6dc: fh. CodE iort Ltcoe Las &,.\ .or arPly !o an owmr of
<br />rhc pmpcny who hilds or iqmB llEmtr ud wlb &rr st w* hihsclf ot h@lf o. rhrcu8h hh d hcr ow. en9h)rcca,
<br />nmvidql lhll suh inomwmnls sc m! hrcnd.d orolI@d for sle- lf. hoesi tlE hildinS or i,{mvcmd h $ld silhi. onc t€e
<br />of compbrion. tf, Oincr Buith. will lllw lh. lukn of !'rcvins G.r h or shc dil mt tuild or in9tuw $c tmpdty for llr puqDs of
<br />-1.
<br />as orrer of rnc !mp.{y. m erclusiwly onr.eline wnh lcctrsd .ontGloa lo ontrruct rtr Foiel (Se. ?044. Bu\ifte
<br />ard PJofcqchn Codc: Thc co.rrclols Liccnsc Law d*s nor apply ro &o*m, ofp.6p.ny who builds or ihptuvca lhdNn.
<br />a.d *ho o n rs td tuh Foi{N vnh r C.nt&ro(s) lic.hsd pr*u t lo tlE C.nltrttr 5 Lirn* Lrs).
<br />-l
<br />m cx.mfl under S6lio.- A. & P C. for lhis rc&{n.
<br />Drr.r OwE:
<br />-l
<br />hrw dd eill min.in a Ccnifrclic of C.nenr ro Slli{mE ftr eorlcd @tp.n dio.. 6 Fovidcd for by Ss on 37m of thc
<br />Lrbor Codo fd rhc psf(ffic otllE tr.t fo phhh tlE p..6it i! ilrNd.
<br />I hak ,nJ w ill n0inrnin worke(i coq.nslrion insuEmc. as rcquircd by s.dbn l70o of thc L!6or C.d€. for fte ndt @ncc or
<br />rhc wor* for which lht p.mil is icsbd. M, *orts ion inru@ @icr 8n lbli.y numbcr e:
<br />_l.cnilyrh i'r ih. F.li,rnrn.. of ttu $uk ntr ich this Frftit is iss!.d. I iholl mr cnphy any peMn inlny Mftr
<br />$ * io 1,.6s subj.d lo lh. *orlcl cotrp.n$ion lo{s of Cdlifodia. dd ,gE lhal il I slnuld b.cor* subid to rlE
<br />wolrtr,.omr.nsarhnpmvisionsofSstion3700ofrhcLatnrCodc.Ighall,lonh*nhsmply*ithltnsPnvhkrns..
<br />Totq\q
<br />,,src {/ zt / I {Oz-
<br />coxs:rauullruulNrNc-fclNsl
<br />I |rcrel,y arfirm unlcr !(idryorFrjury rhst rhcrc i\..-tr$rudn,n [fldins.scmt {.r rhc pcrtonumc olthc work f{ which thi\ Fnnn is
<br />nsucd (scc .10e7. Civ C.).
<br />ATTIICANIDECIdAA.IION
<br />I hcrny dim unrr.r Fnax, ot ,.rjury orc of $c folbunrB dcclant ioor:
<br />o.rrchion PclmitsAsbcsros Nolincario. Fcdcrel Rceuhrio.s (Tnt 40. Pin6)
<br />-Rcquncd
<br />Lcncr of Mnifi cxri6i
<br />I ccdiiy rhar I h. tud.rsl rc gulol ions rcSudins !\txnosEnn,vrlm nor {dtablc to lhh lDrc.r
<br />-l
<br />ccnily that I havc rcld lhis .rtli.arion sid srorc r har rh. ohovc inlorml ion h cner. L8N ro comd, 'nh oll Ciry lnd Glrnry
<br />o ifllrc.\ rd Srrrc lrs\rcLrin! k)hoikhtr!n,.rd lErcbyruthotuc epEscnisrives ofrhis Cily Md Co! yk,cn!c.uronUr
<br />!hov. mniioncd pmFfly ror inTccl
<br />Aprli.ml orAAe Siamtu
<br />./
<br />Waste & Vent 6-il-tg mP(rt1 f)
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent 6-t2-ty J trJC)PT L1
<br />Water Piping
<br />Gas Pipino
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough 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 />Sanitary Sewer/Cap
<br />Back Flow Device
<br />lf \
<br />Rough Plumbing tL-t7-tg \.Uei,tl il
<br />Final Gas Test 6-lz-tg hld(61 1)
<br />Meler Release iA
<br />FINAL 7-\\"tY hv.l1d
<br />Notes, Remarks, Etc.
<br />PLUMBING.INSPECTOR RECORD
<br />UNDER GROUND
<br />TA8trE8S:CAMTENSAIIO!
<br />DECLIAAIION
<br />I hcrcbyamrnundrneMtyof FrjuryoncoallEfollowin8dRldalio :
<br />IVARNIN(;: rirhr. r) c.urc sorkcm conrlrco!'ltr covcrogc i\ unh{liil. rnd shrll suhFll an cmploFr ro oi n.J F,ulrici a
<br />.ivir ftr.\uproo.chu rcd thous!trd dolh^ (t100.01x)), in lddirnnr h rhc.osr ni comlEnsrlion. drtuscs as Folidcd ror lhc
<br />S(rnr 10T6ofrhc tjhor(nlc, inicrc{ aM alxrlry s lccs.
<br />r,.,.: 5/z.t/lE ^pprisr: Dc"t-- ?op.,4;'5
<br />' Ll!];N5f,DllNraduaa
<br />DECLAAd.IIAN
<br />I hcrcby rlltnr utr(lr llcmlrroipurjrry nu I rli...soduod.rtn,vi!.troiChrlrlcrC(connfn(ingwirhS..rion7t[,0)olt)ivi\iot:]
<br />.l rh.llusi...sn.d Pi(nt$iorFCodc. afrl my liccnsc i\ in tullln.cmicihct.
<br />L.ndd l Nsm
<br />-
<br />trtrdci' Addc*'-
<br />/.4 ^,-nzq/tt
<br />I
|