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PLUMBING-INSPECTOR RECOHD <br />APPROVALS DATE COMMENTS OWNI]R BTJII,DER DELC I ]ION <br />I h.rcb rflnn undcr pc.rlry ol !.rjury rhdr I m cxcnu rio rhc coitacros Li.cnsc Lrw ror (hc rolkJwin8 Btr$.lss70:11.5 <br />Busin.s lBl Protu$n,n Codc): Any Ciry or Courry qhich icqtrncs r Fnnir h consrrucr. rllcr. inlllrovc. d.rmlish or rcnrn ony <br />socrrrc. !.it b irs irsu!t.. rko rc+nds rtd appliclnr for such pcrni ro filca siBncd sr c'mnr rhar hco, shc i\ liccn{d pur\ui , <br />'o <br />rhc nrcvisions olrfu Conrra.lois LilTnscd L!$ (Ch.trn 9. comEncnrS with Sccrion 7fix) o, oivision 3 oflhc Ausinc\r rnd <br />Pdt\\nrn\ Codc) or rhar h. or rh. i\ dc U rh.rcliom d! rhc M\i\ Ior lha llhgcn d.nprn'n Any vi{nnn rofS.lrion?0.ll5 by rny <br />Erpli.lnr Inr. pcnnit subjNls rM optlica ro i .ivil Fcn,x, ol mr nx,crhln ivc hutrdrcd doll.h ($5{n). <br />l. .c owner of $c nbl*ny. or f,y ennloy&i wirh {ascs ds rhcn sk coh0tNrrion, will do rhc !trt ud *r stn.l@ ir not <br />inra& orofi.rcd for $1. (Sa 7(}l4. Busi..s !.d RDfe.sio.s C6dc:Thc Co @rmsLic.nsLlwdxmrapl,lyloMowmrof <br />rlt FoFny wha boitts or in{rcws lltmG !d wlD &Es sh wlt himslf or hcNll or lhmu8h his or ls own cdplort!. <br />!.ovidcd ihor ru.h amt$wftnrs m @r hrcndcd or oficrcd for sle. ll how.!er. rhe t{iuins or n,tmEc h sld sirltu "nc )ur <br />ofconpLrio.. rh. o,n( Butin will hM rh. hldcn of povins dd ho o, fic did mr t{iu or itr{lmrc rhc rmpsry for rlE plrrrs 6f <br />-1.IowrcroflhcFopcny,ucr.lusircly.onhclirEwithlierladco,rclo6looElrucltl[Imi.{t(Sm.7044.BuiB$ard ProliBliDCodc: The Co etof s Licensc llw d@s rcl lpply ro owncrotlDp.ny who blildsor imptuE! U.rcoLrnd vho coihdsfor sucnrmj.ds wi'h rC.iue|o(r li.cNd l,UEu rorhcCo rrcr6r's Lienr Liu). <br />-l <br />an .rcn udcr Selion- B. & P.c- for lm Eamn <br />llaxrE8lrrQMfE sarl(r! <br />DECI,IBAIION <br />I hcbhy afind undcr pcdl,y of rqj!ry om of rh. follo* in8 delsarn]flsl <br />lhalcoldsillmlinrrinaCclrifEorcofConrnrroSclflnsurcn,qor*c^.onrncnllrion.!xrr.vnkdfornysdn,nlTtrootrhc <br />trbor Oxle- for lh. pdnrmrcc ol rhc Bork rbr qhich rhc lsmn is is\ucd. <br />_l nlw .rd sill dinr,in wo.ks .orp.@rion in.uraftc, a equiEd by S$tion lro0 ot rh. t$o, C.d.. for the ,,qaollr:ffi of <br />rhis pcrnft i{ tq'd M""^"- irlufi \\) <br />6 <br />_l.cnily rhar in rhc perfo,tuftc olrhc sork lor *nich rhis pcrmit is issued. I shall ror cdq,loy any pc6on in rny mMncts as lo lrsm subF.' lo lhc vortm ompensa(ioo lass of Cllifomi!. lrd igc. lhd ir I sbuld bc.oN subjet lo ltE <br />wortcN' comp.nsrion povisions of Serion 3700 of rh. Ldbr Cod., I rhall. fonhwi'h .oipry wnh rhos pmvishns.. <br />WAININGT Flile ro *c@ lorllm @qanidion @kEse is lnl!*tul lnd shall flbFct o cn{rloys ro €imiEl Fuxi.. ai<i <br />civil fi@! uI to 6nc hund.cd ll|ouord doll&! ($100.000), i. addirion ro lhc colt of @r{Enslioi. d@ger a prcvidcd for thc <br />Scclion 3076 of rlE Llbor 6q hrr$ and romr\ f6!. <br />UCENIEILCONIf,ACrcB <br />DECI.ABd.IIO! <br />I hcEhy aiirm under p(nrllyofpcrjlrylhal I m liens]d ufr,cr nmvision olCh4ra 9 (onmncin8 *ilfi SNri'n 7000) orDilkt,n.l <br />of thc BusiNss and Pnrlcssions Cod., &n nry li.cns is in tull fod ,Jrl .ffccr. <br />CQINIA!STQNITNDIN J'NCI <br />I hcrbt alfirn undcr If,ultrofpcrjuryrhrr rhcrc i\ a coi(rucri.n lcnding agcn(y itr rhc p(rforroncc ofrhc $ork lff *hi.hrlri\ Fmrir is <br />isruc.l(Scc 3(197.Ci! C). <br />AIfIICANIDECIA&$IA! <br />I llEl,y atrnn udcr penolry orrurflry onc ofltc rbUosinP dccl,rarn,ns: <br />t)tmlirion Pcrnih-Asbc(os Noiincalion F€dcBl RcSuln' ions (Tirlc &. Pan6) <br />-Rcquird <br />Lcrrcr o, NorifEorion <br />I ccnifr rhd rhc f.drtulrltlak)n\ ftgudnrg hr{o\rcErhlrrc nor rpplic lcbrhnl,l.F.t <br />_l cqli,, rhd I havc rcld rhn lr,plicr! ion ond srarc thlr thc 0hovc inlormrhfl t comd I !3E ro oryl, wirh lll C y ud Co!.ry <br />onl'trrn..\ rnd Srxrc l.r*\ r.lxrill! r, huinli',9 .d hercbysuthorn! rcprcsnrolilcs oflhh Cn, ond Countyt. enlcr Won lrt <br />obovc mnrioncd pmpcny lor insnccr <br />Apdlca.l or Agcnl Sieelu *,alz-olznt* <br />UNDER GFOUND <br />Waste & Vent <br />Water-Under lloor <br />Buildino Sewer <br />Area./Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pi ptng <br />Gas Pipinq <br />Roof Drain <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 />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing 0!wt8 \rt ?llqul< <br />Final Gas Test <br />Meler Release <br />FINAL Te/l,h 9t\ss <br />Notes, Remarks, Etc. <br />rD/stG. <br />Gas-Underfloor <br />L.ndci" Addr$: <br />-