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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Seweri Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL P/lllu 4^C4
<br />Notes, Remarks, Etc
<br />owNf,R BlrLDlrR t !:l,c^RA]toN
<br />I heEl,y Bmrm urxl.r peElry or Frjfiy Ih, I d d.m!r fmm rh. conhc'oa l-ic.ns. Lrw aor rh. i(nhsiry r.aq,n (56 70] l 5
<br />Burin rr md PftJa6sion Cod.): Any City or CounLy which r.qutes r pflnl ro oNlrucl. alls, !nl1r,!e, d.tul(h nr rq! ony
<br />srdcturc, Drior to ns ssu.ncc.0l$ requt$ th. npnli€a tor such l.mil lo fiI. s esn d {drcn$r
<br />'
<br />h.r ht or r[. h lic.nsd nnR.nr
<br />ro rh. tmvFkrns dflllc conhclois Lic.nscd ti$ (chalrd e. conm.ftins wirh S.dion 70{$ ofDivirion :l ofrh. Busin.$ .nJ
<br />Pmlcssnns(nde) orfisrh.orshc s excnpr rhcrcfiomi.drtch.st for rhe allcs.d qeniro. Anyvolarionofs(uon?01l.5hyrn,
<br />anphcinr lor ! pcrml slhjels rh. lmlrcaor ro a civil neMlty of hl m.. rhrn fiv. hu.drd doll* (3500)
<br />I
<br />-1.
<br />s ow..f rh. pop.nn or oycnplotrB wilh w!8d Lr $.n ik @np.Nlion, will&, tlE sort tld th. ndtE ii El
<br />inrad.d o. ofi.Bd for sL (Sc.7044, BGitus lnd Pmf.sioN Cod.: -l'h. Colnoclq s l.i..M Lrw &B mt rpply lo M oqd of
<br />rh.,,op.ny who t{il& or inprcu rh.6,\ arn wno d.d sh wrt himrlf or h.elf or rhot8i hb l€r oM.nplot6,
<br />ohvid.d rhd tuch intpmrnErbmmti..dqlo.oll.cdfor5L.l[tbwe,ltEbuildinsorinDdEmnh&Bwnhin.rcF
<br />ofotr{,ktiorl tlE Ow Buildd will luE rh. hrd.n ofFovins $I lE or $. drd d build or rnpmE dE nmFly hri. p!.F*of
<br />-1,
<br />ee owmr of rh. ,mFny, on dclliiv.ly @,r6ding wirh lie.€d @mmroN ro oNrud
<br />'h. r,!j.{t (Sc ?o44, BcrB
<br />and Pmftslbn Cod.: ', h. ConrE€rols Lic.Nc Law do$ not aptly ro on osn.r ofpop€ny who 6!ild. or imp,ows lh.r6n.
<br />and who 6nrEcl3 for $ch noi..$ wirh o C.lx6c16(0 ltctr€d l,uriufl b ln. Contdtloi! Lic.trr L.*).
<br />_l dd.n lndd sftrio B &PC ftrthir..asn.
<br />]4Af,5let:CnMlENSAM!pEctdsAua!
<br />I h.Eby lmm u.dd p.n lty .f0dju!, om onlE f.Uowi.s d(ldlioor:
<br />_llr!(r'xls'llmrnn nrc.n'ncar.oa(dF.mhsrlllntur.li'r$orkcrucon,pc.rrnrn,istorntdn)rhys{rk)nl700olrlr
<br />l-ih.r(idc,iorhcFrlilmanceolrh€qql nnNh'.hrh.ncn Fsst.
<br />_l tBvc.nd eill ori ain worl.ru' conp.nstion iN6E., I r.quircd by Sdtion 3 70O of lh. Labor Codc, f6r th! t6fomm. oa
<br />Uis l!.mn is i*{e{ My wo.kd! codlEMlion imuBn.. cmi6 oid pli.y rumbcr e.
<br />lql
<br />(?r.tutrrCc t34O72
<br />I c.nirythlr in th. Dcraormncc ofrlE *ork ror Dhich thn pmir ir n$ed.l shdllmr cntloy sny r€mn in any nlnmr
<br />$ nrlo h.comc auhjtt ro th. workdc@Ep.nrdion lass ol Colifomi& .nd .se thit ifl rhould b(omc trl,i.d ro th.
<br />sod.6 odplnsrrnt'frvi.io.soasdionlr00ofth. bbor Cod.,I sh.ll, fonh*irh mnFly *irh rts* pmviei.n.
<br />WARNINC r0ihrc lo surc {orlcR @,it.Ntion cov.msc is !ih*lul, lnd shau subJdi m mplo'tr lo rimitul FnxB a.d
<br />ciril lin* ur b onc hundr.d tlbued dou6 (tloo.i)(n), in addirrn ro rh. cd ofomrEnqliorl d.mrc, al p..vid.d fo, rh.
<br />S.crioo 10?6ofrh. Lahor Codc, inl.rcst and anomey s lcB.
<br />,,","Nov | 5 2010
<br />I hcEhy r,Irm u.d.r ,,.n0lry of nsjury th8l I !m lien*d
<br />ol lh. Bwimsr rnd Pmf.$ioN Cod., ond my lic.nr k
<br />nofch:pr.r 9 (..nmNi68 wnh Sdion 70C\()) ofDivB'on:l
<br />r,rqsc cras, I Lr.ns Numh.,\ooz 1%cL.
<br />toy 1 5 20lS Yq
<br />ca!$allcrrcNrllDrNcScrNcr
<br />I h.Fhy amm und$ Fmlry of p.rjury rthl ther. is a con(ruction Lndins as.my for rh. p.rlolfua otr h. mrk (lr wnicn lhis lEflnil is
<br />iriu.d (Sa. :1097, Ci! C )
<br />AttucalfDlict rAua!
<br />I hn$yafilmund.. r.nakyof perjuryone ollhc lollowin8 dccl.mrions:
<br />D.ml(on l'crnnrr Ash.sros Nonficdrmn l:ci.6l Regul.roni (Iirl.40, P.d6)
<br />-Rcqurcd
<br />Lellerof Mnfi eri'n
<br />I cdr& rh,i rh. i.d..rl qllnrions Esmniry .sh.stos rcmovrl ole nor a,T,lrc l. ro rhii pmitr
<br />l^)a*n ify lhar I ttrvc rcad rhis arplicltionsid na'.rhal rh. atnvc iilomhn is c.ftdr. LlrE to omnly wilh all Cnylnd connry
<br />6 rarc6andSl.r. taws Elalins ro buildine codcNcri6lr' ald h.r.6y olthi Citylnd C.htyh enrd u,nrrE
<br />rbvc n .rioBd pbp.ny for imp.crbn p I
<br />P.mlte...DC Onnr):__
<br />,","Nol/5 ?N8
<br />UNDER GROUND
<br />\.\ \1
<br />l..tule' . AddE*
<br />ADpli.anl or AE.nl SiIn{lure:E
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