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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <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 <br />FINAL <br />*\D vl{v( 'L $f,X*Lefl Bg) <br />OWNIR B!N,DT:R DI]L(ARATION <br />I hr.br afim und6 p.nahy of Fjury thn I m .rotr frcm rhc Cod..doR' ticN tls for th. follo*il€ r.alr( 70r I 5 <br />aBin*s anl PNasion Cod.): Ao, ( ny o. Counr, shi.h rdtoir6 r Fnn ro mfflrucl. dl6, improrq ddnol6h or rqFt lllr <br />situciua Fior b h! isumc.. dlo r.quir6 rh. dpplicer for su.h Fnrn lo fik s 3isncd 3!ti@dl rh.l hc o. sh. ! lice*.1 purSum' <br />i.r lh. Flvilioc otrhc co.tsrol-s Lic..e! trw {(-iaprd 9. (.Brmins wnh S(trn 7000 of Divtion I ofrh. Busins 6nd <br />Pofdions Cod.) or rMl h. or $. b .rcnpl lh6.fio'n ard fi. basis for lh. oll.s.d cxdflion Any violarhn of Sdion 70ll 5 by.nt <br />dppliclnt lor . Fhit slbjdr rh. .pplic. ro acivilpcnalryotnor <br />'noG <br />rhd fiv. hundr.d dolla(1500) <br />l. E omq ofUE FDFry, or ny .r'phtE wirh sig6 6 rlEn sk omF!.tbi. wi[ & rlE *dl ad tlE r^de b ml <br />irGd.d q ollsEd for sL (SE.?044. AuiB ed PiofdioE Cod.: Th. Coinnclor't Ltce t * &,6 nor.pgly !o a oM6 of <br />lh.FlFq wlio hrikh o iqoG rncotr rd vho doa lcb srt hiro.lf or ha*laor ltFwh hi. d lE os nn9Loy6. <br />Fovidcd rh.r sh isp.orq6u ft@r idad.ddotuld t'r..L.ll h.*tE, dE hilding or ir+.lruEi ir eld vhhi! o.c rw <br />oforlplabl\ rlE O*M Builda wiU hlE tlr hrra orFlvi!ts rha lE or ,lE di! rcl hrild d irqlE {E FoFty ttr d. Frpoc of <br />-1, <br />a os6 ofrE Fopsty, m qclddy corrrxtiB *Ih li.d4d .ottr.clN lo codrrud llE Fojql (Sd. 70lrt. BGd6 <br />srd PrDtBih Codd Thc Co.trr.loi. Licd. Lsw &6 not lpply ro o oMe of propdr, plE blilds or inprov6 lh@n. <br />,nd *tb otrnd! fo, s.h Foicl! *irh. co,nreb(r li@..d p6od to th. c.fraior'r Lt@ L.w)- <br />lm.r.mfl od6 Sdtbn .a &Pc forrhisBon <br />lo8f,E8gCAlrrENSArlO!Drcla8alto! <br />I h@b, trm udn Fllly of Fiury oE of lb. aollowiig &.LEli.E: <br />I hlE!deill m.illlir!C6ii6c.r.ofcoIgr ro S.l tEeaorw 6 @ne6s!rion. d Fovi&d fo, byS..li.i 1700 oith. <br />tlbor CoiL, tu ln Ff.ffi. oIllE mrt for whi.h llE Fnn ir isu.d. <br />I filv. .d vill ilnlin wo*d comp.sdior iGUEnc.. s Equn d by Scliot l70o of$. Lrhor Co&. for th. pafomo.. oa <br />,on iButrc. @io.nd Fltt D0mbd e: <br />,//{ <br />_ -l cdri& thar i. rh. pdioruocc of rh. *ort hi shich rhi! Fon is itsu.d. I $rll nor mploy u, ps$n in 6y mDnd <br />$ a to beorc lubjdt to th. wrkd'comFNdion LB of C.lilomi& Md isc rhar if I slbuld b..o@ ebjet to E <br />*0116' snFs.rion previsioN of Sdion l?00 oflh. Lrbor Cod.. I 3lBll. aodhwnh com9l, *nn rh.E pDvirioE <br />qARI\iNC Fnturc lo su. ertd conpdslion cov60s€ i unla*tu|. od shrll subjd e anplots lo cihin.l Frhi5 rd <br />.ivil fin.s up lo onc h!nd..d lhoutud dollu (1100,000), in lddilion rhc co$ ot .o6FNlion, drmgd a provid.d fo. th. <br />Satio.1076 oath.t bor Code inr66l ed aliorrEy s lcg.lo-/7 <br />I hatty ilIm urdd Fulty ot p6juy tha t 6 Uca3d o.d6 Foviliotr of CtrPrq 9 (@min8 wnh serih ?000) or Diviliot ! <br />of rh. B'Biid &d rbfBioa codt, rtd by lt.@ i ii tull foc !d cftcl <br />B //aoftr7 <br />*ro^r7 <br />I h@by allm unda pouh, of p<j!r, iha U@ t a @intudon knding .emy for li'. psfMc of lh. srr 6r *hich thi! Fnn i' <br />is.d (sc. 109?, civ. c.), <br />ATIIJCANI.DESJAAIIA! <br />I h.dy .frD und( p6!hy olpsjuy orc oI lhc lollowin8 &(ldalioE: <br />D.mlnion Pdtnr-Alb6rG Nolilicalion F.d@l R.auldio.r (Tirl. 40, Pan6) <br />-R.qui.d <br />tdrd of N,odf.dbi <br />wrr,ailFd* <br />I ffi <br />a. <br />Remarks, Etc.u^rrt |I .diry rhd th. a.ndrl EluhlioB E8.rdi.g ab.stos mold . nor dpl,lic.blc lo lhis pmj..r <br />4 <br />{[or'ryru t t',,. ,oa rhB "pghclhn Ei d.rhalrh.atorcinlomrrcniscotrcr I asrc ro omply \!nh aI cnr.nd ( omr] <br />lulhoriE rc?r6aialiv6 onhi! ci, Dd coury ro a's uFn tlE <br />App c.nl or A!61Sl8mlrrc: <br />P.mileMm.(prh0:/l*6 ^ Qta -/7