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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE to/stG.COMMENTS Own.F0trrldcr Dcclar.riotr
<br />lhcEby rmmund.!p.nalr, olp.lory lat I nncr.npt l6m r[?ConnnctoB Lrccisc Li* lor rh. followrtrS].dor k.( 70ll 5 Atrsi'rcis
<br />d P,ofc$io Cod.) Any cnyo' counly *l,ich r.quir.s a pdnnroconsltoct, ill.r. inrprovc. dcndth or'.p.tan, sru.rum l'l.rroirs
<br />isiuanc..!lrorcqui.*rhcapplicanrlorruchp.mrlrolilcasie..drarenttrr thal hco ihc is lic.nscd ptrruanrrodcpxJvrsio.sollh.
<br />c.nr.crofs Lic.ns.d Llw (Chapro e, Comm.ncins wirh S.cnon 7000 ofDivisron I ofrl. Busin.$ dJ Profcseons Cod.)o.lhd hc or
<br />shc lscx.mpr rhcrclromqnd l1[b8ls fd'rh. !llcs.d .xchrrion Any vlolonon ofScclrdi 70lll s by iny ifDliconi ror rDcnnr rubjcclstlr
<br />4plicanlo acivilD(naly olnd mo!. thrn fiv. hundrcd dolla (t500)
<br />_1,6 ornd ol ih. ro!.dr, or ny.mrloy.cs snh wiscs s r[.ir sol.con,p.nsariotr, * lldoth.lv.rland r[.rruc'm k nor 'n'.id.Jor oflc' Gd for ilc ( Scc 7044. ABrn.s ad Prcfesionr Ccic Th. Co.h rdofs Lic..s. Law d&s
<br />^or
<br />aPply ro oai.roirh.protErly
<br />who builds or imFoyB lh.rcon, dd who do.s such wort hitu.lior h.6dr or rhro!8h his or ndo*n cmplor..s. povrd.d thai suclr
<br />improvcm.nb dc nor inr.nd.d orofa.rcd lorsalc lihowcy.r.thcbuildinsorimprcENcntistoldwir[]tron.r.r,olconrpldioD rh.
<br />owi.GBuildcr willhav. rh. burd.n ofprcvins thit h. orslt nd build or implov. fo,lhc pu'losc olstlc)
<br />-l.Nown{of$eproFnr.dncr.luiiv.l!conticrins*nhliccns.dcoinrcl.rsbcornucrrhcplorccr(Sc.'r0'rl.trNtrcstnndProtsiooCodcTh.ConlrnctorsLic.nscLasdcsnorapplyroanowncrofpop.nyqho6trildsorimprov.sihcr.on anilwhu
<br />contels for such proj..G qthaConrrctft) lt.ntdpoiuintio th. Conhcrort Liccns. Llw )
<br />_l !m.xc,.fl urdrS.crion
<br />-- -.4
<br />& P C lo rlrG r.so
<br />Oak
<br />-O*nc,
<br />-
<br />WORKENS COMPENS4TION DECI"ARATION
<br />I h.r.by atfim lidcr !-En!lty ol pcrjury o.c oalh. f6llowint d.clunlids
<br />-lhrlcmdwillmrinuintccdific.t.oacons.
<br />roS.lf.lNur.rors'or[.'5conrp.ns.uon,sD'ovrd.dtubysrcL,oi]700orrhc
<br />Labor Cod., for $! pdfom$c. oflh. *..k ior *hich th. pcmnt i5 issucd
<br />_lhalcudw'llm.inuin*orl.E .onrBnssuonNurcnuc,e rcqur.dbys.dk 1700nlllt t $!tcodc.ln' tl[ })enomr$c. oi rhi
<br />worI forwhich rhis p.mirii isstrcd My wor[.r'colnpcnr ron rnsuraicc cNi.ritrd PoLicy trrmbcr aB
<br />_Erpircs
<br />\, tr s \adiol...d ror L{ \orri.kd r rl'. tmir r roi Orc [rnJ cd J,llr'' !'
<br />- /r .e,,rr r,,a ." rrrc p-r,r, .. ^rrhc *o'\ ro' s\'rh,l'tr pcm ' ^ r"..d
<br />bNmc5ublai ro rh. woltos compcnrrrion hwsolCrLfirm,a.and iSrc
<br />'hrrconrr.nsrronpovisionrof S.crionl700ollh.L$or Cod(.1 slrrll. fo !n[c*q+?zg9L- ^,,
<br />cmployc, rodiminll lEnrkr.s nnd cierl
<br />fi rcs uD ro on. hutrJrcd rhousand doLl s (1100,000), r id,l @r b rIc
<br />!h. LiLrn Co!.. ,.r.n indikm.yt l.cs
<br />is r) fvklcn ln' rrc Sc!rrnr rr)7.,n
<br />! hcrcby.flim lnd p.iahy ofp.'jury rh ld li..nscd u.dq povisior olchlpr€re(c.
<br />lhc Bulin6s and Proldions Cod.. ifd nry liccnsc i5 rn full fdcc rnd .ffccl
<br />n,l1 7-zzt-o It\
<br />lhc,.by amm undcr po ry oipcrjury rhd lh.rt le r consr!.rnrn I
<br />r$Ed {Scc :1097. Cn C)
<br />f rh. *or[ tu wh,cl, rhE Ixm ls
<br />_ R.qut.d ktt.r olNorifi €non
<br />ffirlrlr rh. rcd.rrl ,cguliti.ns rctrrdnr!
<br />$ar I hiv. r.rd rl'i ipplic.rion sd iocomfly wirh,rl Cty ond Coury
<br />dd Srnrc L!*3 rclin.B b burldin lhh Ciry nnd Counry ro.nlcr upoo lhc
<br />obovc h.nnon.d t oncn, for i p.crion p!
<br />>.:
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Underfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipeing
<br />Roof Drain
<br />Rough Water Heater
<br />P{rap/Drain Line
<br />Main Draini Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Misc
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device Evor ?ED
<br />Rough Plumbing FFA- r
<br />Final Gas Test
<br />Meter Release a;r, o-43, 2g 0, 556, ooz
<br />FINAL
<br />Notes, Remarks, Etc.
<br />Tub/Shower Test
<br />POOL/SPA
<br />L.trd.'! ^dd'6!
<br />!Lt!.|t4!.lt!a!!!_a R^rro\
<br />l)rf n)1,.n lic'nrr! A$.!bs Nlrfi crrf ,r.(1.'i R.Eu i!.'s ( f irle 40. I'r r.)
<br />r
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