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PLUMBING-INSPECTOR RECORD <br />ID/SI COMMENTSAPPROVALSDATE <br />UNDER GROUND <br />LWaste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildin Sewer <br />Area/Storm Drain <br />lnterce tor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pi i <br />Roof Drain <br />Tub/Shower Test <br />Rou h Water Heater <br />POOL/SPA <br />c'-P{ra Drain Line <br />Main Drain/Pool Pi tn I <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />0 lo- <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn S rinkler <br />Sanita Sewer/Ca <br />Back Flow Device <br />ro]bj l-22-7.D <br />Rou h Plumbin <br />Final Gas Test <br />Meter Release <br />FINAL <br />o\\'Nur Bu rrEn DEL(,\ll,\'l'l()N <br />I hseby ami,n trndcr pcnrhy olpclrry lhal I an €xe rfl liorn rhc Conta.ro6 t-iccN.l,aN for rhc lollowinS rcasotlsecT0:ll5 <br />BusinBs .nd Prot6ion C.d.) Any Cr! or Cou lv $hich r<lur6 . llmil lo ..nsl ct. allq. iq'rore doolirh or qnn an\ <br />{rucrurc, pnorro ir3 isnr.ncc. sLo rcquirB rht appli.nm for sr.hlEmirio nka sisncdnardd rh.l heorrlr 6licms'{ ldlianl <br />b nrc r,rorisions ol rhc (-onrractt. l.i.ensJ La\ (Chapler g. (-(nnmcn ii,g \rirl Sdiofl 7000 o' Dnisio' l ofth' Btrsinss md <br />|'rci$sions(iJd.)orlhlr hcorshe i,.(cmfl rhftfroo.nd lh.b.sis for lhc all.ged c\onplion Any liolation of Sqliotr 70]l ! b}an! <br />appli.a r f.r n lEmil subjdr. rhc oPplicatlloaoriltk.allyotnor'norcrh firchu dr.d dollsB {5500) <br />I. as oNn.r ot rfu lrolEnl, or .ry .inplqc6 \ iih Yas6 as rhcir vn. (nrrmsirion. $iU do rhe { oli and $c sni:luc k nd <br />i.l6d.rl o.olTsen rtreh(ae 70.1a- sii$ .id Profs"ions Codr Thc Conlncroas r.icss L.s dos nor lpply lo an '$i'r or <br />lhcpopcnt tr n. larilds or inlrov6 rhsmn. and \60 d(6.uLh $ od ninN.lf or lrrel t or lhd'sh his ot hq orh tmPloyc' <br />l)()viddl rh such i,npnNdnrs mc nor irrlodsl d ollddl lor sle li ho\v.v6, lhc tnrildi.s or nnrovcm.nr ir $kl silhh oic )a <br />orco'npltrtun. rhe G\ F ltuild.r \ill ha\t lhc tntr&n oa F6 iry rhd r€ or shc dil d hrld or i.lprort thc lmpolv tu rh' !o4ir* or <br />t. s o\ ner o I rhc flol€ny, am clctusn e! .onta.l ins \ irh li.enscd .onkacto6 lo coisrtud rh€ I'ojRl (SE 7044, &'<in6s <br />rnd l\rrsnn Codc :l <br />hc Conka.rois Liccnse l -i\ LldG or0rpltlo o\n6otpnp.nvrho boildsor iBpnxc rncrsn' <br />ind Nho (nrn B lor srch pnrj.ds $iri a ao ra.ro($ lt.ns.d Nmua ro lh.(ont,aclois Licos. La\r) <br />linri. rtn trr o Scclnn .ll & l'( lnl rh,s,casotr <br />'lloRxElls' colllPENSAT!oN <br />DECIdAAIIA! <br />I hecby aflirfl rnd6 tdahyotFjury of,.oflhe folhr$ i.g deldnliois: <br />-th6v.edwiltnrinraintCcnific!|.otCons€ <br />lo s.lf-|tr{rc lo.(ili6 omlosalion. ,s Pro\ idcd for bv Sdtion 1700 'lrh' <br />trbo. Code ior lh. pdfomsce oflh. wo,t for ehich lh. pdmi i! isuc<|. <br />th.v.a(lvillm.i oio {0116 comFNlion ins!B..c s t.quittd b}_ Sdtior l?00 ol rh. t b.. Cod.. for th' p<fomMc' of <br />rh. wo,k for which rhls pmil i! isu.d. My sorl6 comFNlio. iGrranc. cari* and policv ntmbd el <br />I ccnify lhar i. rhc pslomanc. oflfi. vork tor vhich Inis !.mil is i3str.d l shsll nol oplo, lnv P6$. i. a'v oan'd <br />*r. *."..sUciro rt'" * o*d' compos3l ion |tsolcalilomi[ d.srerhal ifI sfiould b.(od. sul'.i4llo li' <br />sod(d'.onp4iiionpo"isiosofsclion]TOOoflh.L.tnrCod..lshatl.lonhwntcodplt*irhlhosProvi3ioN <br />WARNING: Faiturc lo Br. m!kd' coopo$liofl covdsc i3 ul.wtul. and shall snbjdl s onploF to Gimintl Fnhi6 ud <br />.Ml line up ro on. hondrcd finlMd dolls (5100.000). io addilio.lo of conp.Ntion. dmag6 6 prcid.d fo. the <br />sdion 1076 ol lh€ l ibor Con . inlcr6l dd atomEy s <br />q'7 s't 1 <br />I nsehy amrfl tr dd porlryoft rjry lh.l I am licen{n undq pm\hion olchlprc 9 (corn d'inB\ilhS'clion7000)'rDi{hi{$l <br />of rh. ausinB dnd Pi.Gsnrns (i'dc. ed ml li.cns. is in finl Lr.. a c|(t <br />I '!.nsc{ ],tr\ I r.trsr Nr rl{r <br />t hscby amrn untld p.nalty o I pdjury lhal lh* is a codru.li,r. kndine a*dcv aor ltc psfomtn(. of lhc so* <br />issrd lS(.1097. Civ. ( ) <br />l.ndd'! N.,n.: <br />- <br />Af PI ICANT DECLATLATI()N <br />I h6.by athn uidd pcnslly of pniuty o.. otlh. lollovinr d6la'l tuns: <br />Dmolirion PsmiteAststor Nolifi calion Feddal Resulalions (Til. 40. Pd6) <br />Requi.d L.xd of Notifi.alion <br />I .dify rhar rh. f.dml r.sulaliof,s Egddirs 6bGrG ronoul arc nol spplicabl. lo tha PDjc.t <br />I l\ <br />abolc norio..n preD€dy lor 7-7rt? <br />Notes, Remarks, Etc. <br />q-7r- /? <br />Arllic.nl or At6l Slgn.lur.: <br />n"*n.n"..,,rn,,, 14 fi4 ,lt,a <br />TN$.Q <br />Gas Pipino <br />A, <br />1),lW <br />\.wffi <br />7-,''olwi <br />l;vilNL,rA <br />J- l'l Vlbi) <br />2'rwt4 rro^rb{rt D