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PLUM BING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS ([vNt.:R lllIt,t,l':lt Dt,:|.( ARA l l(rN <br />nl)plicul litnlErnil suhjccl\lhc il|lplicnll loil(ivill)crHlll 0l rx{r[rclhxnlirrh[ilrhcrl(l('lliil\ls5lxll. <br />sillc l. <br />iul(l tt,lro cottlr:lcls lirr srtch grrrrjr.cls s'illt ir (irrrlrirt'lor'( s) licertsctl nur\lt:ull lo lltc ('ottltltr'lot"s l.iccttsc l.rts',. <br />-lutttcxcllll)ltttttlcr.Scclir,lt-.l}.&l'.(..|ill.lltistcitsrrtt.()rvrter: <br />r1'ortKri*s, c(rNtI,riNsA'r'r(rN <br />DUCLAItA'l'l0N <br />I hcrcby al'linrr urrtlcr ;rcrrulty ol';,,*riuly onc ol'thc lirlkrwirrg rlcclarllirrns: <br />ffi#- <br />lirr thc pcrlirrrrurrrcc ol'lhc work lirr which llrc pcrrrtil is issttt'rl. <br />;rcrrrril is issuctl. My cortrlrcttsirl ion irtsttt irncc :rrxl ;xrlic1, rrttrrrlxr ;rrc: <br />Policy l .rpirt's 1-l-e\ <br />civil lirrcs u;r Io onc luutrlrctl lltousltr! rkrll:rts ($l(X).(XX)). irr lrltlitiott lu lln:ul'iurr. rlirtrurg('\ ir\ lrurirlcd for thc <br />,:::'Afl#_ <br />jit,l.Act t'sl ;ttttl ;tl lot ttt'.v' s lt't's. <br />(-{-/ Appticnrrt: <br />I lrcrclly ntlirrrr untlcr ;rcnulty ol'prjury lhal I lrrr Iicur-..*tl provisiorr ol'('hl;rlcr () (corttntcncirrg s'ith Sccliort 7{xx)) ol'l)ivision 3 <br />ol' lltc llttsittcss :rttrl l)trrlc'ssiults (ltxl tttv lir't'ttsc is irr lirll lutt'c ittxl cllt'cl <br />UTLiccrtsc <br />l)ale: <br />l-iccttsr-' Nutttht t_ <br />L+1aA('orrl rncllrr:r\ <br />issucrl (Scc. l(,97. ('iv. C.t. <br />I e tttlt't'r Nlurrt'' <br />1-crtrlcr's Arltlrcss: <br />A I'l'l,l Cr\ N'l' Dl',C l,r\ ll,\'l'l ( )N <br />I hc'rcbf llllrrrr urrtlcr pcrrllty ol'pcr jurl,onc ol lltc lirlkrs'irrg rlccl:ulliorts: <br />l)crrrolitiorr l'clrrrils-Aslrtslos Notiliclliorr ljt'tlcrll llcgrrhrtiorrs I'l itlc Jo. l'irrl(rt <br />-ltctlu <br />ir ctl l.cl lcr ol' Nol ilicll iott <br />-l <br />ccrtily lh:rl lhc l'crlcrtlrcgttlirliotts rcglrtlirrg uslrcslos rcrtxrr':rllrc n(tl ir;t;tlicnhlc lo llris prrr.ir-'t'|. <br />is cottet'|. I itptcc lu t'otttgtlv s itlr;rll ('ilt'irttrl ('ounly <br />cr,c\c,iircs,r <br />:: :4#ff <br />llrc irlxrvc irrlirr ttt:rl iott <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <br />Fill Line/Back Flow <br />Pool Heaterlcas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back Flow Device <br />Rough Plumbinq <br />Final Gas Test <br />Meter Release ll <br />FINAL I c{LO DKW I <br />Notes, Remarks, Etc.