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PLUMBING.INSPECTOR RECORD <br />APPHOVALS DATE ID/SIG.OWNER &I,'ILDER DELCAf, ATION <br />I heEtry .frirn und* txnlly ol pcDry lh{l I u .x.opr fno th. Conttrto6 Lien$ hw for lhe followiog ,!sn (Se.?011.5, <br />Busin.s ud Prof.ssion Cod.)r Any City or Counly which rcquircs s Fnil lo @nstocl, dlci improw. &mll1h or Elai dy <br />srncrlre, Drbr b ns issoafte, aho rcquirc! rhc aDnlic.fi fot such ocmn ro fih r sismd sr.l.m lhn lE or sht is licen$d putsud <br />lo thc pmvisioN of dE Conlr.clort Liensn Li* (Ch. .r 9. Conmrcing walh S*don 7000 ol Divliion 3 of ln Bain.s aod <br />PDf.slioni Codc) or thll lE 6, sh. Ls .r.rpr ltmfiom snd lhE h.sii for lh. &lL8cd cr.nPdon. An, liot lon of S<lirn 7031., by lny <br />spplicanr lor. pemn sobjersrlrc aplrlic! ro rcivil lcMlryofnor mrcthr! ove huldpd doles (1500). <br />-t. <br />a. o*r.r oa ihc pDp.ny. or my .mplofrs *iln wa8.s as thcn sh omrc.rolion. wiU do h. Mrt ad dr srrlrE is mt <br />intcn& or ofi.rcd for elc (56.7044, Busirc$ lnd Protessionr Codc Thc Coor.chas Lian* t!* do.s ml rylly lo ao owftr.f <br />lh. F.Fny who t rilds or inp,DG rlf,ffin. a,n who dG htu* nims.lforlENlf.rlhtuuet his o.ho6wn cnthy..s, <br />providcd lhd such imlmEm rs @ mr inr.'!d.d or ofisd ftr sk. lt tFeE llE tlildinE d irpre@nr i! $ld wilhin orc Jta <br />of corqrldiotr rrE Ovn r Buib€r wi[ haw ln budcn olpmvinS thlt lE or str! dil tur bnild or inpmt lhc pmFny lor n5. lurPs of <br />-1, <br />osowncrofrhc pmrcny.6merclusivclyc.nlmcring wnh Iccnscd conracroN ro conslruct ll* rmj$l (S€c.7044. Bu\m$ <br />ond Bnftssim Codc: Thc Contr!.rols Liccnsc Llw docs nor q,ply ro an osncr ofpmFny who builds or ioFrows thcrcon. <br />and *hn o Gls tor $ch Fbj..ts with . Contn ro(s) licctricd ,u6un( to lhc Contrelols Liccns lj*). <br />-l <br />amcxcmtr undcr Sccl <br />-lhn\c <br />$dwillrroinrnin a Cc.rii6rc of Con\..r trs.ll lhsurc r{tr qorkcri .o'rt.trsrtioD. as |Iov]d lnriysr.ri,)nl?u).lrhc <br />Lrh.r Cd..lbr rlE ncrlhrnunce oirhc *ork for shkh ihc lcnnit is issucd <br />_l hlw ud will miflaa *ork rs.omtEns ion irour.mc. !3 Equircd by Sel ion l7O0 of rh. Liho, C4d.. lor lhc PcrfoMc of <br />il is issucn. Myworkss sflrpcrsolion insumnce caricr !.d Flicy nun'b.r dr <br />\.\lrt <br />l.cnili rh.r h rhc prrronMncc olrh. wo.k lbr Nnich rhis tcnnir i\ nsucd- I rhall nor.n'plo, dny pctnn h any mlnncr <br />s n to h.otrE subjsl <br />'o <br />lhc sn*c!s'co.{.ns ion law s or Crlinrnir. rnd,8nc thrr ill should lito,E \uhJcd t,rhc <br />*o crs mnllf,nsrl ion provnions ot Sarion -17(n or lhc lihr Codc, I \hnll, aonhwirh (ndy wirt Ihoc ,,fl,visi{,n\ <br />WA|rNIN(;: F,ilurc ro r.urc workcn'conrcnn ior .olcrarc is unlu*tul. {nd rhall suhlc.r ,n .m oy.r ro cnninll Fmhi\ 6d <br />.ivil fines xp b.nc hxndrud ihousrnd dollis (SILU.uro). in udlilion ro rhd..i orc.nfcnstrnrn. dtrm08cs ir lrovidcd ror rhc <br />Sccrhn .t076 of thc bhor Cod., inr.Est ond allorey s les,o. <br />I hcrchy n{fid undcr pcnslryorFrju.ylh l m liccn$d und.r lmvis 9 (comfto.ins airh sdt)n 7000) oiDivision 3 <br />ol rhc alsincs a.d Eor.siohs codc. md my liccns is in tull lorLr or'd €1161 <br />\0ctq%n <br />tL.ro. <br />CANSItrIJ!.II9NIENDINIiIOTNCI <br />I hcrchyafilnundcrpcnalryofpcrrfyihnr rhdc taonitudi{,i rjndrSaScm} for lhcpc rnunccofrhcwdAntrshichrhnP.nri n <br />n$cd (Scc.1097. Civ C ). <br />AfIT.ICANLDEO.AIAIIAB <br />I horby.trEh lndq pcnnlty ofpcriury orc ofrhe followi(g rk lanrio.si <br />D.mlirioD Pdmils-Asbcsrd tlorifi$tion F€d.nl RcSubrionr (Tirle 40. hn6) <br />-Rcquircd <br />Lc .r of Ndificalion <br />-+(6ily 'har <br />rhc l.d.al mEuuuon! Esedrna locq.r rcm!!le m' lnrrlK06h ro rhs pmirr. <br /><.cturr rhar I hak rcM rh6 snnlElri.n oid {!rc rh.r rhc.tnvc infomlion is comr. I neG rocoDplywithsll cilyand sounly <br />ordiMn .r md Siarc li*s mhlinS ro huildin8 rlrc*nuriks olrhis Ciryand Colnly to entcr lFn t,rc <br />xhov. nrtrrirni.d F'Jrcdt for fftNtiotr n. v-. t eApt li(lnl or ,4aent Slgtuturc: <br />r, (,Cct <br />UNDER GBOUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ter <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P{rap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq //-ze 4 ..4/ zz <br />Meter Release <br />FINAL Wr/lz iDl$ <br />Notes, Remarks, Etc. <br />COMMENTS <br />Miscellaneous <br />Final Gas Test <br />!A8f,E8l:l;AM[&TAITl! <br />DECIJIAIIO! <br />I hcrcby a,lim ! cr pcMlryofldjuryorc orrhc fouosins del@rion* <br />.-,*"" k ar*c.'.- <br />Irdcr'3 AddBr. <br />- <br />M <br />-------T------ <br />-------T------ <br />tl <br />= <br />=