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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.()lvN0R Dt, -t)t,tR Dut,( IRA'r()N
<br />I lErchy u,Iom und.. tEnahy olt dury ltld I d.xc.I,l lion lh. Co cloE Lia.* tj* for llE follo*ing Easn (S...rcll5
<br />Busin.$ lnd Prcf.ssion Codc)r A., Cny or Cou y whi.h rcquncs s Fmn b 6in{d. tlio, impmvE, &mlisn or E,ot lny
<br />slode.Fbrbtu issuftc..tso equiEs rn lppltol for such Fm lonbtsignns.t.mnl lhsl h. or shc ir lie.sd pul:mr
<br />ro ttE FDvhions of lhc Conlrerd! Licned Lrw (ClBpr.r 9. Com@xi.8 *ilh Scclion 7000 of Divisio. 3 of thc Busic$ 3nd
<br />Prcfcssions Codc) or rhar lE or shc is .rcmpl lhcrcfrom Md dt h,sis for lhc dllcgcd crcrplion. Any violalion ofscclion 703L5 by any
<br />rDplkafl for ! p€ml subj.{is tlE lrplic! ro !cilil Dcelyofmr mrc rho fivc hundEd dol$ (1500).
<br />-l-r\
<br />o$rcrotrhcprip.ny,{trnr!cnfby.csqilhw08csnsIhcnsoh.onllnnuri(,n,willdolhcsork ldrlE{rldurisnor
<br />inrcnJcd or offcrcd tur rk ( sn.-.7ort. Dusincs and hon\sn,ns Cixlc It ('( tracM\ Liccns u* diE\ n.r |ldy ro rtr o$Nr ol
<br />rhc pmDcdy uln h,ikh or impr'r\ rhcurn. dd wh, dds sNh s.* hiDs.lfor h(!{clfor rhoulh hiq o. hcr oancmpl,)r_ct\.
<br />lmvidcn rhri srclr inryrvcnrnh m nol i'nc.dsl or olliBd ior \alc ll ho$ clci rln- luldtrrS or iqn rcnr i\ vrkl *irlrir onc )tu
<br />ofm'nplcrbn. rh. O*mr Buildry *illhNr rtE hunlcn ol p(n ir8 rld tE or \lt did mr huiu.r irlabvc lhc PDIdy lor rh. Nqn* of
<br />-1.
<br />{r owsr olrh. pqrcny. !n cxclurid, .onrading with li.rn*d .otusclo^ lo onitrtl rh. tmirl (Sd. 7044, Busi*sr
<br />aJd Prot\:btr Cod4: Ttc Conimrol s Lic.ns. Lnw dmr ml apply lo an ownc, ol pmFny who builds or inl'ots rhcM..
<br />a.d who onrack for sucn ,tuirls with a Contero(O li.cnsd llBuunl lo fic Co lador's Liens kw).
<br />IA$EBLCAIITINSAIIOI!
<br />DEqI,AMIION
<br />I lErcby dnrn u.d.r Fn.lly of pcriury one ol lhc lollowing deht iots:
<br />lhlax willtrli'ir'.iCcnilicnrcofCon\cnrroS.ltln\urutr*orkc.oqrctr\dinr.r\pi,ridcdforhySccrid3T0Oofuhc
<br />l-rhtr (tnlc.lor ihc |rtrfonnrnrcol rhc qork nrryhich rhclcrmil is nsd.d
<br />-l
<br />hi{ ond wi ll nainiaii wnrtcr' oop.os"lion in$6Rc. ss rcquiEd by Sd ion l70O of rlE t hot Codc. for lht pc,to.@c of'lrilua h is$.d. Myworkcn mml.ns0ti.n inrumncccMicr 8rl t.li.y nun$.r m:t L olh r rur (.
<br />(?u,.tt^r-ot a qo \\\q
<br />-l
<br />.enify fial i. thc pnfordna of lhc $ork aor which lhn ,crnl h hsucd. I sfiall ml €mf,lo, dry !eM. in uy Mftr
<br />$ &s b bc.om sut'jccr ro rhc so*6c @mt .siio. liws of C.lifomh. and tse rhd il I ihould hcom sublrl lo tlt
<br />mrtc6' compen$lion povisions of Serion 37m of ihc tjbor Codc. I strll, ronh*nh @n{,1, w n rno$ Pmvhions
<br />W RNllt(;: Fiilurc to sccua sorkcF conD.n\arnnr colcm[c
<br />.ivil fincs xp lo onc hundied lhou\&d dolla^ (S,m.OoO), in tddilion Io .omp.nsario.. dlnEB.s as ,toridcd tor rh.
<br />Ihcrcbyrrlt otulrr Fnahyofp(rjurythlI, anr li.cnBd undcr prcvi\ionol chslrd e {conrmncinB $irh sd!i 70fi)r ol Dirisiotr .l
<br />ol lhc llusi,E$ rnd t\orc$n tr codc. md nry liccnsc is in lLrll rore ord cllitr
<br />lM4q W\.
<br />o,,"rlrf. oi r0ianrr{,
<br />rallrf, lcll(rlt tErDlNcjiilNq
<br />I hcBby aflnm undcr Fndl, of Fcrjury rhur rhcrc n d constflcri.n lc.dinB o8ency tbr lhc lErfo.r@.c olrhc sork rbr *hich rhis Fnnn ir
<br />nsu.d lse :r(r7. civ. c.)
<br />Lcndc' . Nsm
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<br />AIPLICANLIECIAB{IIO!
<br />I lmhy rffrn undq p.trrlt, ot perjury onc 6rrhc roilowin! dNlenions:
<br />Dcmolirn,n Pfimir* shrsos Norific n,n lidcBlRc8ullri R(Tirl.tl{). Pd6)
<br />tuquncd k(ur olNorifi coli)n
<br />2*tfina m
<br />iiti-i,-*,',,a sr," r-
<br />rcdcrul rcgxl,xonr rueardirB ashcs{os rcmvnl nrc nol urplicihlc b rhi\ F$jccl
<br />Ead rhk qpltdion and rr c rhar thc sbor inlomrion h .orel. I !8@ to .oq)ly *i$ all Cily lnd Colily
<br />ws mltrirS ro buildln8 coNruclion. Md rcEcpnr ivcs olthis Ciryand Counlyto cntcr upon thc
<br />ADDlirrnl or /1Scnl SiInaluB;
<br />Pcmlre mm. (trlnl):
<br />_,,ArJ6-CI,3_2lllg
<br />UNDER GROUND
<br />Wasle & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOLiSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<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 Plumbinq R/qll<5bg'{
<br />Final Gas Test
<br />Meter Release
<br />FINAL 6tt?/k
<br />^6tNotes, Remarks, Etc
<br />COMMENTS
<br />I m.rcmDr urdcr Sccrion .B & P.C. forth6 EMn
<br />D.t.
<br />-
<br />owr
<br />-
<br />s( j,r r1)76!ll]n llhtr (nJ..
<br />',,,lluG lt ?n'^
<br />L.ndca\ Addrc{1
<br />-
<br />lhovc mnlioncd pmpcny for i.rFction
<br />Fill Line/Back Flow
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