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PLUM ING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMEIITS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent ?--1r-lcl lz-LA7
<br />Water Piping 2-26,11 Lc'zrl
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test 21f -/q Ea Zit
<br />Rouqh 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 />Gas Service at'r-? .26 .t1 (-c- z 17
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Devrce
<br />Rouqh Plumbinq
<br />Meter Release / /
<br />FINAL 4ht l/4 PLqt2fa-/-ol
<br />Notes, Remarks, Etc
<br />OWNER IITIILI}ET T'EI-CARATION
<br />I h.rcht allto undcr lxnlh, or |rrJUr, rhar I rD urcn,Jn lirnn rh. (i'nti.ru^ l-icrn{ I dq f.r rhc lollowin! rcasnr lss.?0ll 5
<br />Busi,,L\s and ltorc\li,nr Gnlc) Any Cny .r Couiry *hi.h r.qtrn s i Fnnir t) . nsrr.r. .lrcr. iD|tovc. dcnElir[ or rcP3t uy
<br />(rurhm. fllorro ts ($rcc. d$ rcquncsrhc rmli. trr tur surh Nmi o lllc r (i8rcd {llcnEnr rhir tu.r \hc n li.cn\cd pursunnr
<br />ro rhc prcrisionr ol ihc Conrrrcntr s I-ic.n\cd lr,* (Chrtrcr 0. (i)m!r.n.in! sirh scdn,n x[x] of Division I ol rhc Bu\nE\\ nnn
<br />d,rpli.rdniattchnn\uhtccrtrlt,ppl].nnrrod.ivilt^*n!kyormrnnncrhtrlivchunllr.ddollnr\(S51x))
<br />_1. {s own* of rhe nrcFny. or ny enplo}Bs wirh $gcs a! thcn sb conD.Nstion, will do lhc vort und lhc srcl@ ir nor
<br />inLrxk trod.ed for sl€ (56.?044. Busin6s lnd BofcssionrCodc Tlrc Co rsrol! Ue.* hw <ro.s mi l!pl,
<br />'o
<br />o owrcr of
<br />rIE tmFny sno hilds o. Lr{,ows rtEsn. dd who dc sh wd( himsclf or h6*laor $F!gh hk .t h.i ow..mrloyei
<br />pmvidcd rnar such inlroEftnrs m n.t inicnd.d .r .trc'st f.i sh. Ir. homwi lh. tnildin8 or ir{,mmnr h sld silhin onc Fd
<br />ofsnpldhtr rlE Owmr Builhr wil h.rc rlE bord.n of proving th.r lE or dE dil mr b{iu or inpr.E rhc pmFdy lff th. purpor of
<br />-1.
<br />.s owncr of thc l,oFny. am crclrsiEly onEacrins *nh [cctrEd .onreb6 b onsLlct rrE troj.rl (Se. 7044. Busircs
<br />,rn Protlssi, Coder Thc ConrBcroi s Licc.$ trw des ml qT,l, to e own.r of prc!.ny sho blild. or ihpoks rh.rm..
<br />lnd who snlnds for s.ch pmjats *ilh a ConrBclo(t licenscn p!6u ro rhe Conrrrctm s Liftmc bw).
<br />I u ercrur urd.r S6tur ,A.&P.C.lorlh Eesn.
<br />UOATESS:.(;OITIINSA.IIIIN
<br />DEq.AAAIIQ!
<br />I hcrcby !flifln undcr Fnohy of lisjlry onc of lhe followin3 dcchftlionsl
<br />I hnv. dkl $ ill rniNrin r acn licnlc ol Con{trr lo S.ll lnsn lnr qrlrku^ comNn\xri,,i, a\ tR)vid.tl lar h, S.dlion :17(} I oi rhc
<br />Intbr Gdc. lnr rh. p.rlnnnncc otrhc qoA Ibr whicl rhc p.mrt N i\sucd
<br />-l
<br />hovc ahd will nsinrain *utcn compcnsalion iNrarcc. !s rcllircd hy Scciion l7(D .fih. bb.r Codc. for rlrc !.rfo,mre ot
<br />thc work for *hich rhn pcmit is issucn. My aolkcc .omr..sarion insurarce .da.r &d poli.y numb.r ml
<br />PolirY NuntEr:- Ernrcr
<br />_l enilyrhat in rhc lj.rfomENc or rhc wort ror whichrhisFrnll k issucd,I sholl nol employ !n, !.r$tr in lny @@,
<br />$ $ b h.\Tm subjcd to lh. wrtsj ompcnslhn hws of Cllifonio. and lrE lhlr if I .houkl b.com .ubjd lo llE
<br />w.lts om,,.nsaltun tmvisions of Ssl ion ITOO of lhc Lllnr Cde, l slEU. f.nhsirh 6mplt w,rh rh.{ povirhnt..
<br />WARNINC: Fdilur ro *m sotkc6 @mFnulioo corcag. i! unLwtul. snd shrll su6jrcl rn cnpblr to diniMl pcetis &d
<br />civil fincs up ro otu huftlcd rhoo$nd doum ($100.000). in addirio.lo rhc cost of.omp.ndio4 datugcs as polidcd for lhc
<br />Ser io. 1076 of rh. Ltbor C.dc. inr.e.l and .llorcy\ res.
<br />lhlr, ,\ppli0nl:
<br />UCIINSILIaNIIACIAB
<br />DECI.AAA.IION
<br />I hcBby rlbrrxndn tr.mltyofpcrjurt rhr! I a liccnsd undcr provision olChaprcr 9lonmnciig {irh sc.lirn r00o) olDivntun l
<br />ol rhc Bu\irc$ond l}otsnrBAd.. rnd'ny li.crs. t ir1 tull laNd .llarr.
<br />CQNSIAIJCII3}NIINOITG.ACII.C1
<br />I h.tuhy afinr uMcr Firlryofpcrjury rld rhcrc is a.otrsrudbn lcndi.s lscrcy ror rh* pdf.d,,m. orrh. work lar whtrh rhis Fiint is
<br />is\ucd rscc 1097. Civ C ).
<br />Attuc rfDlrclrtf,allllN
<br />I hNiy Mnfl uMcr !<ruky ollE jury orc of the rbllowins dcclmri(n'\
<br />D.nr,lnion P.nhn\ A{rn.s Norific.rn Fcdcnl Rc8ul.rids (Tilc,ll), Pan6)
<br />RcquirL{ lrncr of Norifi .irbn
<br />-l
<br />.cnify rha nc lcdcBl rc8ulorions rcgrrdins asbcstos rcmvrl !,c .or atplttrblc ro rhis pbirr
<br />Applic. or tsetrtSi*nnlurel
<br />Miscellaneous
<br />Final Gas Test
<br />Co m.lor:
<br />ttr1.,1.''. A,lJ'r$
<br />I..niftrhd I lBm rc:drhn 3flrltnri,nro i3rr rhd rhcxtx'!c 'innrdnr i\.orccr lrsRr,,conrplytrirhLllCirylndcornrr"
<br />odnr cr!ri SrrrcL's\ftlarin!k)burldnr!.on{tu.rbn.drdh.rcbtr rhorizcrcnr$ iriv.\{,lrhkCilyflCntiryt,cdrcru ntrh{
<br />abvc.rnri,nNd prop.ny n)r in\|*di,nr pu'poscs
<br />I
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