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APPROVALS DATE tD/stG.COMMENTS
<br />UNDER GHOUND I I
<br />Waste & Vent V,l+slLl (8 WNI uho":I" Fl.'{'-.
<br />Water-Under f loor I Ue lbo ot unhln,ldt
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent /"
<br />Iei
<br />Water Pipinq
<br />1-21'td -I
<br />Gas Pipinq lo -L'tE A 6$ \-E&-Z/-?J-lq lfi
<br />Roof Drain 4c-a-:)
<br />TubiShower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain Drain/Pool Pipinq
<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 /o {l-,(3 n
<br />Final Gas Test
<br />Meter Release /z-/-/g
<br />FINAL /23-/e 4€ 2?*.-.-{
<br />Notes Remarks, Etc.or>r. a^z-/2.-6 -/ I
<br />:Ld.s ztRr n4ll8 -s &Q'a -" _)-lA; A t@t**-*
<br />o fi zraZ
<br />l/o/ I
<br />7€rlC,?5
<br />OWNI]R BTIILDI'R DI'LCARATION
<br />I hcr.hy rlfirnr !nd$ F-.ahy ol lcrjurl rhrr I !u cxcnrl tionr rhc Conrr.n,N Li.rn\. hr fn rhc n,ll()winB rcivr ($c 7o1l5
<br />Ru\inc\\ lnd ttoicsrn'n Codc) Atry C y or Cotrnry *hich r.quirc\ r lrrnii k, .on\ifl.i. allcr, nnrrovc. dcmlish or ruFi my
<br />nfucrrr. p'ntrb ir! i\\urn .. d$ r.qrnc\ rhcapplicrN n)r ruchFnnir ro rllc r \ig,rd \r$r.rrfl rlrrhcor \l[ i\ licci\.d ltrr\tr r
<br />rii rhc proviliuN olrtr Conrrr.nn r l-iccn\.d trtr (( h3pr.r 9. Co nnci.inC {irh Sc.rion 7m0 .f Divist'. ll oi lhc ,tusitrcs n d
<br />nffli.,rl l r trciini subjNr rhc rpplic{trrro.civilpcnilly.l mr nFrclhu livc hundr.d d.llrs ($500)
<br />l.r\o\mrofrhcpn'Fny,orut.'npk]rrc\wirhsrlcsrsrhcir$lr$.r|lcr\[i(r].srlldorhctrorkonrhc\|ruItr(snor
<br />rh.J[,|tnr- sh. lnril(hor n,rr\G rh.ftir. rnl $,r, d,f,\ {'.h trorl hltrr.llor fu^.lt.r rhr)ugh hF or hcr otrn cnrploy$!-
<br />ol cotrUilcrior- thr OwDrr lluild.r lvillhrrc rho l{rdctr ofpmving rh[ t.r shc did ior huild or i'nnn,vc rlr fmtMy lhr l,t jrrt.scor
<br />(.*.*"q"rrhcr-r-ry,,n.r.lrirclycotua.riissirhlicriscd.otrtdtitrsri.oniru.llh:u,'r..r(sc.7(H4.lru\iic\
<br />drl hnllr\irC'{lc lh. Conrdoi\ l.i..n\c l,Js,l,)c\ norrDnlJ-ri x osNr.l[oNnyvh. huilthor nnp(rc\thcrc.n.
<br />3d sho rodrd\ tur su.hltrr'f.rr trirhn codn'.kln\r lrcn'cd !trrsrN n)rhc Gnrr'rcntr \ l-i..!\c trs)
<br />I amryuudssdror B. & PC. forrhisrq$n.
<br />!!QA$il!s:!ou!!tt]IQI. DECLAAAIIA!t I h.Eby arrnundcr Fnnlly ot rcrjury orc of lhc rolh*n8 &rl!!lions:
<br />-l
<br />hrw rrdsill mirr,in a Cenif{{.of CoMil to ScrlnsuE lor wo 6 strWnsriol! a Flvidcd for by Serior 3?00 oftlE
<br />t bor Gx!., fo lh€ tErf()tlrec of lne eo* t6, which tlr p.mi h hsu.d.
<br />I hNc and will @inlrin wortcB c.mpcnsation inslr.rcc. !s rcquied by Sdion 3700 of rlE tlbo, Codc. ,or rh. p.rfoMc of
<br />rh. wotk for which ihis pemil is is$€d- My Bortss conpcflslion insllee ceid .!d Flty nurhq mi
<br />-l
<br />crlify rhul in rh. Ilrformm. of lhc wort for whth lhis permh is h$€n. I slall not cnploy an, FBoo i. a.y monmr
<br />w N ro t coe sbid ro tlt s*6' mnpcnuion l,s. otcrlirdmia. a.d a8rc lh.l ir I sbuld t*.otr sutj&l l. de
<br />trrL.s smlcnsarion frotilions ol Scclio. lT0o ol rh. Lit{r Codc l slEll. fonhwith.omply wirn rhos lmvishtri..
<br />WAf,NItC: Failur. ro suc *..kcrs co'ry.nsrion 6wnEc
<br />cilil fiocs up ro otu hundr.d rhousrtrd doll r ($1(x).(xx)). h rddir
<br />Sd ion 1076 of $c lrh)r C.dc. inrdcar dld ,nomy\ lds.
<br />o,*, S'9'c9
<br />-
<br />appr@i:-
<br />UCENSEILIONIAACIAf,
<br />IECLAII.IIAN
<br />I hceby,fu,D ufld.r p.ullyofp.rjurylhar I rfl lien{t undcr Forisn'n ofChr/$ 9 (.omftncin! wnh sNri}n 7$0} ofDivision 3
<br />of thc Busincrs tun Ptufcsli.nr C.d., 0nd m, lic.nsc i in iull fire md ct(l
<br />(:(tNSTITI](ITI()N LFNDIN(: A(;DNCY
<br />I h.rcb!,nirnuMcr |Euhyoitxrjury llur thcrc n r contru.rirtr tndin8 rs.i., rrn rhc Frrorfr,n.c.lrhc wo.k for *hi.h lhh lErnn is
<br />i$ucdlScc..l097.Civ. C.).
<br />AfzuCIINfDECI.i IBAIION
<br />I lmbyaltir undcr pcnnlly otplrjuryonc otthc lollowins dcclarolions:
<br />Dcm,lirion Pcrn rg-Ash.sos Nori,ication ltdcral Rcsularions (Til[ ]O. Pan6J
<br />Rcquncd krl.r DlNolifstion
<br />I I c. f, lnar 6. fcnml rcBulolions EgadinS oslEslos rcmlal src aor lptlicBbb lo lhl\ trcirr
<br />-l
<br />ccrlify rhar I have rcod this applicdioo ltd sratc thd tnc alFr infomElion iscoimr.l aSrc ro c.mplywilh.ll Cilyand Cohl,
<br />odiMmcs lnd SI.l. Lrws rclari4 ro buildi )n. a.d lErcby aurhorec rcFu*.raliKs oa rhis Ciry and Counl, nr cnrs lrDn rnc
<br />ablc nrmioncd pmp.ny nr ins,,.cl
<br />^,,, <-81g.\!plirnnl o.,\[rnl Sisnnlurr:
<br />PLUMBING.INSPECTOR RECORD
<br />/2
<br />Fill Line/Back Flow
<br />a( la
<br />7zn
<br />/-n ,l ln .-rr. tt+i.srZ 4
<br />/arz htrL /L/)-..e- t
<br />l1nn.\
<br />,.," .(- g-,$
<br />L,,,tr,'\ ,t,ln..
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