|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILI'ER DIiLCARATION
<br />I hcrcby rfilnn uidcr pcmlry of prrjury rhnr I ur crcrDr li(,r rhc C.'ntr.krs t-iccn$ tiu fitr thc rolbwinS rca$n (Scc ?0ll 5
<br />llu\ir.ss {nd ProLssio. Cdc): An, Cily or Counly whrh rL!trtrc( n Frnir to ..nslrud. llrcr inrnvc. d.nrlth or rcp3n my
<br />ntucrurc. pio! t, il\ isulncc. lko rcquires rhc lPlli.rnr t.rsuch E-nnir ro lilcr \i!trcd nrkmdr rhni htor sh. h li.cnscd pusuMr
<br />k' lhc r)vtnnN oi rl[ (i)nnrcktr s Li.cn*d Lr* (chiflcr L com.rncinB silh Scclion 70ix) oa Divisn'n .] ol rlt Bu{n8\ lnd
<br />I'r.f.$i,nNCodc)orrh,rhcorshciscxcmnrrhcrclioflotrdrheblNisl(,rrhulliqcdcxcm|)ln'n.Any!iobrn,n.fsc.rir?0.rl5hyrny
<br />rpnlicanrt)r!pcrnril\ubjLcr!rh.arrlicaiihacivill)cnllyofnorBrcihrtrfivrhu rcddolla^(S500)
<br />-1.
<br />a owrcr of llE pmFny. or my.nglo)trs with w.A6 s rn t sh onpensrlion. wiu .lo dr wort snd ft strEr@ i! ml
<br />inrsdcn or or.r.d for nk (s6.7044. ausiBs drn PEf.sioN codc: Th. CDnlrr.'ld s Litn* Liw dors mr auty ro s oM6 of
<br />lhc l,bp.ny wtb tuil& or irp,or! tl@,! &i sho dc uh r&tt hin*lf or lE.*lf o, lheugh hi3 or hs ow. eoploycca.
<br />pheidcd lhal such impmwnfils E ml inr.'xlcd d otrerEn fo. slc. lr. IFEE lll hoildinS q ilp.awcnt i! sld wittin om ,@of.or{'lclhr th. Owrcr Auikr wil lIw tlE hidcn ofrmving $d rE or dE dil mr hoild or iqmrc rh. Fbpdy lor dE lu4re or
<br />_1. &r owr ot rhe DoIcny. an e r.tusivcly conrering Mrh liccnd conrreror ro coNmtl rh prcic.t (Se. I)44. SEim$
<br />srxl Rol*\hn Cod.: Thc Co.rBdofr Liccn.. Law d@s nor ap0lyro {. oercr olp.oFny who builds or improv.s lhcrcon.
<br />dd vho @ntrocrs for s&h pmjEk qiri ! Conr,zcto(s) lic.n$d puisuanr ro rlE C4nrrcroas Liu* L3*).
<br />-l
<br />adcxcmpr !trds Sccrion- B. & P C. tulhn rcN,n,
<br />D.l€: O*Der:
<br />EOATEILCOMIENIAII!}!
<br />PECIIIXAIQN
<br />t hcEby .flirm und.r D.nalry ofpc.jury orc ol tnc r.losirs dcclrnionsi
<br />_l hrvc rnl * ill roirrun, r CcniliurcoIC.n\ctrr r. Scltlr\uru li,r workcre coilxnlxrioi, r rtuvid.d tar by Sdltun ]7m ol thc
<br />I rtrn Onlc. lor rttr lErr'ornBncc o f th! ror t ntr which lhc plnnir is ^!al.
<br />_l harc inrl pill @i.l!a. wo*.6 c6mp.ns.rion inru.orce. &\ rcqlircd by Sdion 37mof rh. khor Cod..lor rhc rcrfoMc of
<br />rh. wort fr which lhi! pcmal i! hsEd. My sortfa .on{aBdi.n iNu.uc caEilr .id polty numh.r e:
<br />Bexchnra-t"t-c€7-q bo cl <Zt)
<br />-l
<br />ccniay lhd in rhc Frforrorc of lh. wor* for whi.h fiis Frrn is isscd, I shall ml cm?loy a.y pcrsi in aiy Mno
<br />s N ro h.sm slbrcrr ro rh. woltn onpcnsrion has of Calitoniu, lnd a8M rhll il I shou! b6oB subj..t lo lh.
<br />m,lcrc' onp.nsalion povirions 6f S.diotr l70O ot rh. LrlFr C.dc. I slEU, tonhwith omply eth rlhr I,bvirions..
<br />WARNINC: ,joilurc lo surc qorkcs comFnsrrion .rvcEBc is md sh6ll slbjel an cmlLyer ro dmi.al Fnrlras and
<br />civil fincs n! lo orc nundrcd rnouen nollar (Sl(D.qnr. i[rhc .osr df conpcns.ri6r, di@ges as providcd for thc
<br />Sc.rnnr 1076 ofrhc uktr inrcrcn,nd .rdr'\ fL{!
<br />Ihcrcbyllifinnu.rn.trllyolI'crju,th3tIaDliccna_d!trd.rprovGionotClut'lcr9l.ommncnrs*ilhSc.'ioi7uD)olDivisn,rl
<br />ol rhc B!\inc$ J PnntsionsCodc. d'd orliccnsc t in,nll n,N tnrl cfr..r
<br />?oz7
<br />glutrB.uc[0t{rElDMc-alilN.cr.
<br />I hcrcby rfllinuidrr ncndryorlrriury rh rhcrc isrd,riru.ridn hMnE,Ecnc) lor rh. I'.yfoirD'ncc ollhc $ort li, *hich rhn rcin ir
<br />iisk.i (Scc lO97- Ci! C.)
<br />AITLICANLDESITSAIIAN
<br />I r.nby rtr6n !.df pcnihy.rpcijnryonc olrhc r.llowinS delahri.ns:
<br />l).rdirion Pcrmih AstEsros Norincarion Rd.ral R.!ukionr(Tirlc 40. Pd6)
<br />-R.quncd
<br />lltrcr ol Noriardlion
<br />I.cnilrrhxrrhc fiJcr lrguLinJn\ rgudir!,rh.iot r.ix,rnlrrc tr.rlmlieblc ro rhis prcjccr
<br />l.sria!rhsrIhilcrcrdrhhrrtli.rrion.Jrls,rcrhdrturh)v.inlanDri, is.orrc.t.lrsrcclocomt'1,tilh!llCirydnitC.ury
<br />.i(lintrkorand srlc tiws (hrin8 k,buildinS bo. &d hcrcby dudori& rcpr.snrllilcs of rhis Cny uld Coonr, ro .nr6 q$n $c
<br />ilve mnrioncd proFny for ifl\t .adn
<br />Aprlicsnl ,r Aa€nl SlaElum:
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<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 Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device A
<br />Rough Plumbing Tn4i x,v/.10
<br />Final Gas Test
<br />Meter Release .71-t{ltf tYzt)
<br />Notes, Remarks, Etc.
<br />-,
<br />Water Service
<br />FINAL
<br />_,",,s1y4
|