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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O\YNER I}UII,DI:R DIJI,CARATIoN
<br />I hrrct', rlftn rnJcr Fnrlry.l rrjur, rha' I u crcnrfl tn ihc(lnnrrrroN'Li.cn$liwritthcli)llo$in8rcastrlscc7o.rl.t
<br />Bu\inc* xl P('ics[,n Cixl.r Any Cit, or Counrt $hkh rtqutrc\ r Fnnir k, conirud. a]tcr. inrProrc. d.n,li\t or NP!tr rnt
<br />{nicrurc. rrirt, ik i\\unr.. rl\o r.qun.sihc lptlf,!trr ft, su.hFrnnr b tjlc! \hncd {rtnE.r rhrrhcor\hc i\ lic.n\cd tuAU it
<br />xi rhc povi\tD\ ofrlE Contnctr'l l,iccn{d liq (('hpr.r c. Connrcncnrg qfh Sc(ri,,n 7(]X) oi l)ivi\ion.l ot rhc Bu\i'res and
<br />Pnnt\\i,!trtCodc)or rhd h.or {t* N crcnrd thcrcfNnrklrh. h!\i\ tur lh.rlIg.J.rcn,prin, Anyvi,,lrri,,norSc.ri]n70:tl 5hyrtry
<br />!pl,li.!d ntru p.nnrr \ubj.cnrhc Jlplicnnr b aorilr{tulryolnor nkrr rhrtr lirc hurdrcd drlhr(15(,0)
<br />l. N .wn.r or rh. Jror.ny. or 6y crtlo}lc\ qrh wrSc( !c rhcn vrk comr.nsar ion. wil &, rhc r( rn]'h.{tu18 i\ rx,
<br />id.ndcd or ontrcd for slc (Se.?(}4i. Busincs and Pmnsi.ns Codc 1hc ContN,tr\ l-{.nsc h* &*s frr 0plly h mo{nrr of
<br />rh. pnpcny who hnilds or impro!$ rh.Em, rnd *b d(r. h* rhnnsclfDrh.rtlforthmughhnorhcrosnc'npn)rccs,
<br />pordql rhit \!ch mF\emnr m n, i,rr.BLd r .nrrsl rhr slc ll ho*.\ r., rtr [.i[i'rA or imln,Eftnr ir q)ld wdhh om )tu
<br />ol.u phri,n, dx Owncr auiUd *ill hrr ltr t rdcn ol prcli.8 rhd hc or \h. dil mr huiH or itrF*r rh. In)ttiy lrtr rlf luqrr{ oI
<br />l. ,s oskr of th. l,olf,n]. .n cxclu\ir.ly .onr&r in8 wirh lircn{d .onrrrcbr ft' .on{dd rlI tn,lur tsN ?ui. Bu{nc$
<br />fl! P!'Ics{ih Codc ThcConrructr\ Liccn\c l,rrdo.\ noi rpplyb !n own.r or p(,lxn, who nuiUsor nnpnnc!rhcrcon.
<br />ud rtn' conrBcr\ nn \urh IroF.( wirh i Conk{ctln n liccn\dl fu^uinr t' rhc (bnr0.nni l.ienr la* )
<br />I Jnrcrrnfl uRlcr Sr.ri( .B {PC lrtrrhi\r(n,r
<br />O$$
<br />uaSa&89.9&rtEdsArll!TECIJIAIII}!
<br />I h.Eby .mrn und.r p. lry ofFiry oB of llE folloqinr d*Lhlitrfi:
<br />I hrvc rl'ilr rMitrtoitr o C.nifi.lrc of Conenr r,,Sclf losnrc nr workcr L\,mpcn$rion.!s rmvid.d rbrbyScctnrn lTrx)ol'rhc
<br />htrtr c,tc. idr rh. pcrfnnutuc of'he *oll lor stich rh. lsnrir i\ h\!cJ
<br />I hr\cnmlsillmrinluin soikcri (omFn\rri,)n in\u.rn.c. r\ rcqoncd bysc.ri('.17(x).1!tu fatln Cod.. l()trh- pcdn E(..t or
<br />rh. sor[ hrwhichthn p. nil i\ G\ud My $orlqi .onTLtr\rrn'n in\r']tur.rd'cr !{ F,li.ynun$ct{rc
<br />N icrr r" St CEru -.,...-\.\.r9r_
<br />-l
<br />ccnifyllEl in lh. lErformrc of rh. work tor *hkl lhn Frf,ir i. iisu.d. , shnllnol cmploy lry pcaon in lny MM
<br />s s ro tx.om rubr.cr ro ih. m*6 onp..sdion laws oac.lihmio. atn asr thlr ia | fi)uld bc.om suhj.rr b tll
<br />wltm.omFdsiionpbvishnsofS.crionlTmofrh.LrhoCod.,lshalt.fonhrnh.oflplr{irhilrEp,nvishns..
<br />\c.rk{ ro76.lrhc lntin(inl..'nl.r.{rtrtl
<br />i.t aal ,\
<br />f,TKTIfATTU D[rr,\&ula)
<br />I h.Eb, lrtrm undd pcnllryorrErjur,lhd I am liensn undcr F)vi\n,n or Chapr.r I (.omtrEmin8 with SNrhn 7(r)) ofDivtion l
<br />or
<br />'ht
<br />Bu.ims snd Pn,rcsions Codc, ,rn nry li.cne t in tull foN anl cfi'6r.
<br />lo,><1*'1
<br />,",.APR 1 0
<br />tlllsllucuoNrEdlrNi-AliEltl
<br />I hcEtry!ftnund.r F-ulryol p.riury rhm rh.r. i1s L$n{tulnn ldin8 u8cncy lor lhc pqforumc drrM work for *hi.h lhh Fmii is
<br />kucd rss. 1097. cn. c.r.
<br />A$IICANLIII:ILAIAIION
<br />I tr*ty dtian uM.r pcnrlty ol pc.jury onc ofrhc loll{i*ins d.{larJrt,n\
<br />O.n,lirnt Pr \ A\hno( N.r ill.dnrn l;.dc(l R.3u hr tr{s (l irlc .l{r, Pln6)
<br />Rrqutd lrrr.r or Norll.rrrnr
<br />-l
<br />ccnity rhar th. fcdcal rcrlbrion\ rcs'rdins a\tx or rcn,v m mr amli.lhlc lo lhn pmj.rl
<br />-l
<br />$nily rh, I hrvc rad lhh ippltalion !d st!l. thel lh. trtrr inrorBliotr t cord.I .8.6 ro orillly wnhallCityo Counly
<br />,,tl rnrr\.trtrl Sr, . |.'*\ rtlrrtr'!n8 ..Nlrucrio., oid h.r.by .urhori,. Rtr.*nr.Iir! oa rhh Cn, rrd C.u.ry lo cnrd lrDn th.
<br />rbov. mnlioxd prcFrly fm
<br />Appli..nr o. AE€trr siaMr LP,9 I rn ?01n
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />ltrlain 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 -yon(StSt
<br />Notes, Remarks, Etc
<br />r.,r"yr,.r.., - *N0\r.rc-ot?4 o?u ea*.
<br />Y."*nru,
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