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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER DEI]CANATION <br />I hocby illm u.dd p.@ty oa pollry lhil I @ ddpi 6Dn rh. Contrdc Lkcc Llw lor tlE folloGns r.en (Se.70l L5 <br />Bsin6s .nd Profsion Cod.): Any Cily or Cou y whkh r.qlt6 i Fnt lo o(<tud. q. inlrovc dsreli:ln or Ep.n uy <br />srruc1u.. Fn lo irs is@cq abo rqlt6 th. @rlkd for 3u.n Fmn to 61.. riSEd 3lllatrs'l lhlt lt or nE b licas.d Fmat <br />to rhc FovtioE olthc Conrrrols Licms.d Llw (Chlprd 9, Comdcin! wifi Sdiof, ?000 ofDivisio. I of th. Bui6 ed <br />Prot sios Co&) or lh.r h. or !n. i! .r@fl da.from sd rh. bub for lh. dlc8.d qoBion. Any viol.rio. of Sdbn ?01 L5 by dy <br />applicmt aor E p6nir subjcru thc applicdr ro d .ivil pdhy of rol rcc rhrn fiy. nun&.d doll6 (1500). <br />l, s owE of rh. FoFrry. m ny mphr6 wnh wr86 a rh.ir slc @nF!!io[ will do {i.Er Eld th. drude i @l <br />itinxLd or o66!d lor $1. (s6.?qu. BBitB ed PFfd.i6s code TIE condm r Licc@ Irw &€ not.pply lo & oge of <br />rh. FDpdly who bnd. o. i.rFo€ $q6[ !d *ho dE sh md. hirolf or lEs,f or thrcush hn or hs ow dplor6. <br />prcvid.d lh,l lEh imFEE ! @ mr id-d.d $ o,Ia.d for sL. lt holrEG. $. hildiie o. inFlq4 r ir Dld wini! on tq <br />of@nplii.{ lh. O$na B{il<!, eiu luv. iE hrn6 olFovire ttd lE or *'. did rcl hild or iEFoE t FoFty tu tlE Pu!d..of <br />L s omd oath. Flpdy, m .rclBiv.!, co.rtuinB wirh licdcd cotrra.loB ro 6rrtu r rlE Foj.<r (S< ?044. Bund <br />rld hollsid Co&, Th. Conueba3 Lk.e t $ do6 nor.pp,, ro eomd ofprcp<ry wto brilds or inprov6lhro.. <br />ed *ho @nft.ts lor such prdd3 wnh ! CodE ro(, ln6.d pus!fl lo rh. Conra.br's Lk* L!q) <br />lan, c\c'npr undr S(rn,n B & P C. for thi! r6on. <br />raaf,fifcalfiExsalro! <br />DECI.ABAIIO! <br />I hd.lry !fiim uid6 F,l'y of pdjury onc oa$. aollowinS ddldaliosl <br />-_lhd.enwill@inr!i..c.nifK.ofc.Mrros.lf-lBu.forworltd@oF8dioo.aFovidallorbyscrioo1700ofth. <br />Llhor Codc for lhc FfolrM@ of lhc m for *tich lh. Fmil i! qsucd <br />I h.v. and will mli.lsh worl6 .omp.Mtion iNtue.. a ,.qun d by Scclion 1700 oaih. L$or Cod.. for th. p-fotrMc. oa <br />rh. wort lor whth rhie ponit ir isucd My *ot6 conpoBrion iBu@. caid dd policy nudb6 G: <br />* <br />-l <br />cdiry lhd in thc FfolMc of li! rcIk for phich lhi! paiit i! i$uc( I rhrll Nr @ploy ey pcs. i, oy Bs-E <br />e s to b<oM 3uqd lo fic wort6' compadior l,vs olc.lifomi.- td .sE lhd if I 5hould bdom. 3!bjd to llE <br />wo*6' ompd!.rion Fovi3ioro of Setiof, 3700 oalnc kbor Code I slull. fonhwnh onply s'th $os FD6&B <br />W RNINC: F.ilw $ Guc wrtd .onpcslrioo @vdrc. i! unl.*L snd sh.ll subjct e 6plo)6 lo sifiinsl poultis sd <br />lhc coe of compcMlion. d.ms6 a provid.d tor th.civrl fin6 ut io onc hundr.d llrusd doll6 (ll0o.0o0), in addil <br />S<t{n 1076 oalh. Llho Coda iilq6t &d <br />>,,.5ltBltt <br />I n@by rffm unda Ftdry oa Fjury rld I m li.d.d 6dd Fovnior otchrprd 9 (@q@.i!g eith S..lio. 7m0) ol Divilior l <br />ol rh. BBinB &d Prof6.ioB Cod.. dd my li.@ t in tuU forc. !d.lIel. <br />tIFc(sSA <br />o.t. 6 2_1-+- <br />CO!EI8!qIqB.IE!DIAC$ <br />I hqlby lrm lrdq p@rly or FjEy tbr ttar i .otrrndid bii,s a@y for fi. Ffotl11lc ofrt *o* lbr *'lti.h thb p66i ir <br />L$.d (Sa. 3097. Civ. C.). <br />APPLICANI DFCLARATION <br />I hdtly atrm uid6 po.hy of p6ju.y o@ oa th. aollowi.8 d.clmliof,sl <br />Danokion Pmhs-Asberos Notincdioo Fcdssl Rcsuh io6 (Ttlc 40. Pan6) <br />Rdunal tlra ol Ndi6unn <br />-l <br />cdily thar fi. fqloal E!u1.rio6 Egad,rg Bhdto! l6ftvd e f,ot rp?licabl. lo lhb pmjdt <br />l:i car it rhal I hlvc @d rhit applkarion ed ndc fi.r th. ahov. idrorsllio. i! coE6r , .Bre ro oEply wnh Icnyudcouty <br />odidnc6 d Sratr hwsElri.s ro .urhoriz. Epr.darivB of lnis Cily &d Counry to otq upon th. <br />otovc mBtion d prcFny for ', ltSl< <br />Jqv?-p-,-'ta -, \.-.a* _,, - <br />I <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />lnterceptor/ Clarifier <br />TOP OUT I I I <br />Waste & Vent q 2r+,tLt Dt*Yd tb A s <br />Water Pipinq 6 >rt ) <br />-L\btr"A-d <br />Gas Piping t -t <br />Roof Drain I <br />Tub/Shower Test tLb ?(Dk*67 I <br />I t l[al?t Dt4.6-'Y? <br />Rouqh Water Heater I I <br />POOL/SPA <br />P{rap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Waler Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release ,l . rL. <br />FINAL 1 t?A yqqra I <br />Notes, Remarks, Etc. <br />Area/Storm Drain <br />(,ltrrlzL DklVZ <br />Miscellaneous <br />4- kt.t.qlslzz