|
APPROVALS DATE ID/SIG.COMMENTS OMd-Build.r D!.l.,iri@
<br />I h6.by anim udd F.lty or lajury $c I d cxdB f6m U. Coitr!.td!, Li@s tle lor ttc rotlowin8 @6 Ge ?o3l . j Burinlls
<br />ed Pmadi.i Codc): A.y Ciry d CMV *hich EquiB . panit 10 dsElct olld, ihFovq ddotish or rcp.n by .Eucrurq pno ro iE
<br />i$ud@, also rcqui@ rhc .pplicul fq &ch PGmn to fib . !i,r.d srltmot dEr h? or rhc ir li@rcd puEu r to $c proviri@s of$.
<br />coitndqt Li@rd Lrw (Chrpl6 9, C.fficiis wiln S6tio ?000 of Divhid 3 of lh. Buind sd PrcfdiN c.d.) d rh.r h. q
<br />th. tu q@F $dctom ed th. bai! fd $. dlcscd qdprio Ai, viohdd ofs.dion 70ll J !y -, rpplimr fd. pdnit subj.dr $.
<br />rpplimr io . civil Frlty of no( mN $o fivc hudtd doltd (1500)
<br />_1, s owra of d. lroFny, d my dployE witt wla6 s lh.ir solc @hp.nsdim, sill do lhc *o{ dd rh. srucrw ir nor i .^d.d
<br />o otfscd fq ..1. ( Sa.7o4, BBin6r &d Prcfdi@ Co<b: Th. C6E&rd,r Uc@ taw do6 .or apply lo ar oMd of th. p.op.ny
<br />who build. d inFov6 0!og, Md *ho dE rucll *dt hirelf or h*lf d rhmsn hi5 d ha osn mployG, Fovid.d rh.l such
<br />imprcvcm6r.r! tur inrad.d d o,Icrd fdid.. Il h d6. rh. blildi.A nhrprovmdrii soldwithin o.cyd of@6pl.rion, rh?
<br />Oud'Builda {ill nD! thc burda of proviit rllll h. or .hc nor build u imFov. fd rhc purp6! of s.t.)
<br />_1, a omo of O. prcpdty, h .xclcivcly @nrerini wirh lienr.rl @Etro6 to o!ri,.r dr poj*r ( Scc ?ori. Bsin65 sndProf6io Codq Th. Cdt ldor't Li@r. l:* d.6 not +ply to o owDa ofFoFry eho buitb d ioprovd lllc!@ . dd eho
<br />@lr&E fd .wh prcjeu wid . conE&lo(.) li.@.d pt,,!er ro rh. Coffitadl Li@rc t-!w.)
<br />_l M cx@r{ q&r Scri6
<br />-8,
<br />& P C. fd rhi. llei
<br />WOf, KERS COMPENSATION I'f, CLARATION
<br />I hqcby !flim undd p.n.lty of pqjury on. of fi. follwif,s d..l@dons:
<br />_l haw &d will naiir.i. s Ccfli6.r. of C..!or ro SclfJ$ur fd wdt E' cmp.nrdi.n, s providcd td by S@rion JToO of lh.
<br />Lalor Cod., ld 0!. p.rfm@ of 0!. wdt fd whid tn. Fhir ir iB.d.
<br />_l h.vc dd will einuin *dt6i @hFs.lid insNdc.. d ..quiBd by S.clion r?ooof$c Labo Cod., fo.lhc p.rfollM@ otrh.
<br />worl for which lni5 pmit is iilucd My wort6 cmpcN.tid insude Eia $d polacy .mbo d.
<br />Poricy Nwta ErpiG,Y-:,:::b.€mpl.lcdilthcptmnrforOn.hundr.ddoll6 l5l00l d
<br />Ffhse of i:. wd* ad *hich oris p.mn is isu.4 Iwat6 ' .dnpa*&io lsr of C.lif6ir, 6d ssrd
<br />cdFsdion Fovisid of S@d6 3700 of 0E L.ba C.d.. I rhJl.
<br />wARlmtG: Frilurc to .dc *dr6' co,rpc..alion @v.ag.e.hploy.r t6 qimin.l p.nrlti6 md cieilfin6 up !o @. hr6<hd tql,&d ddla (ll00,000).ii .dait@ ro dt c6 of ffipalajo, drn ao E provldld fc. $. S@dd 3076 of
<br />ih. I-3bo cod., inr@r &d .Irm.r! fe6.
<br />@&r p.idry ofpajry dar I m ltncd sdt
<br />d. Buin* ud PrcfBiN Cod., sd oy lic4c is in tull f*E ed .flEr
<br />amn udo p.ndty of Fjlry $r,r rh@ is a contEu.rion ldding rgacy for thc of thc wd* lq wtich lhi! pcnit i5
<br />i$u.d (Sa. 1097, Civ C)
<br />APPLJCA.IIT'S Df, CL"I&{TION
<br />D.molirior ?miE-]\!b.sb! Noili.did F.d.d R.Sulltim (T c .0. lrfl 6)
<br />_ R.qlircd t4tta of Norificrdo
<br />10 @pl, Pirh rll Ciry ad Counly
<br />abow m@rj@.d prcp.riy fd antr,elio D!tDo!6
<br />c
<br />Waste & Vent
<br />Water-Underfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Misc
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Ca
<br />Back Flow Device
<br />Rough Pl umbing EXPI RED
<br />Final Gas Test
<br />Meter Release FEU -I IUIS
<br />SAMC 8-43 'FINAL
<br />Notes, Remarks, Etc.
<br />PLUMBING.INSPECTOR RECORD
<br />UNDER GROUND
<br />Area/Storm Drain
<br />I Gas Pipeing
<br />Tub/Shower Test
<br />I ,tc f.ddrl r.SulBdos r$rdiry sbdrs Moval
<br />ccniry rh.l I h.w Hd $b lrpti.3li@ 6d il,r. rh.t rh.
|