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PLUMBING-INSPECTOR HECORD
<br />APPROVALS DATE COMMENTS OWNER NUII,DER DFJI,CARATION
<br />I htrch, rlilnn und.r pcnalry i)f pcUury rhnr t m.rc'npr fmnr rh. (t trdo^' l-iccnsc U* for lhc ldllo*ing rcatun (Sc!r7o.ll 5
<br />Busir$\ xt Pn,rccst,r Codc): A , Ciry or Cou y ahich rL\xncs n !.nnil ro con(tucr- !116, inpfur., d.nn,lirh or rct'rn ltry
<br />{rucrurc, rrh, !o il( hsuaoce. rho rcautcs rhc aprlicu.r lorsuch p.rmi' b fiLn \ittr.d sarcmnt rhd h.or shc is litc{td Puisurn!
<br />b (lt F,vhtun( of dr CodBcrols l-iccnrd bw (Chnflcr 9. Conmrn.ing silh Sccrhn ?(XD or Dirhion :l ofrhc Au\i.csr ond
<br />Pnrfcsidrs Codc ) or rhrt lrorshc hcxcmnl lhcrcnonund lhcbosis i lfulllcscdcxonfln Atryvn'htionofs.clion?0.115brrny
<br />ltpliuoll'orarcrnrilsubjc.lsthcInrrlicanrn'rciviltc.rlryolnolnnc'hrnfivchundrcddoll rlS500)
<br />-1.
<br />&\ owrcr of rhc pDFny. or ny GmploFcs wilh ws86 .r rn.n $t oqEn$lion. will do lhc w6lt od ttE srial@ t ml
<br />inrcndcd or o,lcrcd for $L (Se.7044. Busituss dd Pn,f.isions Code Thc Conraclo r Lictrs trw do.s nol srply to an owrcr of
<br />rhc rotEny eho loildr or irqfrB rrrmtr old slb dB swh eDrt hins.lf or hcelror $Eorh hii d t t ow..mrloyes.
<br />prcvid.d lhlr su.h impmtlmnls e ml i'r.rdcd oro,M for s].. U. ho*tr. rE boildi,8 or ii{mwtml h sld *Ihin m. t*
<br />ofcomplcliotr lnc O*M Buiue *ill hle $. blrdcn of pmvinS lhd tE or shc dil m hiU or it$rcw 6c pDFty aor tlE pu4D* of
<br />-1.
<br />$ owmr ofihc ptrpcny. rm crcl$ilcly contr.cr inB sith lien$d conhlc1o6ro o.slrlcr rlr pbid (Se.1X4, Busirrsr
<br />Md P,nf6sion Codc: Thc ConreroCa Li.cnsc h* d@3 nol npply ro m owM ofproFnywho builds or idtmlcs rhcrcon.
<br />.nd who €nrds aor such p,ljds wirh ! Conrmrr,(s) lien*d prBu td rhc Comr.ciitrk Lkcns tlw).
<br />-luncxcnpl
<br />undcr S(l ll & f( li)rr[n rt.]nnr
<br />TAEf,EEfl.COMPJNIAIION
<br />PECI4SAIXTN
<br />I h.tby olfirm urdd Fnlllyoflsjur,om of E followins dftbrErioB:
<br />-l
<br />hrv. {d will@irrain !C.rrifrrrcof CorFn! to ScI NW for mrle6 co*D.n.{io., a previdcn for by Sdlioo l?m of 0t
<br />Lrbor Codc. for rhc F.fotll9N of llE mrt fo. s'nth 0'c p.mi n irsud.
<br />I hrvc dd will minhin workcrl co.Densll ion insur0mc. 0r rcquircd by Sc.l ion :l7m or rhc tjh.r Codc. for lhc lqlormncc o,
<br />is is$.n. My wortqs omtcnslion insurlncc cnic. aJ'd pli.y .umhn m:
<br />ct,h
<br />-l
<br />ccnify lnar in thc pcrfolmme olrhc work lor {ti.h rhir Frn h i\Ncd.l shall rcr cmployany I'cMtr in lny @e.
<br />s as ro tFm subirt k, rtE sork6 mn{Ensalio. laes of Calilorni.. .nd .8rc lhar if I shooB !.coe {bjccr ro llE
<br />*o cF.onpcnqtiontevhiongofselion3T00ofthctjborCodc.ls\sll,aonh*nh@ntlr*Inrhoctovkiom..
<br />WAnNNC: Fuilurc ro suE wrkcB ompcnslltun covcra8c t unlu*fu. md shdl suhjtt' 0n employct lo sininrl IrB[i.\ and
<br />x,.nc hundEd rhousond dolles (S100.000), in xdd ion ro rhi.o of.onqFnsdion. dlmBcx us providcd lor rhc
<br />:":riiii
<br />*ff*?tto1
<br />DECI.dNAIIAN
<br />Ihcrcbyoffiflnundc!!c.!lr,oir(rjurylh lJm licn$n und.. pn,rtio..tchit'rcr e(.omrmnci.8 \'irh Sccri,n 700) ofDivision l
<br />or rhd Bu\i'rcislnd PtufcssionsCodc. nnd $yliccns i\ ir iull nrcc !dc,tc.r
<br />H<o \teO 4c.r
<br />HAfffzuru
<br />CONSIf,IISIIANIENDNC.AG.ENCI
<br />I turcby rmrn undcr pcnally of rc.jury lhd lI@ is . onnrucl ion bndine ae.ncy for rnc lcrfomsmc of lhc so* ,ot whth rhis Frnit is
<br />assucd ts*, 1097, civ. c.)
<br />APPI ICANT DFCLA({'IION
<br />lllrthy rninn unddr pctrslryrrp.qury orc o! rhc lollo*ir8 dccl0rurinrs:
<br />Dcmniln,n Pcmirs A\lE\lo\ Norificlrion tudorl R.!xl ionr(Tirl.,(). Pn 6)
<br />-Rcquncd
<br />l,c(.r oi Noriftnrbn
<br />I ccnify fid lbr fcdcml rcslhl ioas Esddtr8 asbcsro\ rcmval @ nor .p/itt lc h
<br />'ht
<br />pottr
<br />al ccflify rhsr I hlvc rcod rhis applhrrion {rl srdc rhd rhc ahov. irlorndbn is co,mr. I aE e lo@mdy*ilh 0U Citymd County
<br />ordinamcs and Shtc L{ws rbrine ro buildirg consrnkrion. 8d hftby sulhrn
<br />,tsvc nEnrioNd pmp.ny for insFrtion 7 2
<br />UNDER GROUND
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<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 />Rouqh Plumbing qL'.,/4 t'rs,rnar89
<br />Final Gas Test
<br />Meter Belease
<br />FINAL y/2.4X 5\ 6{
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Waste & Vent
<br />TOP OUT
<br />",","-,*. (i{\hKJCt. l?4c4,o-'-0,..,1.\.\q.
<br />c"*,"a." (aL<.<'w-
<br />L.rdea! A&tcs:
<br />-
<br />P.mile. Mm. (Drlno
<br />--
<br />6,
<br />tt
<br />I
<br />=
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