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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE oWN!]R II(J!I,DIiII D ,('ARAIIoN
<br />hair.\s r l"olc\\i{in Cq]t) AtryCirror(on y Bhi.h r.qu ,r\ r pdn ti co (tu.r. i,lrcr. n\!n\c. dcnx'lrh or rqirrty
<br />rotuprori\nnrlofrltCnnhcroi\l-iccn\cnLrq(Chr.rt).ComnreNing$irhSc.rim70(X)ofDiri\n,n.l.frlkausin.{\and
<br />rmlicntrr tur {!cnnirsuhjc.r\ rlN rpnlicrtrlri (.ivilNnnIyol troi trocrhrtr l'ir! hu .cd dollrtr r55u)r
<br />2($nsN{,rrhcpn,rdr,(tr t. phB\trirhqr!$asrhcnv)h.ortrtr$n.r.$rlrdorh.tr.rkiftrrh.nMrur.i\ft,
<br />ickll\l orollcrdlor{r!c(Scc7(}1ll.BusircssindPnna\\iot\(-( c Ihc(i rr.!oi\ l.iccn$ l.rs doc\ norlPPl\ r,rno{ic'or
<br />rhc p'oprnt $h, buiu\ or i'n!(nr\ rhcRar ud sho d(f,\ such troI{ hl'n\cllor hLr!.llrr rhhurh h\ or lrr oqtr cnlpl,)y.$.
<br />oi..trDLlior. rlr Owmr lruild.r N'llhr\c lhc htr(lcn oi flovin3 rhtr lE.r ih. dd tror htild or nnpnnc ihc pn,|Liy f,rilf puqxEof
<br />-1,
<br />rso*mrofrhcpmFny. a.rcichsiv.lyonrrmrins wnh li.cnscd coorDcloR rd..ndo.i rn pElrr (s.c.7044, BusR$
<br />and PDlixsirnCodc:ThcContrnlolsLiccnrcLawdo.\.or,pplyroanownc.ofprorcrlywhobuildsorinDrovcsrhc,e6n,
<br />o.d *no.onrEcrsto,su.hO11,cr(airheConiEcnr(s)liccnEdp!(uuorbrhcC.nracror\Li..n$kw).
<br />I mcrcn{t undcr SN'
<br />,*,, //t/za u**.
<br />DECIIAflION
<br />I hcrcby lfatrm udlr pcmlty of pcrjury one of lho follovin8 delu.lio.s:
<br />-l
<br />h.vc sd will minrain . CcnifMt. of Conmr ro Sclf.lnsurc fd vorkss oElxnsriotr as Fovided for by Scdio. 3700 ol rlE
<br />l,ktr C.dc, fu. rhc pdforun.c of rh. rcrt for which lhc pcmil h ksucn
<br />_l hrEandsillmi oin sorlcs cohlensrrio. insrnrcc. !s rcqlied hy Ser iiJ. ]700.r rh. Labor C.dc. ror
<br />'lE Frfommc of
<br />rhl worl lor whkh rhis E mir is j$!cd. My eorkB smpenqrior ansn6nce $rtr 0id p.licy numh.r aE:
<br />lzt.cnily rh,i i.rhe pcrfomftc .r fic wort for whhh rhir p6mit ir iss!.d.1sh.ll nol c'npbyanyFrs'n in lny mnNr
<br />s, ss to t rorN subj.cr r. rhc vo*cn ompctrsrion laes .r Crliaomi0. and asee rhrr irl shoold l$6m subF.r io lh.
<br />uorlcs orpcn$rionnn'vi\bns otscdion 1700 6frhc ljlir ciic,I rh,u. tinhwirh.omply wnh rho* pmvhi.nr..
<br />WARNING: Fnilurc lo surc vorkna s'nltn$rion .ov.mgc ir utrhwfll. lnd shall suhjcd u cmtlorq lo oaointrl F6xi.r md
<br />civil lines up ro orc nundrcd thousond dollaN ($100.0001. in eddirion ro thc.ort ofcomncn$rio0, d!tu8cs,s providcd l6i thc
<br />Sdrion 1076 of rlE Lrtor Cid.. hrftsl dd altonE \ f.rs.
<br />D'ELr/lar/rz nrn^r,rt/ / I /
<br />I JdTNSED CONTRA( -TOR
<br />IIDCIdIAIIO!
<br />I hcrchy rflirm utrdcr I'cnilrlofoerjlrr rhar I !n liensd undcr lmlhion ofChsprd9 (conmring sirhSc.rion IxD) orDiviihn.l
<br />of lnc Ausi,rc$ &d Pofcs\iors Codc, and nry liccnsc is in tull furc &d clIsl.
<br />Li.cnsccl$: Lic.ns. Ntrnbcr
<br />D.t.' co .rdor
<br />g)NStBI]euQ -LirulNl;_d1i&lll
<br />is\u.d (Scc 1l)i)7. Civ C.)
<br />Lcn 0 \ Nrtrr
<br />AITLICANI.IIE(IA8AIIAB
<br />I rm*'y Iinn undd pcnrlryorp.ijury on. orrrr i.lhRnre dccldirnrsl
<br />Dcnrli!ion P.rnirlAsb.{os Norili.drn,n F.dfidl RrSularidns (Tirl. {1, Pad6)
<br />-Rcqutel
<br />txn.r of Noific.riotr
<br />- ..1onib rI rhc lallcrrl r*uhri($ r.EinlifS r\tunosr.r(,r lxr. for rtpli.rhl. n, rIn lnijr.r
<br />otxru mnrioncd pmncny t, inspccrion
<br />lpplicnnl or ]1,tcnl Signslu.cl
<br />A-,,/h
<br />Waste & Vent
<br />Water-Under floor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release I
<br />FINAL z/zh.o 44-14,
<br />Notes, Remarks, Etc 7 \J 7V
<br />ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Gas-Underfloor
<br />Water Service
<br />trnddl Addrir
<br />-n^"_fq/ze
<br />I
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