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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OI+'IIEI BIJILDET DELCARATION
<br />I hmby .tfrm undcr pcndly of Friury lhll t m c,cmpt fon ttE C.nlr!.roB Lic.n$ ljs for lh€ follo*ing Eren (Seroll.t
<br />Bushcas and Pmfc$io, Codc): An, Cily or Cou y whih rcqlircs a t,cflnil to onslfu.I. all6, inpmw, &mlisn o. spC, uy
<br />srJu.turc, prior ro irs hsurrcc. ile rquirca rhc !!rlt! for ruch pcmi lo fih 3 signcd sflcmnt ttul lE or sl.. i liccn$d ,lrsdt
<br />ro thc pbvl\io.s olrhc Conrmlols Liccnsd tiw (Chlprcr L Conmming wilh Scction 70m olDivhion 3 of lh. Busiocsi ed
<br />Pmfcssiotrs Codc) or Inll hc or shc is crcdfl rkefroh and llE basis for rhe dleged crcnprion, Any violarion of S6thn 7031 .5 by e,
<br />amlicanr for . I'.mi sbi6rs rl* appli.anr ro ! civil p.nalt, of mr ftr Od aivc hurtr.rl doues {$500)
<br />l, !s owtrcr ol rh. !tu,rny. or nry .nrdoyccs s nh w!8cs r! rhcir {nc d,nrpcn{( ion. will do lhc sorl ud rh. srurh s fr
<br />il cRlLn or ontrcd li,r {lc lsa 71r{l.llusims sn'i lirolcsion{ (itrlc: l hc Co.t crtr \ l-i.cn\c ljw docs nor drply to un otrncrof
<br />thc pm!.ny who huil s or iNprorcs rh Eu. and wln dos such sor k hirnscll or h.rclf or rhouAh hk .r hcr osn .frpk,ycc\.
<br />trcvidcd rhrrsu.h i'npmvc'mms rn 0or iirdnLd or oafctod fr srlc li howcwr. rhc huiklirA or improlcntnr h\rldsirhironc )tr
<br />oiconDlction.lhcOanerBuildcrwiuhrrcrh(hurdcnolrnlirrn hco!shcdidfl srild or in{,nrvc rls pop.nli Id rlr lixr|FEof
<br />-1,
<br />as owtu olrhc lopenr. d crclusarcl, .o.r,cring sirh lien-d .onldo6 ro onstrucl llE l,oj.rl (56. 7044, alsirc$
<br />and Eoftsrbn Cod.: Thc ConrRrols Licctr* lj* d6 mr .pply ro M o*rer ot !Dl.n, who buil& or ai!revcs lh.6n,
<br />a.d who .o dck for sh Fojecr* witt r Comdor{9 licr*d puBunl to ltE C,nlftlols Lietrs L{*).
<br />I rncxcnrfl u.dd Ser
<br />Ilrr.hyrfln r Dful.r pcnalry of tlcrjuiy o.c oar
<br />-lhr\c
<br />rrl willnun lin ! Ccn irErc of O,n{nr k' scu l nsurc lnr *orkcr' com!.n$r tr,n, $ pr,!d.d rr hySelion l7(x)oflhc
<br />Ir$or Codc. {ar rhc Fni'nMn.c oillE work r'or $hich llE Fnnir is hsucd
<br />I huvc and willmlinhin *o!kcr! cor{.n\ ri(,n in\orrnce, r\ rcquncd by Sc.ri.n lTmofIhc l-aborConc. nn rhcF iornEncc of
<br />rh. work nrwhhh rhtFrnrir is i$uc{ Myworkc( c.mFn\rtion i'Nu$n..c,nicrmdrolicy,umhcr ire:
<br />_I.cnifyrhol i.rhc p.rtoim,kcoarh. work tiJr *hich rhh Frnir h issucd.l shlll nor cmployonype&n in.nydannfi
<br />$ ns ro bcc,m sul,ict k, rhc *o (crl comDcnsul ion laws of Caliibni!. and as@ lhtri if I should trcoft snhj.El ro rhc
<br />*oric6 co,npcn$lion polnions ofS€lion l7(U oflh. L.bor Codc.l shnll, rodhwhh.omPly wirhrho* Pmvisions..
<br />iTARNING: Failne ro sm mrtfi( .omp.ns,iion srcr0Sc h u.luqliil. dd shnll subttt an onplortt to dai@l tEmlri.s a.d
<br />.ivil lirc1np to ore h!.drd
<br />'houund
<br />dollar$ (Sl nerion. dlNscs r! provided for rlE
<br />sR ron .1076 of rh. Lf,hor Codc, olcr
<br />.",., g - 1-o-\1
<br />I hcEby arrm lndcr lcoaly oa Frlu.y dBr I @
<br />of lhr ausimss dd Prcfdsion\ Cod.. and ny
<br />of Chft.r 9 (comminB wnh Sdioo 7000) oa Divi.ioo l
<br />CI,INSIBIJCIIAI{IENIIIIC.ACENSI
<br />IhcEby Ii,nlndcr rEnahy.tFrj!ry rh rhcrc isrconntudion lcndin8 r8.my f.r $c pnlornEmc ofthewo* tnwhichihis Froi n
<br />ksued (Scc.109'7. Civ. C.)
<br />AfILI!:ANLIIECIASd.IIAN
<br />I hcEty llim hdcr pcnllry ofp.rjlry onc or'hc followins dccldirnN:
<br />hnrlnion PcrnrirlAsbc{os Nolificarion rcdcol Rqular ions (.Int 40. PJn6)
<br />Rcqun d L.llcr ol Nolincal6tr
<br />-l
<br />ccn iiy rhal lhc fcdcEl r.Blllrions EgsdinB astEstor rcmlal lrc nor applicabL ro rhis pbicr
<br />-l
<br />*nify rhar I larc rcad fiis,pDl rlE rb.vc i.nnEl ion is .o,Nr. I tr8@ ro coq,ly Nirt nll Ciry anrl Counr,
<br />ordi'rnr.\ rnd Srarc l:'$\ rclrr nurh.ri& rcF.*ndiws .r rhis Ciry and Coonry ro cnrd upo, rlt
<br />$ove mmioncd pop€ny fM
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />FINAL dlltll$at Ll-ar*t,r,r -1,P1U\Notes, Remarks, Etc rl
<br />Lcnd..l Addrcs
<br />-
<br />-"' €z2O-tG
<br />UNDER GROUND
<br />Meter Release
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