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PLUMBING-INSPECTOR RECOHD
<br />APPROVALS DATE to/stG.COMMENTS OWNER BUII,DER DEI-CATNTIoN
<br />I hcrcby trrftnr undcr |rMlry ,,t prrjrr, rhrr I d cxcnu from rhc Cotrkr.bN l-iccn\c tiw for the iolk'*in8 rcavr (scc 70jl 5
<br />au\i',.{\ r t Psrtc\\ion CnL)r A.y Crly .r G{nly whkh rcquitc\ . pcmir ro condEc!, !hcr, inprorc. dcmli\h or ftlui m,
<br />srrucruc. pritrto irs isuan.c. ahorcqrirs rhc npplicanr ,irr \uchrcntrir b filca \i8n.d narcnDtu ihar hcorshc n li.TnscJ lufttrlnr
<br />h rh. phvi\n s ofrhc Conrn(ktr r Licctrscd L.w (Chr,,tc.9. Comn*nci'r3 wirh S..rn 7 x)of Divisoo ] oirh. Ausim$ rnd
<br />E oltssidrs Codc) or r hrr hcorshc n.xchpr ihcrcfnnod rhu h$n nrihc allcBcd.xcnutun /\., viohrio.otSccrbnT0ll5 hyr.y
<br />rpplicnnlbrrrlnnir \uhjc.r\rh. rppli.nnr t,,.ivil r.nxlry.rn.r nrrc rhnn livc hunned dolh^ (S5m)
<br />_ -l. rs o\n.. ol rh. J,oJrny. {nn,) lmpk)rccs Nirh srlcr r\ r[.n (nc co rI!- Nrin. \illdo rhc so* trl rhc {nftrr \ dor
<br />11[ I'r,rny $lrhuild\ori'npror.\rhrRnrndtrhod,$such$o'lhi'n\clf.rhch.llorrhnulhhi.orhoro{ncmpk,!(s,
<br />L os owncr orrhc prcpcdy. amcxcrusivclyconl cl ins vilh liensed conlmcto^ ro.onsruc h pojccl lS(. 7044. Bu\iBs
<br />aid llloEsion Codc: 'rhc Conlreror's l-iccn.. hw do.s nor ipply ro m owm. of prorcny *to blildi or improe. rh..con,
<br />! who onln.ls for sst pojcrs wirh , Contrdcro(s) lkcned poalallr ro rhe C. d.'ols Licns tjw).
<br />l,'ncrcnrr undc! Sccrion .B &PC fttrlhi!r.on
<br />Owncrl
<br />IYAXf,Ef,IIjAMIIiNSJIIION
<br />!ECI,A8A:I]QN
<br />I lE.cby amrm undcr Fnrhy of Frjury om ol rhc folldwin8 d(lurhnr:
<br />I hrvc .nd will minroi. a CcnifEal. of Con*nt ro Sclflr$rc for hrkB onl|Ensarioo. as povidcd aor hy S6lbn 1700 of lh.
<br />Libor Codc lor rlf pdf(rue of ltc work for wnich rh. psrril is issud.
<br />_l hrlc und will nli.tain ao cn .omFnsilio. insuramc, !s rcquitd by S6li,n 1700 of rh. t bot Cod.. for lfic Fafomtut o(
<br />.l .^,
<br />G issEd. My worl6 omp.nelion ireurare cmi6 ard Flicy oumbff m:
<br />ol ,.t6l
<br />r.l.ln-
<br />-l
<br />enifyrh in rhc !.rfortumc or rhc *ork f6, shbh rhn Fron is iisucd. I shlll nol cm0loy uny 0.Mn in any nenrcr
<br />s a. io tdoE rubjccl to th. wo*6' ory.nslior laws of Califohh. .nd ,S@ ihal ir I 3tbuld b..om $bjml lo lh.
<br />mds o,rp..slion pmvisioosofSelion l?0O of thc Llbor Codc.l shlll. f.nhwirhsnply wnh tho$ pDvnions..
<br />WARNING: lnihrc ro $c!rc qorkcrs conrF.iarion drveEse is unhwfxl. md shlll subFl an cmplorr lo dinioalFMhax and
<br />cilil 6.cs uF to onc hu rcd rholsnd dollds ($l0o-000). in addni.o io rh. c.{ oa.onwnsalion. da'E8cs as provid.d ror rhe
<br />Scdrion :10?6ol rhc lrtxtr iDrrrcn rnd rrhmy \ ltc\
<br />I ( trNsIiD ( t()NTRr\CT()R
<br />D}:CL$TIION
<br />Conlslor Y4q,
<br />CONIIAUqIIONIIM}ING.dIiErcI
<br />I hcrcty aIfi,m lndcr pcnalry of r.rury rhal rhcrc n a mnsh.tnn hdin8 .scnc, aor lhc F*fomht ol rh. w.k for qhtt this IEmil i!
<br />isslcd (Scc.l(})?. Civ. C.).
<br />AIILICANI.I'ESAAA.IION
<br />I hor6y dtinD und$ lcnilty olFrjury onc oI'hc followins d6larari.ns:
<br />D.mlirion Pcnnirs Astrslos Notiticlrinn FcdcruIRcsultrtio.s(lirlc.10. PEn6)
<br />-Rc{uircd
<br />t tlcrof Norificlri,n
<br />_l ccniDrha' rhc tcdcrnlrcgrldion{e8rd1n! \h.{osr.nFv rrc mrnpDlicabl. h lhi\ pnr.cr.
<br />2llrn,[ rhr I hr\r r.r,lrh* rnnlkrtnn iln lJrcrhJr rhcaho\c i.r'omuriotr hcodc.r lrgrNb.onDlrwir[allCilyondCouor!
<br />;rJ 'rirc\ rtrrl \rJr. titr\ELrtrt !, huildirE!nn{rudtr,i. uxlhurcbyourlx k r.lY.\.nrnrn cs of rht cil y ind Counry u cnls uF)n rhc
<br />nhovc nrirnni.d pn,t dt rd '.stsrnn'rtrlnss
<br />Applldnl o. Ag.nl SlgElurel f n I
<br />P"mile dm (r.lrl), _Pr4
<br />UNDEB GBOUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipino
<br />Roof Drain
<br />Rouoh 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 />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing c 'qir9 A,t 1/i4
<br />Final Gas Test
<br />Meter Release
<br />FINAL 1Da6
<br />Notes, Remarks, Etc
<br />ol rhr Burnrssiid Pnn.$irurC.de. {lnry li.cr\c \ n ltrllliBrndcllrcr
<br />l9oet l?2',
<br />t trd.is Addrc$
<br />-
<br />Area/Storm Drain
<br />Tub/Shower Test
<br />71'24/,.1
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