|
PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BtiTI,DI]R DIiLCARA ION
<br />I hctcny lmrfl u cr |{.alr} (,t Frjury lhnl I an cxcmfl lnr
<br />'hc
<br />Comrn'n l-iccn*- Itrw l',,r rhc rolli,wir'g rcaq '
<br />(scc.7oll I
<br />Bu\nrs\ rnd Polcsi{in Cdd.): Any Cirt or Cotrmy slrich rdqut.r s p.nrir k, cotr{fl.r. 0lrd. irprovc, dcnFlish or rcFn ,ny
<br />(rucrtrrc. rrior to nr nsurmc..ko rcquncs rhc0mli.r lor su.hlxnnirto flc ! sigtrcd slolcflr lhd heorshc i! lic.nscd plrs.anr
<br />b rh. pi{,vkn u olrhe Corkrck s Liccn$d l-rw (Chrflcr 9. Co rmcn.i'r8 wirh Sftr ion 70(r oi Divisin I (f th. Bu\in$s nnd
<br />P()lcssions Cndc) or rhd lx orshc is cicnrfl rhcrclrormd rhc br(is turlhc rllc8 ncrcmplt,n AnyriolJlbnolSccrioiT0]l.5bydny
<br />rlplicrnr loru pcnnir suhjcch rhc aptlicnit t' rcivillcuhyol'nor ftrc rhr fir. h!tulrcd dolhs rS5($).
<br />I. rs oun.r orrhc pmtrdy, or nrycmployex wilh wl8cs.s lhcir $lc conr|cDsolion, willdo lhc *o* ud rhe {er@ ir nor
<br />inlsncd or oflc.cd for elc (Ss 7014. Au\incss and hotc\sions Codc l hc 6nt6croar l-iccnsc tiw docs nor +tly b nn owncr ol
<br />rhc psFiy wh. builds or inpsws ttrrcn. Md who docs su.i M,.t hinscllor hcMlf or $rou8h his or hcr own cnpt'ycc\,
<br />proliici rh such inr.llEnrnr\ lrc fl, intcftllt or oficNl ritr eL. Il rhscvcr rh. huildin8 or nrrmwmnr is sld *ilhin .rc )r{
<br />ofcoq,Lrion. llE Owncr Auiu.r will h.rc rhc hudcn ol rro\ ine rlv! h. or thc did mr blild or irymw rhc pmFny for $c nu4rr ot
<br />-1.
<br />as o*ncr of rhc ,mtcfly. an crcluiiwly conr.cting with li€cnsd .ontracrou lo onnrud rh. Flret (Sc. 7Or4. Busims
<br />and hofc$bn Codcr Thr Conhc'ol s Lic.n$ Lsw d@s .or ,pply ro e own r of tmFny who builds or imprcecs thqon,and sho 6.rDcli for ruch pEimh with a Coi!6do(s) li.ensd nurs@r lo rhc Conlrd.rm r Lkc.sc hw).
<br />-l
<br />m crcnfl undc, Scc
<br />EoxxEEs_laulENsAr{tN
<br />NTCLARATION
<br />I ncrc6, .116 und.. Fn y 6fprjury o.c oflhc folowine d..la.8ions:
<br />lhrvrrnd silltrui' rinn(lcdii.!r.ofCutr{trrt,S.llli\u..,itrworkcri.. !..\nri(nr, 11 pn,e cdn{byScdion.lT(x)olrhc
<br />llhor (ixlc. nn rhl Iu hflnm( olrh. work ri which rh. plnnir is ir\udn
<br />I hrvc rtrd Rill'nrinrain eolk.h comJEN,tun insuan.., !s rcquncd by Sccriotr 3?(XJ ofih. tibor Codc.lbr lhc ncrlortuncc ol
<br />ir bspd. Mywortcu ..nvrnsarioo insur cc cmicr md policy numbcr m:
<br />r.A,y'\rCOr3 1[]oJY
<br />-l
<br />ccniiythor inrhe !e olrurcc or rhc so,k for qhich thh rErmir h hsrcd. l tull nor employ uy peNln in 8ny mmkr
<br />$ tri ro b.com subrdt to thc m Gc conF.erio. hws of Caliror.i,. and a8ft nd if I should bccom subjcd lo lh.
<br />vo*cm' .omFrstion pmvision. of Setion l?00 of lhc L{bor Codc. I $tnll. fonh*ilt cun ly qilh thos ,mvGions..
<br />WAtrNtN(;r FlilxE ro sur workcu' .{m!.nrdion evcE8c n u.hwtul. nnd shall subjet on mploycr lo aininal Fn.hi.r lnd
<br />.ivil 0nc! np ro orc hnodrcd rhousad dollus (SlLl0.0O0), in oddiiion ro hc.o of conpcBorion. dlmgcs !s loeidcd n,r rhc
<br />Scctron :ltl76.frhc tib.r C.rdc. mreF(n.d omv
<br />*,,, 1.b./d-. n0,,,*,.
<br />D&SAAAIION
<br />I hcrcbylrfirm undcr lr.nolryolp{riury rhd I am lian*d undcr rrovision nlCnaplcr 9 (rootrffinr with sNlion 7O0O) oiDivision 3
<br />ol
<br />'hc
<br />Busims &d Pofcssions Codc. and my ltcns is nr rull lorcc .nd cfin.-l
<br />o (e-7/4?
<br />a.L.lr,
<br />T
<br />toNtfBlc[ url])MirllitNl.Y
<br />Ih.r.hyrrftnrunl.rpcn!lr,oin.rjurrrhrrrhcrcnrconrrru.iiotrbndi',arrcnc!,nrrhcpcnairrnccorrhcturkiorqhichrhi\tEnnnir
<br />is\ucd (Sc. 1097, Civ. C )
<br />A.TII.ICANTDECLABIIION
<br />I lIeby Jtnn utulcr Nndhyol pcrjury onc ofth. fdlosins dcclttririotrs
<br />Dc'mUir,n P.rtuiNAsb.n.s Norilicrrion Fcdcnl RcguhrnJns (Tirlc.l0. Piri6)
<br />Requn d krr$ ol Noriarcarion
<br />l cdriyrhJr rhc hdcmlrcgul0rion' rcsndin8 r.b.!o'Lnxrvilarc nrr ofi. EJhlc tothn Fnicc'
<br />ffii^",",""0 rn'.rnrr(u,i.,n dd narc lhr rh. rbvc inro'Brio. is.otrsr rrEBroonrriye hsrt:ryand(runry
<br />ordi.ares and Sh'c Lass Bhlins ro buildiflB consrDcrhG an h.rcby rnd Counry o cnr& uB)n rhc
<br />rtsv. mnriomd l,bF,ry for inspctn,n Purpo*s.
<br />Appli{rnl or AA.nl Sitnrlum:4,c.11
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/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 />Rough Plumbing "u/tnx c^kg
<br />Final Gas Test
<br />Meter Belease
<br />FINAL bl?/rx sN69
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Miscellaneous
<br />D!lc: O*ftr:
<br />t'l'[a'
<br />f------r-----
<br />f------T------
|