|
PLUMBING.INSPECTOR RECOHD
<br />DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<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 SewerCap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />AA!\(FINAL 4rtltR b| la.
<br />N otes, Remarks, Etc.
<br />OlYNER BUILDDN DF:I,CARATION
<br />I h.r.by slttn urlcr lciul'y {,r Nrjry ih'( I n'n cx.nDl lioD rhc (i)lnrlcrof l,Ecn\c Lr'! n, rh. nrk,wn'g rN)n ( se ?0.r 1 5
<br />Busincs rfrl Piofc\{ion Cod.)r Atry Ciry or (i,umy $hich rcquirc\ x tcr.xr t. ..nntu.r, rlr$. nnlm\a. dc mlish or N'lrt rtry
<br />srrucrurc. rtu ro its issuancc. rl\o rcquncr Ihc rltlttrnr r.r $.h Frnrir r. rilc r siBncd {dcnrnl th hcor shc is liccNcn pursrn'
<br />h rhc !e,visi(,n\ ofrhc C.nta.ntr s l-ic.nsc.l tjw (Chqrrcr 9. Connn.kin! sirh S..rion 71X)O of Div^ion :l ol rh. Bu\irc\s lnd
<br />Pmlc$i,,osCodc)orlIal hcor\rrc iscxcnU lhcrcliom. d rhch.sis ror rhc illcgcdcxcllr|niinr AnyvnnarionolSc.rhnT0.rl.5hyuny
<br />apfli.rnr lar r |{iinir \unjcct\ rhc rtplic!nl b rcirilncmllro, nol nnnclhin fi!c hu rcddollr lS50O)
<br />-1.
<br />as .wncr of lh. ,,mFny. or my cnplorcs wnfi qagd as rlEn $b orylcNrhn. willdo dE wort a llr srnrrm n ml
<br />ifltcnd.d oroficBn for sk (Sc.7044. Busimss ed Profssio.s Cad.: An.Co r.cltr s Li..nF Lrw do6 mI auty lo d oqft. of
<br />rh. pmFny wtF bdiltb d ir!ftk! rtE@tr.!d en d6 sh eit hitulaor hc*ll6i $rc!!n hh 6r h$ own.nplotE'
<br />tmvidcd rl.r cuch impm@nts rc hr i.rd(h orofi..rd aor $lc. lf. tnwq. r,E l,ilding or nqrettud Li sld *irhin nE Fr
<br />ot o,{'lclhn. l,E Owmr BuiEs *ill h.w llt hntn of rrcvinS lhd lE or shc dA mt h{ild or i,r9mw lhc I,DFny for th. N,IE$ of
<br />_L N owncr oa rhc pdFny. m cxclusarcly .onbadin8 qilt licensd conrracroN ro consrtucr rhc pmj(r (S*. 7Or4. Buiincs
<br />0nd Edtssirn Codc: Thc Conlr.crois Liccnsc Ljw docs nor optly 16 uow.r ofproFnywho buildsor improvcs lhcrcon.
<br />and who contEcls lor su€h pnic.rs with ! Co.rr..lo(9 lisn*d p.srmr to rhc Contmrois Lten$ Lr*).
<br />I om.rcmD' u.dn Selion . B, & P.C. for lhE ,@n.
<br />UABtrESS:.qOMSENTAISN
<br />DECLIf,AIIO!
<br />I hncby trltirm undcr p.mlly of pcdury om of lhc followiig deltr0tioisl
<br />-l
<br />holc !tu *ill ron air a Cen iarcarc .i (.tred lo Scll.l trsurc ror sorkss comp.nsor ion. n! pmvidcd for 6y S*r ion llT(x) or rhc
<br />L.krCdc. i{tr rhc prYfo,otrrcc of r hc wor* r qhi.hrhelfnn isi$ucd.
<br />qt huvc !(l $ill roinhin Norkcrs comr.nsurio! inslraMc- as rcquncd 6y Scd n,n .17fi) o, rhc ljho, Codc. lor rhe ptrtooM.. or
<br />iLJ:'
<br />Frmjl n issucn. M,workss comtcns0tn,n imut{mc.uier andlolty nu'ntcr!rc
<br />L;t
<br />j 3i /o- )-t8
<br />-l
<br />ccn iry lhnt in th. pcrforroR. or rhc work ftr vhhh lhis lciinn k issu.d. I shall nol cmlJby 8ny pcr$n in any mnnr
<br />s as lo trarm subirl lo lhc *n c6'c.mDcnsllion laws of Glifortria. md as@ lh.l II inould lEcom sutjdr ro ltE
<br />Noltas corycnslionpmvisions ofScctiotr lr00 of lhc Labr C.dc.l sMll. fonhwilh co,lPly rilhltos lmvisions..
<br />WARNINC: alilurc lo scurc workcn omp.nstion covcrnSe is unloqtul. and sh!l| tun]ccl !n cmplorrr to simi.al Fneltid lnd
<br />civil nnes !p to onc hundrcd lhousrnd dollas ($100.(xD), in uddnion lo rhc cosl olconrrcnsllioi. drtuE* $ protacd aor lhe
<br />Sccrion 1076 of rh. I ltnr Cdlc inrcrcd,nd
<br />*". L-ts-t8 tn,
<br />Ih.rcbydftnund.rFnrlry.fFrjrryrharIr liccn{d und.r lovnn rolChprd9(.onntun.int\nhSc.ririnTUDroiDirinon:l
<br />of rh. trn(ilr\snnd l,rorlssions Co c. a nrv li.ctrs. h h tullrtic dclncl
<br />lLit'r{
<br />x ,)3 A),* /n tKo-,--)\-/
<br />qoNsraucuo!'IDNulclliElrcr
<br />I hcrchy lnnm undcryEnahy of pcrju,y lhd th.rc t a on(rction lcndinS sscncy for thc ,crtorrone of Inc erk lor *htrn rht ri.mil is
<br />ksucd (Scc. .1097. Civ. C.).
<br />AIPI,ICAIL.DECI,AIAIION
<br />I tmby a,imr und.r !.n.lly of tErjury o.. ol rh. rourw,ns dftlird ionr
<br />D.'ntln,n Prrtoirs Arbc{.r Norific,rion FL{c.dl Rcsrbri.n\ (lillct0, Pafl6)
<br />-Rcquncd
<br />l.rrcrof Norifi carion
<br />Iccniiyrhdrrh.f.d.rdlrcCul,rio.srcB$din8astrsosr.rohl,icnorat icahlc h rhi\ !mtc.l.
<br />-l
<br />ccnify rh.r I hlE Ead rhir rppltalhn a,n sl8l. rh, ih. .hovc infomiio. ii c(rcr. I 08G ro omply with all City md Counry
<br />odiMrccs lnd Shre t ws Ehtins ro buildinS.onero.rio( and lErcby rurhorizc EpGsnrllircs of fin Chy 8nd Colnryro cnrcr uton tlE
<br />!bov. mnliomd pmFny for
<br />Applirnnl or .\acnl Slxnslu
<br />/o(
<br />{-ti. fi
<br />IAPPROVALS
<br />TOP OUT
<br />lf,nds . NaR:
<br />-
<br />P.mneNm€(prlno:
<br />I
<br />=
|