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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE OWNER IUILDER DELCAN TloN
<br />I hftb, lmm ud.r D.elry ofpdjury rhat I m.x.rw fmn lh. Conlrlclou Licda t w for lh. followins dsn (sd.7oll.t
<br />BuriBs srd Pot b. Cod.): Ary City or Cou.ly whhh EquiB . Fmit lo ondrud, ahd, inl,rec, d.mli.h or qrat..y
<br />srru€tEt prior ro ils irurcc. .Ls r.qlirc! rh. .ppltsd for Nch Fmit ro lil. a 3i8n d .td.tr.t dEr h. or dE n li..nBd nUNr
<br />to rhc ,mvilioN of rh. Conrelfl Liccns.d Loe (Ch!pr.r 0, Comncine qnh S.clion 7000 of Divkion I of rn Burir.ss lnd
<br />Pmfc$.ioni Cod.) or lhll hc or ih. n cx.r'fl lhd.8on.nd th. b8a.i ,or $c au.g.d cx.mptiotr Any vioLlion ofSNlionT0ll.5 by any
<br />applic.oi f6r r pomit $bj*r rh. r?pli6r to . civil pcMhy ofrct @E lhr. fiv. hundEd dollss (5500).
<br />l.rsoNncrolrhcpmpeny,orDyemployeessilhsiserrsihct$lccompcnsrrtr)n.willdorh.sork.ndrltsrmlurcrnrl
<br />Lnr.ndql oroflercd lor sle (s8 70,14.I]usincrs od Pn,Icsst,ns Cod. lhc(onticlDrsl-c.trlel-awdo.snotipnlylo!noxn.rof
<br />rlr rDpdy wtn t!'ld, .! mrrovs ttEro.. i,i n h. .i.cs sch $rl ilnscl, or hcRlr or rhmtlh hu or h.r .rn cinrLr.q,
<br />n(,rid.d rhar such inpftn.ikrciEndr mr(nldl.r oftrn ,i" rlc. II lxJqn-6, rtL huilling or inlntr?m.r r,lds hmoncyHr
<br />ofconrpkton. rh€ O{,n r Buikler wlltnlr rl€ hrdcn of pnMh3 rlui heor sh. nrd d huild or inrtmve Ihc pmpoly fo. rhc puqxk ol
<br />_1. ai owM ofrh. lmt riy, m .x.lu.iv.ly co mding wnh lic..!.n conhdon lo otr(ruci rlE pmj.d (S(. ,(}44. Bunn6
<br />rnd PotRebn Codc: I hc Conhctofs Lic.Nc Lr* do., mt orply ro on o,rcr ofDo!.ny who huild. o, imDmvd thcro(
<br />and who 6 turr for sch por.r. wnh a Co,'lom(9 I'cciictl llftMd ro th. Conlreclois ticnr L.*).
<br />-l
<br />ah ci.hfl lndq Srtion- B. & P C fir rht EN..
<br />D.rq O*r.r:
<br />woil(ERs' conrP[NsarroN
<br />[ECt ASAIIA!
<br />I hmby aflim undd Ddlry of pdjlry oE oth. followins drlmiod:
<br />-l
<br />h.v.&dwill mlinrlinaCcni,lc.r.olcnor. ro s.lt l.lorc t r \trk.c comp.nsrion, ac tmvided lor hy S(ri
<br />ljbor Co<|., for rh. dfo.rrrm. o fth. solt fo. *hich thc pmir G is.tcd
<br />Z:fi-oc and wltl mainrnin wuk.ri comp.G.ron in{6e.,.. r.qxiEd bys(tion1700orlh. khor (-odc. b, rh.Isli,m9c. oa
<br />rhc Nort f.rwhi.h rhi p.mn ii r!u.d MyworkoB comFn$ri.. insumnc. qEic! atd policynumhcr d. l I
<br />c,",,, 'z? T4\ z(, , lllll1
<br />".r'"rnr*rrMM'
<br />I enify rhst in rh. F.fomrc.otrhe wort for shich rhis p.mn is isiocd. I shall mr .otloy auy r.Rrn in rnym.nNr
<br />$ a! ro hdft shjd ro th. s6 6 6nD.rer6n lawr.fcolifomio, 6*l a8r lhit if I shlld b.com Nbj6t lo lt!
<br />woRdd coop.nsxonrmvi.ioni ofsdio.1700 olrh. Lrno, Can..l ihnll, fonhwirh eDply wirh rtn* omvisionr.
<br />WARNING: Iailur.lo *flr. qoik 6' smD.trslion c.v.Es. is unh*tu|. lnd qhdll bFr M mFhltr r. simiml n<slti6 ajd
<br />civil nn.s up lo on. hundrcd tlbusnd dolldi (ll00,0ol)), in addn
<br />Lrtsr Code. int.rBr 0d suomry s
<br />I
<br />llliQ &llloN
<br />I h.rehyiflttr,trndcrncnrlryofprru.yrhir I an rtns{luflcr nn,!Ls. olChrlrrd9lconnncncngqlrhsecrFnT00o)olDt1$onl
<br />ol rhe llusinessrfri l'mlc$ons ('od., rd nr) hcense F nr,ullr'.rc.rdcflecr
<br />A - s?Rza1
<br />'t((
<br />I heftbynnnm utokr n Mltyolp.rJuryrh.! rh.E n a sNrudnn lcndmS 0g.ncy for rh. tElomaftc offic trnrli hr wh(h rhf Fnir 6
<br />tsu.<l (Se.1097, Civ C ).
<br />ATTIICAIL!}:g.AAAIION
<br />I tE€hy aflim und.r ,.n.hy oln rjur, o* ol rhc tollowms ddletion'
<br />D.mlnio. P.rmi's-AslBros Noiific{ion Ijd.ral Rqulalion, ( l nt ,10, Pan6,
<br />-Rcquncd
<br />Lctr.roINotifi mlion
<br />r'ion ir coE cr. losrto snrdywirh dll Cnr 6.d Coxnry
<br />ordMr.i ..d sra'. L4ws Eblhg lo_
<br />otnE mntioned nmrsry for
<br />Appll.nnl or Ag.nl Slgnilurel
<br />'v.r otrhFC y md Cnunryr..nrd Lp.nrlE
<br />,,,,. , tt I ':- (tg
<br />Waste & Vent ll*l1"tg I -/L
<br />Water-Under floor -€
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent ll'11-ts
<br />Water Piping
<br />Gas Piping l7-l t1 tc /ttt4,
<br />Roof Drain I
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{rap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service tL q I t/4, (1
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device A\
<br />X"+ 6,+f .F€ff-t-l
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release .A\
<br />FINAL l_"1*i1
<br />\Notes, Remarks, Etc
<br />!-+
<br />tD/stG.COMMENTS
<br />t nd.it A.ldrB:
<br />-
<br />-l
<br />ccrlify lhsl rhc l.d@l Esirhrion! ESddins ashdld llmhl .r. ml q!rlical'1. ro rhis lmjel.
<br />P.mud nan. Orinr):K
<br />UNDER GROUND
<br />Gas-Underfloor
<br />v-wD\,
<br />POOUSPA
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