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PLUMBING.INSPECTOB RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BT'ILDER DXLCARATION <br />t hftby aflrm uder pcmlty of !.rju.y rhat I m cknDr 6on rh. conh<roN' Lkxn* ks lor rlE follo*ht ten (sa-701,.5 <br />Bu.iG$ $d Prcfc$ion Cod.): Any Cny or Colnry vhkh rcqliB r p.ml ro onsku.r. .16. inpbk. &mli.!h or Ep6ir ey <br />stru.tc. prior h ns is$ucc. aho rcquircs lhc .ppli.a.r tor iu.h p.nnil lo 6lc a si8rcd slolcmil lhal h. or 3ic ! licNd pul:@l <br />lo rlE Fovkionr of tlE ConrBrols Uen*d Law lctapr.r 9. Co,mBi!8 wilh Scclion ,0m of Divisbn 3 of rlE Bu.ires nd <br />Ptufe*ions cod.) or rlur h. or slE i! crcnfl rl@tlo ard rlE h..i! for lh. 3lk8d.rcn,lion. Aly vi'Llkrn of Seli,n 7031.5 by ant <br />lpplic.nr fo. a pemit 3ub.ists th. lppliclnl lo a civil pc.slly of tul erc lh.. nvc hurdt d dollrs ($500). <br />-1. <br />!s oercr otrh. plottny. or ny cqllortcr with wdEB s lncir sh sry*nglion, wi[.lo llE wot and dE slEtE b ml <br />iincdcd or otrced lo sk (Se.?o4a, Busircs and Piof6siotrs Codc: Tli ConlBcid 3 l4c.* tt* .IE ml .r,rly ro M oscr of <br />rh. rmpcny sno hil& or nr!$,B rh.Etr .d wlb dG. ocn mrl niMr or hdslaot thhuSh his or trcr own cr$loyc.s <br />pmrit€d rh,r such irymrm'ns G Fr ir ortcd oroftcd for eh ,l hoEs,llE t{iuing or inPtwed i. s! wnhin orc yld <br />ofoftpLriotr ttE OwE BoilLr rill hlE dr hrr&n ol FoviB $!r l! 6, dE dil ml hild d if,ptuE tt Popsiy for tlE Prrb$ of <br />-1, <br />!sowrcrofrhc pmDq|y, d.xclBirely co.lfdtine with liccnsd conlreloFlo orslto.r rlE p,nirr (Se 7044. Busincs <br />.d Aoftr$nCod.r Th. Conlslols Lic.n* Llw dc tul lPl,ly ro olncr of roFny who builds or imlotr rhc,s.. <br />rnd who o mcrs for slch pmF<k wnh a C.nrBlo(o lhcnsd pNMl lo lhc Conba.lolr Ltc6c trw), <br />-l <br />a srchpt lndcr S.crio <br />}ASTEBI..COMIENTAIIaN <br />DEIIdEAIII'N <br />I herchy afltrm u nder pcnalty ol pcrj!ry onc of rhc lollowirg d6la{iioN: <br />I h.vc u will nriririn !Ccnifi(ricol(inNcirk,S.lf ln{rc i,tr wo*ctf coartEnslli,,n. a\ Pmvid.d r(rhySc.li(rl7{}roilhc <br />Iltxr cdlc, r(r rhc pcdo.ur.c ofrhc wolt n)r *hi(h lhc tsnrit n i\\kd <br />-l hovc aod uill roindn workcs comFnsrlion inruEft.. !i Eqlicd by sstion 3700 of lh. Llbor tuc. for dc Ffoll1@. of <br />rh. w..k ror which lhis pcrmil ir is$t!. My workh n iB!.er @id .r'd poliy nuhbcr ft <br />r in rhc p.rr.rmncc ofrh.work for rhis 0ermir n issuc{r. I shall mr .mploy ,ny lEson in an, na.M <br />$ x ro b..o'n subj.Tr lo rh. k kc6'comn n$rioo liw\ of Clliromin. .nd .!rc thar if I shnold bc.oc flbid lo rnc <br />workls comFnsolioo prcvisionsofSeli.n 1700olrhc kbor Codc.I shall. fonh*ilh mq)ly wirh rho*,mvisions. <br />WARNINC: rsiuE lo e.ue w.tk.6' coq,.ns,rion vcESc t u.hwful. sd \hnll sohjccr e cn{,loyer to niminal Fkhicr Md <br />civil lincs uD k) onc huRlad rhou\ind doll,.s (!1100 in rddirion ro rhc co.r olconDcnslion. dlml8cs !s pmvidcd for rhc <br />Ser i.n :10?6 of rhc I ltnr Gi.. ihrceu and\/zil.te <br />ndcr p.oli, ol p.rjury thd I an <br />OEqAAA.IIQN <br />hdcr lmvtion ofchlnrd 9{.ol@ncine {ilh Selion 7000) of Dirisi.n l <br />of lhc Ausinc$ aml Pmfc$iona C.d.. 0ad ny liccnsc is in full forc dd cfcct <br />coNsrBucrl(lNLlltlMi-&c[Ii(.l <br />I hcNby ,firfl undcr lrnrlry ol Frjury rh thc.c n ! onsrtucrirn Lnding rlcky r rhc rrfnmlkr of rh. work Lr whi.h rhs Fnir is <br />nsucd (Scc.:109?. Ci! C ) <br />APTI,ICANLDEILA8AION <br />I ltrtby aln'n u ndcr !.rrlry.Ip.rjury oi. ofrhc rnuowin! dc.ltrr,ri.ns: <br />Dcnx,liibn Pcrmn$Ash$rosNoli6. n,nFcdclll Rquhii('ns('tirlc40. Pnn6l <br />Rcquircd htrcr of N{rifi crrion <br />-l <br />ccnily rhui rhc itdcisl rcgul,,ions nSoding mtrst$ rcmvd arc nol opllicat'lc lo lh^ pn&cr. <br />-l <br />.cnify rhd I harc rcad fi! ,rplicdlion .,i 3rtrr€ thd tlE lhow inroflElion Ls corel I igc lo .omply vnh 0I Cily snd Counly <br />odinaturs atrd Sr!r. tiws ElariiE ro <br />.bovc mnrhmd !rcrEny lor insFct <br />consrudion..nd hcrcbyuurhonzc rcDr*nrariv.s .r rhic Ciyald Cou ytocnrsulnnlnc <br />*'"''A-r/e <br />UNDER GROUND <br />Waste & Vent <br />Water-Under lloor <br />Gas-Underfloor <br />Buildino Sewer <br />Area,/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Rool Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trapi Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq Y-A-t s'il"tVN <br />Final Gas Test -x.\t{Td <br />Meter Release x <br />FINAL 1-17-t(,k.v-(ld <br />Notes, Remarks, Etc. <br />Miscellaneous <br />f------T------ <br />-g-x4r