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PLUMBING-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS <br />UNDER GHOUND /...-\ <br />Waste & Vent '1-Z-l-lg 0il"74 <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT .<\ <br />Waste & Vent 1-/r1r x.tLA\h,wWater Pipino 1-211r <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 Pipino <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 />Rough Plumbinq <br />Final Gas Test <br />A <br />FINAL It -il-lv **ha <br />Notes, Bemarks, Etc. <br />OWNIiR BU II,I)FJR DEI,('ARATX)II <br />I hcrch] nlltnr utrd.r pcmlry,)i r.rjlry rhJr I a crcnr|, non rhc (innrkktr{ l.i..n\. ttrw n, rhe iollo*in8 rcu$n (sc.70]l5 <br />Bu\irc\\ iNl l,rof$\i,,n C,xlc) Any Ciry or Counry trhih 'qunc\ r Fnnir kr (otr{nt t, tlrcr, inrPorr dcff,lnh or eI n rn! <br />{tudDrc, pri{nt, ir\ n{rrn.c. rh rr\turcs rhc E,!li.d nr nrh Eimir ro lilc! signel srar.mnr rhrt hcor\hc ( li.ciscd txrltrrDr <br />l. rhc prcviriqr\ oi rhc C{'nlrrckn \ l-iccn\cd l.r* lchrprcr 9- Co n r .trrg sirh sc.riotr ?(XX) .f l)ivisthn .l oi rhc Brsi"c\s ?n <br />imh.rnr f(r rNrnln (uhjccr\thc {'tii.onllo !.ivil|tnalryoln.rnErhrn firc hu drcddollr^(S5(m) <br />_1. ns owncr ol rhc r!'Icny, (tr n,, c rd.!cc\ sirh w.e.t r\ rhcl s.rc .orlrcrslliotr. rill do lh. &rk lnd rhc {urE i\ dur <br />irdrl.d oroncnd lor eL 1se.7(l1.1. Business 0trd Profclsion\ (odc: Iic (bnlncnn \ Liccn\c Lrw docs nor DI'dy ro oqmr of <br />rhr pmpcdy *h) l,uilds or iq,rort\ rh.B . and shl) d,*\ se h tr o* hnn\cll or hc.sclf o' rhoulh ht or hf oei cmDloycc\, <br />trtivnkJ rhd such i'npmh'mfi src nor inrc L\l or ofiarcrl i(r sL ll howctla. rhc hui[ling or iqrrorcmii i\ srld lirhir .m Fr <br />ofconllcrion. lhc Oqncr l,uildc, will hrrc rhc hur&. of pnvins llBr h.or{hcrid en huild or in{,(,vc rc pDp.ny tbr rhc purr$ or <br />-1, <br />as owns oirnc Impcny. an crclusilely contBdins *irh lian*d conr&roN ro 6.shcl rlE ,mi{ (Sa. 7044. BBiisr <br />ad Ptotush. Codc: Thc Conrreloas Licensc trq doca not lptly ro u owns olprop.ny who builds or inprovcs ih.rcon. <br />Md who .o nck for sNi Foj(lr wnh r Conlncro($) liafl$d F.Ru ro rhc Conrddois Lhen* bw) <br />-l <br />m cxemfl un<ld SdbL-_- B. & P.C. for Ilis nsn <br />D e- Or..rl <br />UOBtrEIII:IIIIIfjISAIIAN <br />DECI.AIAIII]N <br />I hcrcby aflnnundq rcnahyof ,6juryo.c of rhc lollowing d..lmti.ns: <br />-lhavcarnsiumi <br />dn a cenilEat. ofcons lo Sdfimrc for Erk6 or{E$iriotr &r Fovid.d lo! hy SrI-on a?(}) of lh. <br />kbor Codo forrlE Dcd(rue of rh4 sdk fo. whih tlr r*mil ir irsuen. <br />I h0vc rnd will ,nriDtqin wo*crl conFisalhn insomncc, as r.quncrl by ssri.n .1700 of thc t2bor Codc. for lh. pofomftc or <br />rhc work for whth thn Fmir is is$cd. My *ort6 coryEnsd io. inslmne .di.. ,nd Iblty nuhbd rc: <br />Polq Numbd:-Erpmr <br />-l <br />ccaily rhat ii rhe Frlortuncc or rhc wo* ror whi.hrhis p.rnn is i.sucn.l sh0ll not c.lloyanypc6on in lny @mr <br />$ as {6 b..dm subjccr ro rhc workfis sqrn\{lion hvsofcalif{,ni0, und asrc. rhlr if I slblkl tEc.m cubjccl io lh. <br />w.rkcr'contrNarionphviii0n!ofS.clionlTmoilhctlhorCodc-l!.h,ll.foflfi*irhonplr*ithrlhe <br />WA|NIN(: Fi'ihm h o.nr. woik.r'is unhwl'ul- nnd shrll subjccr an cnDloy.r h aiminal <br />nion Io llr co{ otcoqEoslion. daEgcs as <br />llt;lr ltilllor <br />I hcNhyrlllrmunds Nmlryofpcrjory rhJrI rm liccn$d und.r troriln ofChiDrd 9lconnNncirs $irh sccrirn70( )olDivi\iotr l <br />of lhc Bust$srnd P('lc\sionr Co,lc. rBl nry li.rnsc is in tulltu(trndoll.ct ? <br />I hcreby olfinn ultr.ls pcn.hyofFrj!ry <br />h.ucd {se. 3097. cie. c.). <br />ion lcnding tr!.n , ror rhc lcrlornuncc ofthc work r'.r shkh ihh Fnn ij <br />A[[!IqANLI)EC!A8.EUA! <br />I lxl6y rninn rnd.r pcn,lry oapcrjury otrc ol'hc lollowirS dcclnrari.trs: <br />DcnmlirionPcrnrirs AslE\ros NorificIionF.dchl R+nhion\(Iirlc40. Pd6) <br />-Rcqun <br />d lf, rrc! o, Ndifttiioi <br />-l <br />ccniiy lh.t rhc fcdcmlr€Buktn,ns rsedin8 asbcnoi rcnmlalaE nor lPp <br />sril. thd rhc drw info.mrnrn is coriEr. I acrc ro <br />,"*n*qi"y1" <br />APPROVALS <br />Water-Under floor <br />Back Flow Device <br />Meter Release <br />I