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APPROVALS ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Gas-Underfloor
<br />Building Sewer
<br />AreaiStorm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test s
<br />Rough Water Heater I
<br />\\it
<br />)h
<br />POOL/SPA t
<br />---
<br />.E
<br />P-trapi Drain Line :s.
<br />Main Drain/Pool Pipino 1,.)\ ll \
<br />Fill Line/Back Flow N \
<br />Pool Heater/Gas Line f,. I lN\-)\I \
<br />Miscellaneous oll )\
<br />...) ll
<br />Water Service I
<br />Lawn Sprinkler s\_..4'\
<br />Sanitary Sewer/Cap dttl19'u'T;"ror,ro^/ ?2ut
<br />\
<br />Rough Plumbinq \
<br />Final Gas Test N I
<br />(,\ki t-kLK-27q(\i)
<br />Notes, Remarks, Etc.\
<br />I
<br />\-
<br />lt \,A
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<br />O1INER BUILDER T'ELCARATI('N
<br />I hdcby rrrn under penalty of noj!ry rhlr I d cremfl tom rne Conlmcto6 LLtnE Lrw tor rhc tollosing @sn {Se.7011.5
<br />Buiin$s dd Pofc$io. Cod.): Any City or Co!.ly shkh nquiEi ! Fnnir ro @nnnrr. .no, inpmvc. d.mtsn or Epat 8ny
<br />slMnE, I,rior !o ils isrumc, ako rcquiEs l,r trppl&n for such pcmil ro fi!: a iigmd slatcm lnal hc or slrc is li..n*d !!Mhl
<br />to rhc poviiioos ol thc Contelor'! Licenscn Lrw (Chaprcr 9. Commn.ing wirh Sccrion 7000 of Divhior I olrhc Busitr*s un
<br />Pmfcssions Codc) or $rl l! r sne i c!.npl th€r.non md thc hdrii for tb. lcg.d.rcnprion. Anyviohlionofs..lionr03l.5by.n,
<br />lrpli.arl fo ! p.mil subicls tlrc appli.!flI lo ! civil Fully of nol mrc fir 6vc filndrcn dollds (S50O).
<br />-1.
<br />&i owns ot $c po|f,ny, 6 ny c,qrloFrs snh wagcs a rhcn sb compcnsdion, sUl {h ll! eok 8rd lhc atErm k ml
<br />inrodcd or otreEd for sL (SE-rOa4. Busims md Pmfc*skJm Crns IE Conrnctoas Li@ns Lrw do.s mr q,ply h e owNr of
<br />rhcpbFdy who toi!! o irp,lB dEetr drl wlb dc sh tu,t hin$tf or taelf or fieugh hir d hd o*n cnploFs.
<br />prcvidcd Ind sch inpowmnls N mt inlend.d or otr lEd for eL.lf. homwi tlE lnildin8 or itrprorcmnl ir $ld wnhin om Fs
<br />of.or{,lction, tc Own6 Build6 will hnE 0E hadcn olprcvirg tha he or Jr dil ml bild or ihprcrc tlE p'opoiy for iir lurpo* of
<br />_1. ,$ owm, 6f rhc r.rcny. {m ci.l$i!cl, conrracring wirh li.en*d .o'nrklo6 ro cu5lrucr rlE E ifl (sec. 7(x4, susim,s
<br />lnd Etrfc*sion Codc:'rhc Contractor's Liccn* Law d.cs lol.pply lo an owncr oftropcnyvho builds or imlJrovcs thcrcotr.
<br />ard who o Bcrs for slch lfrrc.ls wirh a ConrBcto(9 ltcnsn llnunl ro rh€ Conlraclor's Lkco* Li*).
<br />-l
<br />ancxcmfl lnd€rSftrion- B. &P.C. for rhis rcarn.
