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PLUMBING.INSPECTOR RECOBD
<br />COMMENTSAPPROVALSDATEID/SIG.
<br />UNDEII GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<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 />Main Draini Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release I ,..,N
<br />FINAL WI )
<br />Notes Remarks, Etc.
<br />OWNER BUILDEN DELCARATION
<br />I lEcb, .f,irm undtr Fully of lErjtry lnal I an cx.npl fiDh rh. Coil do6 Ltcn* Ljw lot thc following Easn (Se.7oll.J
<br />Alsinc$ lnd Prolcsshn Codc): Any Ciry or Colnry which rcquies . lrmn lo .onsrucl. .116. imrroiq d.mlirh or EFn 4y
<br />(tuctrrc. pri,r ro its isiu c.,lsrcquiF.rn .rplka fo.3kh Fmil lo fiks sisRd nlrcmnr rhll lE o, d* i lienFd FUNrnl
<br />ro rhc,ovhions ofiE Conr&rofi Liccnsd t s (Chrpr.r 9, CommminS lirh Sftlion 7(x)O of Divi.i.n I oldE Busi*3s.rd
<br />Pof.$ions Cod.,6r thd lEor slE is cxctr{,r tlEcliom. rhc b,sis for rnc rllcled d.nDlio.. A.yviol,lionofstrtionT0Sl.Sby!i,
<br />a,,Ilicrnr for a l,cmh subists thc lmlics ro a civil !.elr, ot nor mE rhu ,ive hundEd dolles (t5m).
<br />l. isosnc'olihc pr)Nnr, r r.xchtriv.ly .ollirNr n+ *nh lr.c0{.(l u{n.rtr k, dnr{td rh. proId r Scc r(!-l.ltr*itl\
<br />rnd rvho cont&r\li)r\u.hpnlccrssirhaConr.rcnfl\rl'ccn\cd!trhtr {rJrhcC,nnracrtrsIiccn\.li*)
<br />I rmrxcn,pr ufrlcr Sccr
<br />woxl(Ens' colllPFNsaTl(lN
<br />DECIdBAIION
<br />I hmby aftlrm undcr !.n*y of p.rjury om oalhc fotlowinE d(hnlions:
<br />IhrvcandwillnEintrirrCcnific.lcofCo.s.nl!,Sclf.lnsurcibrworkcB.o6pcns iotr..s pruvidcd nxbyScction lTmorrhc
<br />Lh,lBitr, h rh. n r,nnrrncc al rhc w.r[ lnr trhEh rhc ,lcrtrnr r a.ucd
<br />Z4 rro' c ura *irr -, n
<br />"
<br />rn *-lcn cnmlcn\sr
<br />'on
<br />in\urrrc.. rr r.quimd hy sccl ion lTtD oa rhc khor C.dc. io, rhc p.rtorrumc or
<br />sut/7va v /- t -zt
<br />-l
<br />.crrify rhrr in rhe perfoosftc of rhc qort for etth rfii3 p.rdn ir i*ucd. I shdll mr .nUby .ny pcrsn in lny mnmr
<br />e !i 16 lism ruhif,r 16 rhc s*.8 @mpcnrdion hws ofcrlifomi& !.d l8r lhtl if I stolld tEcom .!bi{! ro ttr
<br />so*s onpenerion povi\b.s of S6rhn lT00 of U. tjhor Cod.. l sh,ll. fonhwilh mndy {ilh lltc PDvirio$..
<br />WAXNING F.iluE lo surc hrtcs' mnDcnsslion ovcnsc is !.la{aul. und shlll sub.ic.r an mplortr ro ftinrindl lcnlhis and
<br />civil fin.s up b otrc hundrcd lhouend dollas (Sl(x),(rr0), ifl addnbn ro
<br />'hc
<br />on of .oflr,. nsal ion. damScs N,troeil.d f.r lic
<br />Scction .1016 oi rh. titxtr Oxjc. inrcrcsr nod omy \ res Z; A,*/ -?t- z<)
<br />U!lL\!!l!.]A!d-
<br />Ihcr.byrllr nui cr |xnnlryoftctu.yrh I am licctrwlund.r pnvi\i(nrofCn!n!c.9lcomnricin! sirh sc.rim 7000) .l Divisi.n l
<br />of thc Bu\incs Md Pfl'tc\si,,i\ Cod.. d nryli.cis. n in rull ftr.c md cffccr
<br />C c2?>a{
<br />D^,.. / - zt'26
<br />CONIIBUCIIONIIN]UNG.&GENgI
<br />I h.oby ifllnn undn ,rMlty ol l)(rirtry thd rhcE is sconsrruclion hndins lrcocy tbr rh. pqrDnN.c. olrhc wurk ror whi.h rlk Firnir is
<br />nsucd lscc :1097, Ci!, C.).
<br />APPI (IANTDI'(]I ARAII{IN
<br />I br.by rninn u Md lrfr lr! of l'.!ury icor r r(nk)trnr! dc.lnrdion\
<br />I)cn!n(i,rn lti,nii\ A\h.\ro\ Nor'll.rri(r Fr crrl Rogohri{ N l1 [.10. I'Jr)
<br />Rc0uncJ IrI.rol Norill.rrir
<br />I.cnrlyrh rhclcdcrilr.AUlrri,, \rrg dirershc(o!rcNnrlrr. NrrnflicrhL. n, rhn p(,jc.r
<br />rho!. nrnrion.d pmr^-nr lnr iisFcrnnrlurt,s$
<br />Appli€nt or Agent Signnlu C (on q.D-/ -Zg-zo
<br />gtflfltlllNEttT L
<br />Orn.r:
<br />c*'*". /=%
<br />Gas-Underfloor
<br />Miscellaneous
<br />t,
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