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PLU M BIt.IG.I N SPECTOR RECORD
<br />DATE ID/SIG.COMMENTS Own.L0urldcrD.cl ariotr
<br />I h.Eu,,ifim undcr p.tralr, ofr.iury tr l.mcrtmu fom r[.Co(nac!o6 Licctrs.liu ior rh. roL]ow,rBrcs.n G.c 70ll s atrsi'r.$
<br />rnd Profc$ron Cod.) AiyCnrdCouily w[lch,.quir.s 0 pcnnn roconsrrud. !]rcr. inllnovc. d.nrolnh o' '.patrrny srl'ucrurc' p'ror () tr!
<br />issu.n.c. !]so r.qun.s rhuapplica l for suc[ p.nnn ro nl., sign.d al.mcnt rhdl hco' th. h lccrsed ptrrsuln! ror[c DnJvRions oillt
<br />CoMacrort L,ccnrcd Lrw (Chapr.r e. Commcncrns w,n' Sccnon 7000 of DivErotr I or r,. BurD.5s and Prof.s'otrs (o.l.l or rhd hc or
<br />dre r cxcmpr rh.,.nrm,rnd rhcbsis iorrh. i lcs.d.icnlprbn A.y viohrion oas.cnor 70rl 5l,y ,rpDlc.Dr r.' rltm, subi.dsrrr
<br />rpplicrnt to a crvilpcnnlry oliot nro,. rhan fiv. hundr.d dollaB (ts00)
<br />I. as ownci oarhc pro!.ny, or nry cnployc$ *nh qig.s s rhor sol. conpcnsanotr. rrlrdo
<br />'lE
<br />$orl rl Ih. !r!cru,c 6 nor nn.trdcLl
<br />o' orT.'rd roriil.( s..704!.oulin.$ and P'ofdsioDs Conc Th.Con!rcrofs Llccns( Lrs do.s tr.I tpDlyro r owtro.frh.Drcp.n,
<br />Ihobu,ld! or improv.s ir.r.on, sd*hodes such ldrlhi']B.liorhc.s.lfqth'!!sh I'ir{,lr., own.mpr.!ccs. Pa\id.d lh soch
<br />lmprcvcm.nb.,c nor inr.^d.d.r ofidcd lors,l. llhow.v.r.thcbuiTdingdrinf'orcD.trssoldwtrhnotr.y.i oi.onrdclron rhc
<br />Oqn.r 0!ild.r willha!.6€ btrrdcD of pr6!in! rnd( hc orsh. ior burld or nnptov. fo, rhc Durlosc olsrl.)
<br />,_1.Bown.rofrhcprorc!1y.!n.rclGrvcyconr'rcrnrs* hlrcens.dconrtnns1o(rNr crrh(lrlorccrlScc -10r.1 ltutnc$urd
<br />Bof.sionCod.ThcCoiurcroasLic.nscLawdBnorlpplytoanown.rofprofcdywhoLuLldsorimuosrh.r.of.andr[o
<br />corrocB for slch pbt.clsenh iConticrorG)licc s.dpuEulnl lorh! ConkJcktr's Licctrsc r-i* )
<br />_l !m qcmpl undn Serio
<br />-B
<br />&PC for this r.con
<br />WORKERS COMPENSATION DECI.ANATION
<br />I h.r.by lmm und., p.n.lty ofpcrj!ry on. oath.Iollowirs dccldrions
<br />_lnrv.!trdwrllmainrtun.C.dificrt olCons.nr roSalf.lnsur. ror worl.ri co,npctr$riotr.6 frovrd.d r.r UyScclior r7o0orrh.
<br />Libor Cod.. forrh. pofomrMc.ollh. w.r[ iorwh,ch Ep.mtr is issu.d
<br />ll'!vcMdwillnlainiainworhcrs'conrEnsa!oninslraicc.srcquirldtrySecrio,rlT00ofthcLil,or(,rd..l,drrr.!.ofln$c.oilh.
<br />worl 16rwhrch (ht pom iss3ucd My workca .onpcni ion,trsuranc. (ui.ran! Fl,cy numb.r irc
<br />carn
<br />-
<br />Policy Numb.r- Erpn.s
<br />(Thts sc.!on ne.d trot bc conrdd.d illIe Itmr! B ro' OD. hundr.d dollus ]l loLri or lcs)
<br />,r/c.rD r\4 n rh. nolon{x(. .i rh. }or\ for $hrch rh \ p.tr'rr 5,LCJ. lillll
<br />#.mc uorcr ro rnc "o,t o' ' conp.isrtoi lr(r of.Jlilum'n. Jnd !3'.c rhit,f I rl'
<br />comp.nsarion proviior ofS.crio! 1700 ofthc Lnbd Cod..l sn.ll.fonh*itlr
<br />WAR]\INC Failqr.ro r(uE wolt.B cohp.nsation cora!.
<br />find up io onc hurdr.d tiouslnd dollar (ll0o,00o),in addnion I
<br />rh. Lnbtrcod., i.r6.e Md or.yt lc6
<br />io cnmlnil p.nalx.s.6d civrl
<br />d.mag.s a p,ovid.d lor rhc Sccrnnr 10'76 of
<br />t.tCENSfD CoN I'RAc-l oRS Dfal-,\R,\ rlori
<br />I r,(.lfy rlllnn rtrdo perrlry oi fcrltrry thI I anr I ccns.d urdc' t,ovl{ior oICIrprcr') lconnn
<br />rh. Businc$ and Prof.$ao6 Codc, d my liccni.ii i. fulltdccand.fc.l
<br />I h.rcb, alnm unds rcnnlry.lp.rju'l thrr rhoc is aco^suu.iion l.ndi
<br />issu.d(S.c 1097, Civ C)
<br />cc of $. *or I for sl*h rhn p.mn i!
<br />Alt!lcM!D!!:L!!!f!!ll
<br />Dcnd uon Pomlts,\$.ror :!or ficrooi,r.d.'il Rfftrl Nns l tlrlc4l). frr.)
<br />R.quird L.tr.r ofN.nfi ton
<br />_K,^",
<br />$. f.ddll r.8llariont rc8.|rdnr8 abcn6 rcmoval nor rpflicJl,lu t,ll,( p'q
<br />I havc '.!d rh'!aNliori. rndnnkrhar pv\! !rl (Irr dCouily
<br />ordnanccs d Skk L.*s r.llrrn8 to burldrnscor
<br />abolc nrcnrion.d pror.ny lor irjpccrio. porp6.s
<br />Crr, ond Counly lU.nt ruponlh.t%*
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-U nderfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipeing
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Draini Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Misc
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing F](EtEEt i
<br />Final Gas Test
<br />Meter Release FFI t=l20tc
<br />FINAL {o, zYU, 956, 6 57
<br />APPROVALS
<br />^",. , ) '2-4'oL"_c=--
<br />"kl 24'oC
<br />&lMe a;
<br />Notes, Remarks, Etc.
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