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PLUMBING.INSPECTOR RECORD
<br />I hercby afirm undc! Dcnally ol pcrjlr, lhrr
<br />OWNER BUILDEN DELCAN,{TION
<br />I rm cx.m nom rh. C.nrrroF Lkcn* In$ i.r lhc lolluw'n8 rco$n 'Ss701,.1
<br />susir.s ffil Pu,tcsn C(ie): Any C y or Conrry which rcqun \ a lirmir lo .on{fld. rlicr. imlrovc. dctrr'li\h or rc!'tr rnv
<br />nflciurc. pri(n k, irs h\u.trcc, !l*' rcqxrcs rhc {plic ir n, \!ch Itnnir k, lilc r \i-!ncd {rrcNnr rhrr trorshc n lrcn$d puru!
<br />h rh. 8)vnnnN o{ rh. Cont&lois L,iccn{d Liw (Chrflcr 9. Co'ndc'{i|8 rirh secrk TLOJ ot Divirt{ '1 ol
<br />'hc
<br />Btr\inrs\ ind
<br />I,rolis\iurs Cod.) or thrl lEorshc iscrcnu rh.rclio a rh. hj\is lorrhc alLscd cxcmlrion Atryvi.hrhnolscdionT0ll5hvrny
<br />drplicrnrlarrpcnnilsubj((rhcafPlicanrrord!ilP.nrxrofnormorcrhrnlivch( rcddolh^(150o)
<br />-l-
<br />0r otrtr.r orrhc nnrNny. {r 'nyc rPloyccs wilh sngcs !\ rh.n vnc conrFisdiotr. Billdo rh. wrk !M llr (tururc i\ nor
<br />iorctrdcd nr.fiarud tui;b (sLt 7tx,l. Bu(incs\ md Prnt\i(,r Codcr Thc c.nhclois lj.cn{ Ijw docs.or ipllvlo onowNrol
<br />rhc pqrtry slx,t ild\ .r inDro{s rhcEnr. uxl $h. d,rc\ \sh kln( hNtcll or hrrtlr or rhnm3i iis or hcr o$tr ctnPlotc's'
<br />p","i r"l rr,u .u"rr imprxrmnr\ dc tror intsl.d or olTddl n* eb ll howc\tr. rhc hu i[ing or i'ntrorc@nr i\ v)kt u ilhin on' ]u'
<br />;I cunrlclioo, rhc ow,trr Buiklcr *ill hrvc rlE hudcn ol F)vii! rhd h. or slrc did ton build or in n'v' rhc ln'Flr lor rhc FrPo$ ol
<br />I. N owi.r ol lhc pn'F-.nt, nn cxclusivc It contacrin8 snh li.cn{J .onrrcron l. o.nod rlI PreF.r (S" 7(}{'{' Businc-
<br />,M hrli\sinr Codc: Thc Conl.lckn \ Li.cn\c Low doc\ frn alplyto rnown.roflrn)tl.nv*ho btrildsor imPrortr rhcrcon'
<br />und sh. co nclsiorsnhtrcicdswirhnConrmcro(s)licctrscdluAoilk,rhcConta.roirLtcnseljs)'
<br />D.r. ov.er
<br />B & P C. torrhi\ r.$otr.
<br />ullEKEIl[!0lltENlArlsN
<br />IhcrdbynnnundcrNnrlryorp. j,.ynn""rrr,.rotrn*inel-18*ffi
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<br />-lhrlcdndqillntrinlainaccdii.llcofconscillosct|Insulclor*orkc{onpcngln'n'N'mvidcdforbys.ctionlTl]0oflhtt bor Co{u- r'or rh. rdfonMrcc ofrhc wo.r ttr which lhc Frnir is issrcd
<br />ffi"" *, * ', ."t.t *,,.*ch co'nli{ ninr'.n
<br />'n\umncc.
