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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTVNER DU'LDI'N D!:I,CARATION
<br />I h.rch! rfirn u dd l)chrlry of Frjury rhd I am dcnlpr fnnn rhc Contrctni l-i.c s Lnq {or rhc folkrrinS rc!{)n rsc..7orl 5
<br />Bu\nL'sr xl llrtc\snnr Co c) Any(iryoi(i)unryshi.hrcqtrnN.t nr n,.on(rcr. rkcr. irnlnrc. dcnmli(h,t Rt,Jn dn],
<br />itu.rlrc. nriort' ir\ is\urncc. aho rcqune\ ihc rppli.rd lar nr[ nriinirl' ri[ r silncd {dc rnr rhI ltor \hc n liccn\cd furu
<br />r) rh. porisi.trr ol rlr Gtrtr..rois l-iccnsd ljs (chur.r r), Co mcftin! Birh Scdion rdx) ol Divnion .l ni rhc Burim$ rnd
<br />Itolislion\ Codc)orrh{ hc orshc is crnrpr rhclcnom!
<br />'hchr\i\lnrrhcrlicscdqcnDrnnr.
<br />Anyliolirionots(ri.n?0.115hyrny
<br />r!fli.inr f(tr dp.nnir subj..r( rhc rlrfli.dnr b acnilpcfulryofnor 'ftftrhrtr fiLc hundrcddulldrs (55tX))
<br />-l-
<br />\ oencr of I hc pn,p.n y. {n nry cnrdoyccs wil h $ir$ rs rhcn q,b lannp.n\r nu. } lll do rl{ suk ud rhc iuh is n.l
<br />lnrctu.d oroil.rc tu !'lc(S& 7(!J. Bu\nr$md Prolt\\i{,ni Cod. lhc(ln rnktrrl-i.c \.ljqdocsn.rrml,n,0no$ncrof
<br />rh. pFpcny {tu, 6Iil& or ing,mrB rlxmn. md uho d{f,r sch so* hi.tr.llo. hc^cll or rhron3h ik or h.r oso.nDlorcc\.
<br />prniJcd rh{t su.h inpnr.rtrrs.e n idcn !{ or.ff(cd fir rnL ll hort!.r. rh. t^riklin! or nntn$mir is {'h s iriin .N )c!r
<br />ol .ompLrior, llE ()wts BuilL(r *ill hM rh. hi!dcn ol tovirp rln hc or slr di mr tnrildor im|novc rhc nm|cn, trhcl)urFis.f
<br />*0sowncrofthc |Iorny. anrcxclusivcly conra*in8 qirh li.rtrsd .onr!*$ Io otrsdd rhc tmjsr (scc 7044. Burircs
<br />Pn,fs\i,n Codci l he Co.lrdcttr s Liccn\c Lrw doc\ nor slnly r. an os.cr ofpopcn! {ho huildr or ifrprovcs d$co6.
<br />rnd who ootmcts for such pmi(ls with . Contelo(n [rciFd puBu to rh€ Conrr.crols LtcrE Lrw).
<br />-l
<br />er.x.mfl lndcr 56r B. & P.C. tor rhh rcaso!.
<br />e4-fAlllBtrlBltaulult a!
<br />lEcldaArlQ!
<br />I trcEby aruo u.d.r F..Iy of Frjury oc of (E lolLwirg dc.linrhrci
<br />_l havc .rt eill nDinr0in n C.niforc oI C.nent ro Sclf,l isurc 16r wort.ts comr.hdio.. as pmvidcn 6r by Setion 3rGl of ihc
<br />ljhor Crn(. for lh. FrfornMc oI lhc *olt lor which rhc l,ermil h issucd.
<br />_l h.rc lnd will moinrain wor*ctr' .oq,.n$rion in$mftc. I rcauiEd by Sc.liotr 3?00 of lhc bbor Cod€. for lhc Frfornlmc of
<br />rhc *ol fot wfiich lhii Fmil is isnicd. My *ortqi .omn nelion insur.Nc erkr 8nd policy nlmbcr @:
<br />Poli., Ntrtr$cr: [ll)ic(
<br />l.cniry rhlr rnc l).rfortune otrhc work lin Bhich rhh lr.mir t hsu.rr.l rhrller crphy lny p.i$n a" nny mMncr
<br />s s
<br />'o
<br />bccom sbiNt ro rhc wolkcs' conp.nsarion $ws ol Crlifomi!, ond .8N lhal if I should bcsm subicl to lhc
<br />*o*ss cotrrrxn$rbn provh
<br />'ns
<br />of Seli.n l?00 of th. t{ktr Codc. l shrll, font*il h omrly wirh tno$ rmvhio.r
<br />WARNINC: railur. t, s.xE workcB' .ompcnslrion ('!m8c is unlnstul. rd shtrll *ubjccr !n .,ntlLr't to aininal Fnihics and
<br />civil fincs up ro om hu r.d lhouq.d dolhre ($100,000), in 0ddirhn ro $. cost of coryEnslion. damScs $ providcd ibr lhc
<br />L.bor C!dc, irlcEn lnd rnormy s
<br />o o )-a
<br />^
<br />DICIJ.BAIION
<br />I h.nhy trfllrnr u d$ |x ahy.l lcrjury rhd I rnr li.ci*lundcr |flrtnnr olClrpi$ 9 (connNmir8 sirh Sc.rion ?U[) olDivisior:]
<br />o, rhc Busincs and Prnn$tnrs Conc. nnd nryliccn\. n in tulllnrcc dcic.r
<br />SJISIBIJCIIONIIiNUINCJqEN.CI
<br />I hcrcht .{ h m u ,ld ,.Mlty u I lErjury rh.r rhcr. is , on{n.li'tr hndiu r8cn., for r hc l)criormrncc .f rhc sork tur which rhir pcnnir is
<br />hrucd (Sm :1097. Ci! C )
<br />APIIICANLDECIAIAII(}N
<br />I h.t+y afiinn hdcr pcnalt, .l rrjuy oic oalhc aollo*itrE dala,alknrs
<br />Dcnnlnion Pcrmirs^slEnos Nolificarion Fcdcrrl R.BUhln'ns ('I nb iO, Pdn6)
<br />-Rcquircd
<br />Lcrts of Norifrdbn
<br />l.c ilirhd rhc icdcr rclrhriinr\ tog:trding r\hcn.\ r.nr'!rl rrc nor rPpli.ftt t, rhillmUrrr
<br />**rirhd I havc rcdd rhir applirarhn md Ndc rhd rhc aborc infomurn,n k cotrd l,Bre ro coq'ly wirn allCnyand Colnty
<br />and Slare La{t rlnrins ro buikling coi\mdn$. ud hcrhy auh,ia rct$.nru'ivcs olrhis Cny,nd Counlylo cnlcr ur.n lla/e//t ?DA
<br />UNDER GROUND
<br />Waste & Vent 7-lt2d ra<2,
<br />Water-Under floor
<br />Gas-Underf loor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanrtary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL z-//-4 fs-r >t-t t,tds J.^)
<br />Notes Remarks, Etc
<br />*,"tell o1,1 ZP
<br />lrlrJ.i\ A,ldrcs
<br />.'htrc'rnriLn'c'l pn.n(dy 1,tr i"\nc..ri,,!llll@!s.
<br />n*r*,*n**,o***/{/ +ftJ'4,611f
<br />*^u**.*,,n*('/ t J4 rA4g1ft!1t-A
<br />Roof Drain
<br />Water Service
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