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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNOER 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 Pi ptng <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />P-trap/Drain Line <br />Main Drain/Pool Pip tng <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanita Sewer/Cap <br />Rough Plumbin g EXt )IRED <br />Final Gas Test <br />Meter Release FTU I ZUIg <br />SAMC 8.4J <br />FINAL <br />Notes, Remarks, Etc. <br />OmB-Build. Del!.ti@ <br />I tcby .mm a.Lr pcn.lry ofpdilr, t.r I @ .xdpt foin $. Cot &tor' Licar. trw fd th. followirg rq.6 (s ,0! 1.5 B6ins <br />ltd Prcfaiod C.d.): An, City 6 C@nt, which ..4!i6 r pqlitr ro cdlrrlcl dt6, inli.vq dsiolist q rcDsir ey lruc1uc. pnd 10 iB <br />iau$@,.1$ EquiB dc qdian la tu [ tpfin ro fl.. rigtd s6r.lMr thlt t. q thc is lidscd puBudr b ln. proviridr of th. <br />Colanor's U.d.d bq (Ch+r6 9, Co@ocin8 wilt S..rion 70oo of Dvirion ! of rh. Burincss ad PrcfqiN Cod.) or fiat h. d <br />shc h cxhF 6.'!frdI .nd thc h.it f6 thc dl.i.d dhRico An, viol.tion of Slctiod 7031 5 !y Dy .ppli6r f6 r Fnn lubje6 $c <br />appli@r io 6 civil Fnahy of nd mort thlr fivc hudrld doll6 (1500) <br />_1. a owno of $. Fo!.ny, d ny dtrployc wni w.e6 s rh.t solc @p.nsdon, *ill do lh! vort od lllc strucle is nol inm&d <br />o. olt r.d ld !.1. ( se.?o.r, Bsine 6d Prcfstid C.d. Th. conMt Li6rc tr* d6 nor spply ro e om6 oa$. proFny <br />who build! ( imp.ov6 thaw, ad who d6 Buch wo.t hid.lf d h@lf 6 lhrc!8h hL 6 hd oh cmploy6, Fovidd $ar 5u.h <br />improv@ol! e rct i.End.d o o'Iacd for sal. Ii hovdd, th. building 6 inDrovdot ir iold widin onc y@of 6mpl.lim, rhc <br />Om6-Buil<td will h.v. th. buda of provirs $d hc d rh. nor build d imFlvc ror $. pu.p6c of $lc) <br />_I, a osd of ll1. ptDFny,6.,Glsiwly @ib.cin8 wirh licdscd cdrndd to 63Eud d. pmjccr ( Se 7044. Bsinas adlroldie Cldc IX. CoEeror! Lic.M t do6 not.pply be ownaof prDpqty *hobuild! d imFov6 rh.eo, &d who <br />olr&ri fd iuch prcj€E pirh . c6r&r6(.) lic.nr.d put!&r ro $c cdrndor,r Lic.E kv ) <br />_l m cxmpl e&r Setid .B tt P C. for thk r.lron <br />WORKERS COMPENSANON DECLARATTOI\ <br />I hccby lffim udq p.nrlty of Fjury 6. ofrh. followin8 d.cl@rions: <br />_l h.v. ed *ill m.iitain . CcrificlL of Cor r ro Sclf-ldw lor qdt n'cdF edio,, s provid.d a6 by S..rio, 37oo of fi. <br />L3bd Cod., f6 tic pdfdfu@ of th! wr fG whid &. Fmn ir is.d <br />_l hav. dd wiu mint i. rut6' ffiFtu ,li6 inlilme, B rcquiEd !y S..ti@ 3700 of thc t bo Co<lc, for rh. D.rforns.. of $.,o* td whid $ii p@i( it i$u.<L My p6t6' Mp.G.don iisuE@ .Eia ed Flicy nunbq e <br />('t1!h grioi ic.d <br />J^o^,^ <br />.or h. @mpld.d if th. p@n h rorOi.hudr.ddoll6 {1100} 6ls) <br />rhc p6fome@ of rh. wc* for whi.h rhis ,.mn E tsucd, I shall <br />bcffi. subjet ro th. *0116 ' compollrio l.B of C.lifmi.. dd agrc. lnar ial <br />700 of rh. L$G Codq I 3hrll, ldlrih/-o <br />WARNING F.jhE lo scuE sorl6' @mpcnsario @v@e. i! unl.efd dployn !o qiminal p.nalti6 ed civil <br />finB !p lo on. hudi.d thMd &lls (tl u1,000),in .<tdirio to thc .061 of conposadm. d,m'36 a provid.d fq lll. SEiio to76 ot <br />th. llhd Codc, inr6r Dd tnmq.! f€ <br />I h@by !trim ut!.r pdrlry of pcjuy 0rar I m tioroa uar prcvlsimf Ctrapra c 1 <br />lh. Buir6 ud P,of6ri@s Cod., ed Ey licos. h in fdl f@e sd ctlccr <br />tl-o <br />I h.rcby 8fiim undd pdalt, of Fju.y dd 0!@ t a @iJrrlaio lmding aaa.y fn $. p.rfommc. of rh. wrk for which rhis p.mn i5 <br />issu.d {sd 3097. Civ C.) <br />APPIJCANT'S DECLAIIATION <br />Dcnolirio. PmiE,Albeld Notificdio 8.d.Bl R.8!hd@! (Tnt. !0. Pln 6) <br />_ R.quircd L,nd of Notifidio <br />Cny 6d Couty ro drd uDon 0E <br />rbovc Mti6.d Fop.riy Ir iNp€lid <br />Q -(1-o/ <br />r <br />POOUSPA <br />Back Flow Device <br />D.L: Ownd: <br />Poliry Nmb.r-Erpn6 _ <br />t <br />= <br />= <br />= <br />=