<br />os rcqui'cd t'y sslion l7O0 ol thc kbor Cod. for lhe pc'lormi'c 'f, {urr ni which thi. nu"nr's racd MJ *orLh'..n[$\Jltr,n'r\ur,trcc (Jnicr rd rlrv numhcr m
<br />NIE)ta4*-,b '/2" lty
<br />-l
<br />lcnify rhar in rhc p.rfotruncc oflhc work for which rh! P(. r is issucd.l sh,ll
<br />s !s ro bc.om subjal lo rh. mrtcs'comp.nsario. hws of C.lifomix. Md !8rc lh8r
<br />workca srncnsarion INvisions ofscrion 1700ott titx, OnqI shll. fon,Niih
<br />T-T - |'-
<br />r .'llnl^ydny nth.n i,,"n! m mn
<br />ii l\h,uld h+o!m sxbJc.r torhc
<br />.onpt, wnh rno$ l(rvisions..
<br />WARNING: FaihE lo sw wodcB' comrc.slrio. svcEEc is unlrwtul. $d sholl subidl m dplottr m gimiBl llcolrhs md
<br />civil ainc. up ro onc hlndrcd rhousnd dollos ($lO0U)0). in oddilion lo thc cosl of comp.neliofl. damg.! !s Prla'd ror th'
<br />sc.rion lt)76 ulrhc Laho. Codc,
<br />"",..,x/qlt <L zinrcrc,r and auofty\ fcs
<br />Appliconr)4
<br />-T-I'
<br />usEN$ED-coNrBAlfua, DICIABAIII]N
<br />I h.rby !fiim undcr leolty of p€+ry lhrr I !m lieBd lnds Pbvkion olchrrld
<br />of rhc Burilc$ aId Prcf.tsioB Codc. sln my lhcnr B in tutl lorc ed cftd.
<br />aDDliLrnr or Altenl St*nslu
<br />9(.onmncin8 qnh Selion ?000) ofDivision l
<br />?
<br />slrNliltr!!:rloN.LlllllNli-eoElcl
<br />I hcrcby (lltnr undcr p.nnlryolPcrjry rhrr rhcrc is !cor{rucri,n IcnJirB :t8e&, liJt rhc tcrforlM'c ofrhc sorl li'r whi'h rhh Fmir ir
<br />i\srcd (S.c.3O9r. Ci! C.)
<br />Lrnl.r'\ Nam.
<br />tJndd'( Addr.$
<br />abovc mnriomd pmp.ny for insperhn pu4x'*s
<br />APPLICT{IiT DF(ll
<br />^R
<br />TION
<br />I kfthy dlinn undcr pctrrlry.lPcrjury ooc orlh.follo*in3 dcchrlrtuns
<br />Dcmolirnrn PrnftyAsbcnos Notiiclrion lcdcml Rcgulerions ( lillc40 PM6)
<br />-Rquncd
<br />t llcrolNorifttrrion
<br />Fl ccni8 lhar lh. tcd.rll rcSulanonr tsgldin8 asbcslor Fmvtl e mt
<br />0(-l enily rh.r I rEvc Esd !h!
<br />'pprh.rior
<br />urd
<br />'r,rr
<br />rhd rh. ahov. inromr
<br />iftin!ftc( &d Shl. L{w! Ehrinr ro buildins consd.rb,L !d hcrcb} lulF
<br />applhahlc ro rhh pmltd.
<br />ion n.orer. I aF.{ bcomdysith d[ Cnyund Coutrrl
<br />.izc rcFEsciraiivcs olthis Cilyrnd Counlylo cnrcr uc'n th
<br />DATE .lEIG.COMMENTSwUNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Rouqh 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 />Water Service
<br />Lawn Sprinkler
<br />Sanitarv Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbing
<br />Final Gas Test
<br />Meter Release
<br />Notes, Remarks, Etc.
<br />K
<br />s
<br />APPROVALS
<br />Tub/Shower Test
<br />Gas Service
<br />FINAL
<br />--)
<br />/d ...,,,",."Y.
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