|
PLUMBING.INSPECTOR RECORD
<br />APPBOVALS DATE ID/SIG.OWNER BUILDER DELCARAIION
<br />I h.Ehy ,rEn undo p.mxy of F iury rhll I m .rcno tibn rhc C.nrE.roft Ltcn$ raw lo. fic followinS rc&$n 15€.?011.5
<br />Blsincss ud Profcsiofl C.dc): Any Cily or Counly which r.quiEs a Frmjl lo onnruct 3its. irprow. &tulirh nr ep& uy
<br />{ duc. prior to irs issuftc. !l$ qoirs lh. agt licmr tor sh Fm ro lik ! .i8rn $.ieftfl lhlr lr or rhc k li.cn*i pur$an'
<br />lo lhc Imvisionr of thc Contmclols Liccncd L{w (Chalir 9, CommncinB wilh Sdion ?000 of Division 3 oflhc Suiincss ad
<br />Potc$ions C{dc) or rhlt hc or sk h ctcdpr rh.Enon and rtc basis aor rlE albscd cicrll)tion. Any viohrion of Serion 70.} ! .5 by dy
<br />lpplic! lor r pcm r subids rhc .pplicant ro r civil pcnalty of nor mrc ihr fiv. hundEd dollm (S50o).
<br />-1,
<br />as o,ner of rhc Fopcny. or n, emlrlorrcs wilh w!g€. !s rlEn $h ompenerion. wiU do $c wo* ard itE st^rl@ t nol
<br />inl.dL{t or on'.E{ for ek {Se.?044, ausimss and Pmfssio.s C6dc Thc Oontmclols Liccns hw .lo€s ml apply to !n o*rcr of
<br />$c polxdy wno buil& or inqmrs r,E@( ,nd pho dGs tun @!t hin$lf o, hc,elf 6r thrclgh hir 6, h.r ow( coploy.cs.
<br />Imvidcd rh{ s$h ihprowEnk e mr intnk m ofimd lor eL. lt hoMw. rh. hoihii8 o. if,proldit is eld *itlin om }t{
<br />ot $ryttio( rlE Ovrer Builds sil hlE dE tur.kn of prcvir8 drd tr or snc dn d bild or intmr Ur poFfly for tlE purpo. of
<br />l. !rdwmroaUe pnDcny. !6exclurivcly.ooradhs wirh liccnsd coln,,.!oB 16 .onndcr rhe lojdr (se 7Or4, Buirc$
<br />and Pnfcsion Codc: Tnc Conlractols Liccnsc LIs des mr q,tly lo atr ownq oftropcny*ho builds or imtovcs rh.,co..
<br />,nd *ho conmck fo, such ImicB with d Co.t6cro(, liccn*d p!nu!.r ro rhc Conulctor's Lken$ taw).
<br />-l
<br />.fl crrdnr undcr S€lior-, B, & P.C. for rhis Eeson
<br />D.t.r O*.e.
<br />-l
<br />ccnify rhll in lhc pc ormN ol th. sork for shich thh Frnir h tslcd, I shlll nol emplo, stry pc^on in nn, @mr
<br />v, !s ro li.oe subii! ro th. erlc6 con{E.sdio. k$. ofca[n,min. dd ,gN
<br />'hd irl 3rbuld bc.om hicd lollE
<br />so*6.ompcnradoopnlnions6rSdion3700oirhctjhorC.dc.Ilhall.ft,nhsnh@n:pltwhnrhospn'visions..
<br />WARNINC: ljtriluE to surc wrkcrs' comp.trsil ion covcmec n unhwtul ond shrll suhtrt on cnrplors ro dnrind FMlrics dd
<br />cDil fitrcs !p
<br />'o
<br />onc hnndrM lhouslnd dollus (Sloo.om), in rddtrion
<br />'o
<br />lhc.osl ofcompcnslion. domascs as providcd fnr lhc
<br />Scctiotr 10?6 of lhc tlhor Codc. inlcrc( lnd lllormyt fer
<br />DECId8AII{JN
<br />I hmhy .fftrr, und.r ,cndly oa Frjury rhrl I am lien$n undcrymvision of CMpls I (comming *nh Scclion 7000) oI Division l
<br />of lhc Burie$ a.d Pof..{ons Cod.. orld nry lkcrs h in tull tr.c ,.d cffccr
<br />E C/C)>7]^c/3
<br />a
<br />IOIiIiIBUEIIONIJ'NDIXI;.IG}:N(I
<br />I hcmt y trflto undcr ncnall] ofFrtr'ry rhd rncr. i\ r conslruclhn hnding r8ocv ror rhc p.rfurnDnc. ofrh. work f(r $hich rhn F-irnir is
<br />issucd iSc. :l0q7, aiv. C.r
<br />AIILICANLDECL ATIIION
<br />I k*Nbyrlliflnundcr pctrilry oirrcr}try onc ol lhc IolloqirE dcchhriuns:
<br />l)cnmliltr'n I,crnrirlAsh.!os Norilicarion lrcdcrtrl RcEUhtions (Tirlc.l(). Prnt)
<br />-Rcqunc(l
<br />lrrrcr ol N.liriclrbn
<br />l .cd ify rld rhc fddcral r.pl i l rsrdnr! rrbcno\r.ndrlarc nor {lli.rblct, rhis pir,lc.r
<br />-l
<br />ce.rily rhlr I halr Eld rhh api'lkrrion st'd srarc rh,r rhe ihok informrion iscor.cr.I agre ro @nply wirh rll Ciry and Cou y
<br />odinah--cs !.d Srorc L3ws rebri.s rotuildins nnMri.c erd h.n$y authori. rcr.*.rd iler ol rhis Cny dnd Couni, ro cnrd ulb. tr
<br />olFrc mn'nrftd Imp.ny for insFrdn n
<br />ArrDlir nl u. A{$l Silml *," F/zo/rt-
<br />UNDER GROUND
<br />Waste & Vent 1-Zs-tr x.viq 1@ azexg o* Jr{C^'\b.
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />lnterceptor/ Clarilier 1-2s-lg y-v/frd
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heatericas Line
<br />Miscellaneous
<br />Eas Service /Z-t1-tg 4czn Z</ )vL " L-l-
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release /n\
<br />FINAL ?417 U.'V-{oltJJ
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />uoxtrEf,ltloMtEltauoN
<br />DECI,AIAIION
<br />I hlrcby !finn undcr pcrully ol ll.rjury om ol rhc lollowins dcclarations
<br />I hsvc uxl sill'Mnnain s Ccnif{dc orc.n*nr k, S.l n{u*forsorlc^ conrt nsrion..s providcd lir bySc*rion 3?00 oflhc
<br />t]hd Cdlc, fd rh. pcrfonumc ofrh. qoik lor ehi.h rh. Fnli i\ n\ucd.
<br />-l
<br />h{!c rnd Nill minrain *orkc( .o,npctrsarion insu$mc.,s rcquir.d by sc.rnrn:lr()(j ol'hc tibor Codc. for lhc lcrfd.mncc oi
<br />lhc work for whih rhisFmil is i$u.n. M,worlm ompcns,rn,n insurr.c.ri$d lolicynu.$crm:
<br />I
<br />'?o
<br />Area/Storm Drain
|