<br />D.t.: om.E
<br />!!Bf,E8ITI]!'!'EUSAIION
<br />IECI.AXAIION
<br />I hcrcby (fim u.dcr p.nulry ol rdjuiy on. of thc followins dsl&ationsr
<br />-l
<br />hlw !d will tuintdn . Ccnifrarc oac.Mnr ro Sclf-l Nurc for erkcn' conlltGlrion. ds pro{dcd for b, S6rion J70o of rh.
<br />L$tr Codc. for thc Frfolrrr8re ot rh. *rt for *tich llE IEmn ir issucd.
<br />-l
<br />h0!c ond willminrain workcu co,npcns0rbn insumcc, as mqun d hyS.clion 3?00olrhc L{hor Codc. for lhc pslomnne of
<br />ion iBurumcffhr Md 0olty num\e tr t/\
<br />o 0?- 8ut 1 l6-l -l
<br />-l
<br />eniry lhnl i,, rh. pcrforrom oarhc wod( for *hth rht pcrmir is i*ucd.l3tull nor cmploy,'y p.^on in u,y lLnr".
<br />so s lo bc6m subjccl lo llE ro*.s' comDcnslion Lws of Cllifomi,. md .eE lhll if I sholld b.om subiccl to lhe
<br />srks' comp.ns.lion pmrisions of Scrhf, l70O of llE kbo. Codc. I shlll. fodhwith o'lPly wilh lnos pmvi*ns .
<br />WARNINC. Fdlure
<br />'o
<br />wu. rc .c^ comp.tu.l'on mv6.Bc r unld*tu|. ond \tull subiccr !n cmtlo,tr lo cimin,l rnohis !.d
<br />civrl fincr un ro oN hurdEd rhousnd dollm r$00.00,' in lddnion ro rh. rctr ofcoflEnsxotr d!tulrr.r provd.d lor rh.
<br />sdhh .roTdol rh€ bhlr c6d.- inh{ &d dbn* (16!,""Tl1lli8 ^,,nJf&LICEISELCONIf,Aqtrrf,
<br />I hrEby .mnn und.r Fmh, ol pcrrury lnal I m lienEd undcr
<br />or rhc Businc$ rnd PDfc$iorN Codc, ond ny lkc.e h nr tull
<br />,,uviion of Chlptcr 9 (ortmmi.B wirh S6rbn 7000) olDiltn'n 3
<br />C1
<br />coNlilBuqlloulJ,luNr;lcE !r
<br />I ncrcbyaffttrru cr p.nrlly ol tcrjury llul thcrc h n connrdi)n Lndirsascncy itr rhc [f,rfonu0cc otrhc ao.k rar whi.h rhh pcnnir ir
<br />isucd rse. 1097. civ c.r
<br />d.EELICANTDECI.II3AII(IN
<br />llrrhylfnmundcr pen8lry ol p.rj!r, onc olrhc t]llowins dcchdnrni,
<br />txnrlirnrn Pcrmils-AsiEsos Notificrrn,tr fcdcnl Rc,rulariotrs (1irL,1o.I'ln6)
<br />-Rcquircd
<br />Ldrcr ol Norilllarion
<br />_l ftdify rhlr rh. r.d$al rguhlio.s rg.rding aslxsros Emhl m oor &mli.abl. lo lnis ,rcicl
<br />-l
<br />ccniay lhal I havc rcod lhis oppl n and strrc rfial rhc ak,{ infomlion is .otr6r I oBrE ro
<br />o inanccs rnd Stoh tiws ElotinS iflBconslrcrion. and hcrcby lulhorizc rcprcscnlotiles ofl
<br />h)k M ri{rr In)p.nvntr
<br />Applic.nt or Aaenl Siarelu :'ryg
<br />PLUMBING-INSPECTOR BECORD
<br />DATE
<br />Water-Under floor
<br />Gas Service
<br />Back Flow Device \
<br />Meter Release
<br />FINAL
<br />lgsd\
<br />L'nJ, I4'l,l'r.\
<br />I
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