|
APPROVALS DATE ID/SIG.COMMENTS O}VNER BUII,I)I:R DId,CARA 'IoN
<br />Iftrchy,lnmud.rIf,MhyofFqur!rhrr I rtrirxrnr k.n]rhcCorn.ro^'l.ioi\clnwfitrh.ln]|,)sfgrca\.riscrrlr-ll5
<br />kr rhc lm*r\trtris of(hc cunrtu.nr's Li.rilcd LrN (charrcr 9. connnrEin! wirh s.crn nfir ofl)irni{ :l olrhL llu\irr.\\ rnd
<br />rt),,!i.xrntrrNnnir\uhrrr\rhcrtticrtrrn,r.ivillcftlryrln.rnrmrlnnli!.lNndrcd,loll!rs(s5(xrr
<br />-1,
<br />as o*mr oa rfi. p6Fny. or my .mplor$s * n w,e.s $ rh.ir $b @n{Eosilion. will rL, tlE soil ald dE niErm is ml
<br />i.roded or oftrc{ lor elc (56.7044. B$irc$ dd Profcsiom Codc T1* ContrEroas Lic.e Llw ilo.s mt ollly ro d oftr of
<br />lhc prcpcriy *ho hiildr or impturs rheE.. r.d who do6 sEh s.rk hinrclf or lEelf or lhhuSh his 6i h$ o{n cmploy.cs,
<br />,,rovtdcd thd suci inporm . e mr inr.dd or offer€d for $lc.lt hoEE, rlr buildiry or inplwrnr it $B wnhi, oft FE
<br />ol.onlphhr lhc Oqrcr Blits *itl hsw llt hildcn ofF$vin8 dd lE tr slE did ml toild or irpmw $c FoFny for ,E nuFs of
<br />-1.
<br />.s oeBr or lhc tm,Edy. rm erclurikly @nrr&rans *irh liccn*d.ontreroF lo onrl cr rlr pljer (56 7014. Busi.cs
<br />,nd ftlltssim Codcr Thc Conlrelols Licen* ljw do.s nol +ply lo an own r of ropcrly vho builds or imprcrcs thermn,lnd eho cootDc1s for such pbjcds wi,h a c.nrrnoro(, licor$cd !!6un ro lhc crnlrerol s Lien* L!w).
<br />-lamcrcn{
<br />uMcr Scctiotr .B &PC fttrrhisrn\o.
<br />WORKERI' COMPFNSATTON
<br />DECIJXA]ION
<br />I hcrcby afiirm undcr pcnoly of pciury om of lhc followirg dNLnri6B:
<br />-l
<br />h.rc drdwill dinl8in. C.nifrcal.oacoe l. Ser-lBurc ld mrl6 o,pMs.ri,n. s Fovik lor hy S.clio. 3rm of dE
<br />Libor tuc. for llE pdf()lmtu. of llE mrt for wnth th€ pmit is iskd.
<br />Ihavcrnd*ill'naintainworlcn.onl,.aiarioninsurancc.!s EAuncd by Se.rion 1700 o, th. Llbor tuq for rhc pqformicc oi
<br />rrr work fd qhkh lhl\ I)cm is i\$cd. My w.*s oq,cnsdion insuBm. @rtl !t'd tolty nunhc. dc:
<br />-l
<br />ccnifyrhat in lh. p.rtbnruncc ofrhc f,or* for whi.h rhk pfinir is isrucd. I sh,llnor.nlt)loy lny Frson in rny m.mr
<br />e as b tr.om.ubi.r ro rh. wodec e,mpcnerion lausorcalifomia. lnd as@ rhir ifl should ltq,m \!6iri ro rtr
<br />*o*.B cdnlcn n,ntovi\ions6rSccrionl?00ofth€th.rCode.Ishlll.fonhwirh..mply,irhrho*povi!i6n..
<br />WARNINC failurc ro sur. eortcr' snnF.sdidr svcn'rjc ii !trl,wrul, ,trd sh.ll suSrc.r m cmplorr r. dinrinol Fmlra\ ond
<br />civi! inc\ uI b onc hundrcd
<br />'hou$nd
<br />dollaK (S100,0m). in r diri.n ro rhc con ol conlcnsrlion, drmecs.s prolidcd ror the
<br />Sccrion]0?6 ollhc utnr Co{lc. irrercslotrd olromy s ltcs.
<br />urENlilitlcgNr&Icraa
<br />D};!LA8A.III}N
<br />I h.Fhy al6!nlndcr pculryofpcrjlry rhr I an li(nai uds pmvtion olChrrici 9l.onmncinE siri Sccri,i 7{xn) oroivi\nD.l
<br />ot rhc Bu\incssrnd Pmlcs{ns Colc- d nry liccn{ is tulllbNu!.lrirl
<br />Li..nsc CLrs: Liftn e Nunh(:
<br />D.l.i Ci.tn to.
<br />calEllrucnaNrflDtNc-tr{i[Nt]
<br />I hcNhy oti m undd ,.Mlry of p.r.jury rhd lhs. is ( snsrrucrt,r kndirS dB.ncy lor rhc pcrimuncc ol rhc *ork fitr rhich rhis pcrmit h
<br />iseucd (sc. lcD?.civ c )
<br />ABIICJITLIECI.AAA.IIO!
<br />I lN$y alitn uD'icr I'rDJlty olFrjuryone oflhr loln,qnr8 dc.lnfuri'ns:
<br />l)cnmliri. PcinrirrA\h. o{ N.tifi.aron Fcd$.1 Rcgrldri.ns lTirl. J0, PanO
<br />Rcquncd blt.rof Norifi.atn r
<br />-l
<br />ccn ify rh.r rnc fcdml r.Ellrrions Egodin8 ssS.sros rcmv0l d. nor amlic{hlc ro rhis ,mr.cr
<br />l.cnilrrh r I hrvu rr rhis trnfli.rri,ni id (rrc rl rrh. xhrvc itrnrrlni,nr i\cnnc.r l aarlt hmnrplysirhallCiryr dCutr iy
<br />.i{ntrriccs dSrrrcl;,w\Rllr',,9t)huiUingcon{.rnn,.andlrrcSyrurh.riT.rt''c{Drrri\r\{)lrhisCirtudCou yk,c rcr tlxrnrhL
<br />rhrtu nRrri,r.d ptununy lor irrrpcclion purrxNcs
<br />Appllenl or AEmr SkElrE: Dat.
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder f loor
<br />Gas-Underfloor
<br />Buildi ng Sewer
<br />I nterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P.trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL gt?,4 n T\t4t"[t^]/?X./
<br />Notes Bemarks Etc.
<br />PLUMBING.INSPECTOR RECORD
<br />Lndf,'3Niftr-
<br />Lutrd.i. dJ,.(
<br />Area,/Storm Drain
<br />Gas Service
<br />t
|