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PLUMBING.INSPECTOR RECORD
<br />O9d,Buikl6 DcLflion
<br />Ih6.byrf"6und.rp.ultyofpsjuryfi.rIha(.mptfomrtcConu.c.o'Li@cLrwforrh.followiDgraoD(gx703I5luiG3
<br />iid &ofaion Cod.) ny City or Counry stlich rcqliG . phn to @dhd, 1h{, inprovq d@oli5h or r.p.n liy 3rtu.tG., prior 10 il!
<br />i$un@,.bo r.qun6 rh. rppliq for ru.n pmt to fil..3igr.d.nr@r rhI b. or !!. is li@!$d pwet ro d!. pbvi.ios of $.
<br />Co.E Glol! Li@Bod Lt* (Ch!pr.r 9, conn rcins wi$ S*rbn 7000 of Divilion I ofrh. Bub.6. &d Pdfc.rioB Cod.) o,rh hcor
<br />sh. n crmPt rh&.totu.'d rh. hlis for rh.rtl.g.d adPlion
<br />^ry
<br />viot bn ofs.aion 7o]l.r b, &y.pplidir fo, r pcrnn rubj.cl5 rlE
<br />rppliom to . civil p.mty of nor horc du fiv. huldrcd doll.c ($t00)
<br />I, a ow. of tn. trcpsty, or Ey .mploy6 witfi qg6 $ t!.n 5ob @nD.n rioq will do rn qort .nd rlE (tudurc i. nol i.rend.d
<br />o, ofiald lor $L ( S.c ?0r4, Buindr sd Profca3iom Cod.r Th. Conticror'r Liee llw do6 not lpply b s o*M olrhc p@psty
<br />who boildi or inProq rhcr6'! .rd wno do6 rrch eort hi@lf or ha.lf or rhrou8ll his or hd om mployd. ,rovid.d rhl ructi
<br />inprorocn! 16 nor i cnd.d or ofi.r.d for sla Il hoevd, dtc buildi!8 or inpmEftc n sE pithin otu y@ orcomplcri.4 ln.
<br />OMs-Brildd willhE dE burid ofprorng rlltr hc or !t mt h{ild or inproE for $. purDoe ofslc)
<br />I, ! oMo ofrh. propsrr. .n dcluiv.ly @trlncirA eth li@B.d 6nd!.ro6 lo @alrud $. For.<r ( Se ?044. BGin6t sd
<br />Poesio, Codq Th. Conl @li Liru. L.w do6 @r .pply ro !n owr of propgry *ho buildr or inproB rn r6n , lnd who
<br />drEiclr for lEh poj6t! win . coit6.ro(, licm.d puBunr ro
<br />'h.
<br />conurd.' ! Licnt. uw.)
<br />_t 6cr6 und6 Sd1i6D-B &PC for $ii r6on
<br />WOTI(ERS COMPENSATTON Df, CLARAT!ON
<br />I hd.by rdi.6 u.dd p@hy olDErjury on! ofrh. followin8 ddbErbo
<br />I h!v. ed *ill nrirt in I C.rdftqr. of CoNci[ to Sclf"IrolE for workat @mp.Mrior\ { provid.d for b, S6lion 3 700 of rh.
<br />bbor Cod., fo. d! D.rfomne of th. mrt for which dE ,.mh t ilrued
<br />_I h.v. .n l will tui ri! m*@' @DpaBrios iroult@, &
<br />mrL lor wiEh lhir D@ u uuc.l Mv mrld' @Il!.M!.nce' 0g/z R*
<br />r.qun d by Sdion 3700 ofrlE t b.r Codq lor th. pefo@.* ofd.
<br />iEuBnc. aEi,. l poli.r,umbd .r.r
<br />Lvaoa 6zo tQ /L l t)
<br />(Thisratio. n..d nor b€ 6mplct.d ifth. psnn t for On. hundEd doll!6 {$l00lor16,
<br />_r 6tify rh.t ir th. psfoldE ot rE wt for which ln,s pcmn i! iou.n, I !h.ll er 6plo, .ny p. on i..!y roms io u b
<br />h.c.nc subjd !o dc mrrss ' omp.nslioa LE ofc.lfomn, rtrd rBi* thll 'fl sholld
<br />of Sdior 3700officbborC
<br />"""o1- 27 -/7
<br />WA&\llNG: f.ilu. b !6@ wortai onFMrion @E S. it uhr{ll, rnd llnU subjd .n mploys b Eihidl p.Elti.. .rt civil
<br />fD6 up io on. hundr.d lhourd dolhr (l I 00,000),i. .ddhior lo rhc @n of@6p.Mtio4 .Ldgs & provi,.d lor 6€ Sedion 30'16 of
<br />rh. L$o. Cod., i @t ed &iomcr'r f6
<br />I,ICENSFD CONTRACTONS DECL{N TION
<br />I hqcby trlh unds p. lry ofp.rju,, th.l I m liei!.d undd povtior ofchrFd9 (6mm.,.ing wnh Sadon Tooo) ofDivBon, of
<br />$. Buiia r.d ProGrriou Co&, .rd 6y lic.@ ir i! tull foroc .dl cE!.r.
<br />Li@c,..: C'70 L"* Nub.r tlL tqLii=o CC
<br />CONSTNUCTION LENDING ACENCY
<br />I h&!by dirn unds p.Elly ol pdju.y th.l th.E i! i @BElclion l..din8 ls.ncy for rh. pafotmna of rh. wo.r fo. which $i! pshn ir
<br />iE !.d (Sc :t097, Civ C )
<br />APPLICANT'S DECI,AR TION
<br />D.nohion P.rmi|3-Arbdro! Noliliorion Fcd6l R.8uLtioni (Tnb 40, Psn 6)
<br />_ R.4un d Ldcr of Norifidnon
<br />_l eniry thrr th! f.dalquLrions rcg.r.lirS lb6toi r@06l.r. mr lppli.rbl. b rhn plojar
<br />_ I .sdry rh.l I hav.,od dtir lppli@r thc lbovc iiformlion B cor.d I .8rE ro @nply wirh .ll Ciy and county
<br />o.dmn6 rnd SUGrtE
<br />.bov. n.ntion.d prop.q fot
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Underfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipeing
<br />Roof Drain
<br />Tub/Shower Test
<br />POOUSPA
<br />PtrapiDrain Line
<br />I\ilain Drain/Pool Piping
<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 FIow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL
<br />NDles, Remarks, Etc.ft'//k?rP-
<br />o.ms\Plumbinglnspeclo.
<br />a/-g-B
<br />Rough Water Heater
<br />Misc
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