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PLUMBING-INSPECTOB RECORD
<br />APPROVALS DATE COMMENTS OI+]{ER BUILDER DELCARATION
<br />Ihmbyalltrmundd p.natly of p.riury lnd I m.rcq,| fmm llE Conlrsclo6 Licen* ke lor lh. follouing @sn (Se.7o:ll.t
<br />Bliincss and Prolb$ion Cdc)r An, Cny or Counrr ehi.h bqunca a Fmn r. @mtucl. trllcr, improw. .hmlish nr rct.t lny
<br />srncru., prior ro irs ksum. lts Equircs rlE st pli.er for srch Fmir ro fik a sigrkn sl.rctufi ln8r lr or dr i.! lietr$i pmMt
<br />ro rh. rm{eions ol tlE Cont6rn'i Licc.sd Law (Chaprci 9. Co.mMin8 wiri S.clion 70m olDivision I of thc Business sd
<br />Prcicasions C.&) o. rnar tE or snc ir cxcmpl fi.E om md thc ba\is lor thc sllcg.d crcmplion. Any violalion of Serb,n ?0:l I 5 b, sny
<br />.r,plic! aor r Fmil subj€ls tn lppliclnl lo . civil p.mlly of ml mt lh.n fiv€ l ndrEd doll&s (S500).
<br />-1.
<br />$ o*tur of ftc l,mDcny. or dy cnplorc.s eirh *!g6 $ rh.n tuh orwnsriotr will do llE *!* &d dE,tture k hl
<br />i.t ii.d or ofr.nd aor sh (Sa.7044, Busims ud PrDf8sions Codo: Th. Cnntr cltr s Li€enk L:s dfti ml aprly ro { ow of
<br />rhc pmp.ny rho t !ild\ or nrqeB oE@n. ,rd sho des $.h e,t him*lr or h.Nlf o! thmu8h hh or ner own cnployccs,
<br />provid.n rhd such inprcwmrrs m mr inr.nd.d d oFcrcd atr slc. l( hoi4w, dE t{ildine or in{reEmnl is $ld whhin om )dt
<br />orconplcrb[ Ur OsE auihs will hrw tlE hrncn of preving lhd h. or dE did ml t ild or anp,Dt dE FoFly frllE ou.p@ol
<br />-1,
<br />os owtur of lhs [roFny. !m 4ctusiwly .onrrdhs *irh lienscd d,nreroF ro consrucr ilE Foid (Sc 1044, Bisinc$
<br />and hnrsion Codc: Thc ContBclols Li.cnsc kw docs nol {,plyro 0n owns oiprotcny *to huilds or inptuves fift.on.
<br />rnd rho aflrBclsfor slchpoJ€rri wnha Conhcro(s) Iixns{ pu^@r ro rh. C. r&lols Larns Law)
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<br />nnricnrfl uodcr Secl
<br />SI}Bf,E&T.COM}jBIAIIAN
<br />DECLIIE.{IION
<br />I hsrcby !flirh undd r,cialry oI D.riury nrc of tt tollowinA de.lMtionrl
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<br />hav. ud will roinrrin . CEnifglc of Conscnr ro Self'tnrurc for wrtss cDmlcndion. $ povkt.d ror by Selion 37m ol lhc
<br />hhor Codc, for lhc pcraornua of lhc worl fo *hict lhe rcmi is nsucn.
<br />-l harc and will maintain *ortcc comi'enslron insurarcc. as t€qutcd by Sstion l7{)0 ol rh. L$o, Codc. for lnc l,crfomme of
<br />lhc Rort |rlr vnkh lnis pcnni! b nsucd. My n inslrarcc .sicr aid policy nnnbcr ec
<br />I ccnify lhar in rhc p.rfornurcc ollhc Bork whrh rhir ncirnil n tsucd.l shlll not .,nploy rny pcson inmt rotrcr
<br />$ as ro hcom suhjecr to rh. krkc6 hwsofcaliromin. Mdngmth,r ill should tEom sublccl to rhc
<br />$o er cotr{Ensrion prcvtionr of Serion ]7m of fi. hlitr Cei., I shI. nnhwnh conl,ly *ith llxrs tmvtion\
<br />W RNINC: Failurc ro {curc *ortcn cnnpcnsorion covcflsc lubjd & dntlorr, ro niminal Fmlts md
<br />ciyil fincs up to onc hundrcd tlDlslnd doud (Sl0{).000), m irion ro rhc c t of onp.nkiiotr. d,m8.! .s prolld.d for fic
<br />Sc.rion 1076 ofrnc btIr Codc, inrcr$ ann arronrcy s fccs-UtzLe
<br />I2|z!-tsll&5
<br />I heEby lrrmurdo ncn.llyotperiu.y rnd I m [en*n und( p,oaiiton6fchap'c 9 (mllm ir8 wilh Selion 7000)olDivisbn 3
<br />ol th€ Busirc$ a PmfcssiorN Codc. anl my liccns is in tull iorc md
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<br />EQISIBTIIQIIIN,III1;-AC!.IIL
<br />nlLrd lS.. 1l)'rr, (-'\ ( )
<br />^-EII]qANI-DECL
<br />ArIllAl
<br />I lrr$ltrllinun,lor lknrlry oi prrtur t oflc nt Ihc irnloqirS d..lmrn r{
<br />l).i liri,ni l'cnni( A\l1io\ Norili.rrn hlfial RcSulrri,ni\ (lirlc.l0. Pda,
<br />Rcqrtcd lxrr.r of Norifi cdion
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<br />ccnilyrhd rhc fcdcral rcSulorions rcSardin8 0rtEsros emvdorc lorqrpliclblct, rht l1n,j.ir
<br />yvv
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<br />cnity rhor I h8le Ead rhh rplkarion did qddhd thc .!or. infornDlion ii oE<l. I l8re lo 6trp1, wnh all cny lnd colnty
<br />odinaft.s dd SioL Liws rlorinS ro bfit<tirB otrriru.rir .!n tEEby aufiodr EncFdrtik. of ths Chy ]d C4nty lo cnl6 uDon dt
<br />rt vc mntrncd prcFdy for insFdirfi purporci
<br />^-r*", - ^*, *^*7--: z 4 -** 8JQy'za
<br />rrlnlte Mr tDtlnt):
<br />UNDEH GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Boof Drain
<br />Bough Water Heater
<br />POOL/SPA
<br />P{rap/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 />Rouqh Plumbing 9"4-tc K,V.M
<br />Final Gas Test (49-ts "\.wL)
<br />Meter Release x
<br />FINAL 1-lg-/g Y-W"il
<br />Notes, Remarks, Etc v
<br />ID/SIG.
<br />Tub/Shower Test
<br />tJndc' .\ Ai]Jr..
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