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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BIJI I,D!]R DI]I-('ARATIl)N <br />IlNrchyrllt ! cr ncnrlly (n lerjury lhll I a r cxcnr ltuo rhc C.nti.ron Li.cNc ljw r'or rhc ldlowir8 r.o$n (Sc.7o.rl5 <br />Btr\nic\\.ndPn'f.sii,nC,xlL):AiyCiryorCourr\hnhr.quir.\Dlxnnirk,.onnnkr. lrr. inforc, dc'n)lkh or hfl'n triy <br />(nrcttrc. pior lo ns n$imc. lGo rcquncs rlrc.pdicr tu suchlf,nnir lo lllc a sisncd ($cnr.r lhd hcor snc i\ liccn{.1 ,'urunr <br />r' rh. Frvisi(,rs ol rtf, Co.ta.tr's Li.c \cd bw rchllPrcr 9. Co nncncrs \r h Sc.rion 7fiX} uf Drvision :l ol rhc Businc$ rnd <br />PnrL{\i(,'\ codcror rhd lto,{h. ir c\cDrt'r rhcrcr'hnr0id rh.bJ\t n 't lllct.d cicnUi(tr ty(nn ionolSccriDTlr:ll5hyrny <br />!|]rlic!nllnrr|Eflnilsunjcdslh. !r!licrnllo rcivilDcnrlryoftror.r{crhrf in. hu rc(ldolhB ($5(xlr <br />l. n\ rstrcrol rhcrreF y..rnrr.nplorcs \enhaae.sar'hcir qnccn.IEnsdior. silltL lhc *oik ifrlric {trrur! n mr <br />i'n.n ql or ottrcd rhr sl. ( se.7oJ.l. Bu\irc$ lnd l)lolc$t,ns Codc 'l lE (bnrrttr \ l-iccn{ llw docx nor lPpl} t) rn owi.r ol <br />rhcpnrFay f,ln, hrild\ or inlPnrcs rhcN[ axl $ho d(f,( \kh soi him\clror h$*lfor rhnrulh hi! or hcr own cnllb]cc\. <br />p(rnfud rhnr \u.h i'nln\rfr rc tror itrr.'rlcd or olji'.d Lr $lc lt hos.v.r. rl* hrilliq .i iml,ornrnr is q)ll wirhi', om rrr <br />otronlpkrio.. rhc (rmr lltrildc. willhart rlr burdcn ofnntri,E lhd h. or \h. dd nor huild or nnprov. rhc polf,ny for rlr purlrs of <br />_1. &s .sr otrlE !q).ny. m cr.hsivcly co ndins *irh lien$d co.rrrcroF ro d,nntud rlE pFiu {S& 7044, Burims <br />ai Eottssbtr Codc: Thc Conkeloas Liccnsc tjs dm. nor apply ro o owncr ol tml'.dy who btrild! or iq,rovcx lhcron,and *ho dil|a.ts fot sh Dm,ccls airh , C. ncro(3) li.cn*n pusutrr to rtc Coirfttols Lie.c Llw). <br />-l <br />!f,cxctopr und.r Sccr <br />D.(.-_ _ _._- own.r: <br />wonKFRs, (-()nPrNsai(rN <br />DECI,INAII'N <br />I h.rhy rfllrm un.kr Fnallyol pejury onc ofrh. tolloling dc.ldrrion!: <br />L.rtxtr G)dc. for rhc l[rfonrmr. i! r rhc { ork for tr hi.h rtu ponrir n i\su.d <br />_l hnvc affl will nuinlair *orkc6 compensrion insu.!rcc. {s roluftn hy Sccr t,n l7m .f lhc I rbor Codc. lor rh. o.rroflrEk. ol <br />rhc work for whih rhis li.r.f is iiscd My *ork6s ompcn{lrion in rincc ca cr sJd polky nuhb.r dcl <br />VioEo o Z\ <br />-l.cnifylhal <br />in'tu pcrformR. of rhc worl lor whi.h ihir pcrmt h irsucd.l shlll nol.mploy any Frsn itr onymonncrs N ro t om robj.lr rb rh. solt.rs d,hp.n\lrion la*s oa Crlifomi!. ond o3B rh8r if I sholld h<<oft {!bj<r ro rlE <br />wortch @ftpcnrrrionpmixio.s orSecrion 1700olrhc lih.r Codc.I nElL foahwirh.odply *irl rho* povjsi.n!.. <br />WARNIN(;] Fllnrc ro s.urc $orkrF .o r|*n\.riN .rr.rngd ir irx\rrul. rnd shrll suhj..r in c Dloycr t' aimiml Fnntics 0trd <br />crvil hrrc( uf n) om hun(ircd rhonsrM dollnN ($|0O.(Xnr. in ikkliri.r b rhc.on .l .. rtxtrsrtiotr, d rSc\ a( F,vidcd lbr rhc <br />Sc.hn:1076 olrhc Llt r C.dc. inrcrc{ rtrd rii.rry-s rcN <br />ET?-o ADptloni <br />utlltf,!(oNlra1-IaS <br />DICLAAAI]ON <br />ol lhc au(i,rc\snnd Prclclltlr( Conc. nry liccn\c is h turlhr.cr cllicr <br />r-i"-* cr"*, rL-3 (:?4'I?L <br />D,,e: .lt luolr ? <br />SONSIIIJCIII}NIEdIIINIi.&CENCT <br />I hcreby afli.m utrds lEnohy of F,jury ltal thcE t a coDsloclbn kndinS a8cncy for lhc ngfornrmc of thc sm* ,or which lhis Fnnir ir <br />hsucd (S€c. J09?, Civ. C.) <br />APPLICANT DTCI ARA1ION <br />I M,y rtrmr udcr Fnahy of !.riury om of rhc aollo*i.g delml ions: <br />D.mlilion P.rmneAsh.nN Noiifi.rr ion F.rl.ral Rcgubi irns {TnL 40. Pd6) <br />-Rcqutcd <br />bncrol No'irtnli)n <br />-l.cnilyrhir <br />rhe lidcrrl rcguhri,nx rcgrding a\6csr.\ rcnrvrlr. ml rppli.rnh r) ihi\ nrcic.r <br />ordrhh-c\ and Srdrc Ln$ s nl rin8n' buildnr! coinnrrnr rnd hcrcbyatrrhorncrc!rc\..rrriv.\ ol rhi\ CirynidCounryt, ctrtcr trf,nrh. <br />-*" ' l"/to <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Bool Drain <br />Rouqh Water Heater <br />P{raplDrain Line <br />Main Drain/Pool Fiping <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 />Rough Plumbing <br />Final Gas Test <br />Meter Release I <br />FINAL t //a /z.o -.J[1/24 <br />Notes Remarks <br />x;:m.:,:{ r-. <br />TOP OUT <br />Tub/Shower Test <br />POOL/SPA <br />Back Flow Device