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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OI!NER BUII-DI'T DELCARATION
<br />I hr.cby nfln : uM.r |f,nrlr! rl lcUury lhd l r cx.nr l'rnrn rh. Connrntrr l-icci\o I-Jtr fd rhc lnll(ising rc{{in isc.?0.115
<br />au\lnc{r rDd Pnntssior C,xlc): Any Cir, or Counry Nhich rcquirc\ r I1r.[ nr ..n{rucr. rlt.r. inpn,ve. d. trnnh or ruprr rtry
<br />srn(trrc. prin lo irs i\\u!rcc. "l\, rqunc\ihc rtplicr r r{tr \uch p.nni b illc r silrcd {ilcnEnl rhir luor shc i\ licci{d NBUaN
<br />r) rhr f,n'risidr\ ol rhc Cotrhcrtr \ t-ic.nscd l-trw (ChrIrq 9. (innoctui'rg sirh S..rim ?(Xx) ol Oivisn,n .l of rhc Bu\inc\\ rid
<br />l'roli$i(i trs Codc) orrhnrlRorshc irckrnrrr rh.tufro rri(lrhcttr'\i\nYrhcrlL8LalcrcuPrion Any!iolxrionofS..rinrl0ll56yrtry
<br />xfplicxnr nrrFrnnir $hjc.( rhc lptll.rnl hn.ivil|ImIy.l not morc rhan lir. hu rcd dollr\ 1151x)).
<br />-l-No$n$otrlrcpmncny.rtrn,ycrpl,))rc\wirh*!8.sn\rhonvtu.n{cnlrrnnr.qill,lnih.so
<br />ndrlt{Muctiur
<br />imc .d oronircd tur{lc(SLa 701-1. Bu\i,rN\..d Pn'fcrsi,* Cndc t hc Conr(ttr \ t.iccnsc uw doc{ nor lflnly lo u o$nc' ol
<br />rlf, |r)nMy wh. Suild\.r i'rrR,rts rhcdnr. alx,{krr{kh$1)*[nn\clforhcrscllorrhrcughhisorhcro*nc rr]oyccl.
<br />!rcvdcd rhd \uch implovcnrnkrrRn in(cndcdoroll.rd fitrslt ll k,qcvur,rlr truildiqoi iupmrte-nri\snd wirhinonc rir
<br />of.onlnldi,[ rlf OwMr Buildct q'illh!i! rh. hrlcn ollmvnl.s rh[ hc or \hr Jil tror hxild or iq)hv.lhc i'mFnr lor rlr purFJ$ of
<br />l. sowmrofrh. FmFny. !mcrclusiElyc,irEctinS wnh lkcn*n coirr&ro^tooin d ltE p,sid (Ss.7014. Burifte
<br />and Pnltssbn Codc: Thc Com6croas Li.cns Law docs .o' omly lo an o*
<br />$d sho onrmls an suh roj.ch *irn ! Co turo(, ltcnrd ,{Buurr
<br />Serion- B. & P.c' for $i
<br />D"r" g Z ,?
<br />I hrrch, dfinn undcr p.n,lryofpcduryorc ollhc {l'llo*inr
<br />I hrv. ,,rl pill
<br />'Minrdn a Ccnilicarc rI Conscnr b Sclfln\urc nn wor*.6 c.mpctrs,tiotr.0s tovidcnfori,yS..rionlTtn.lthc
<br />ljbor Cnlc. for rhc ldroi,nftc ol
<br />'hc
<br />wor* for $hiih lhr ncnnir h is$cd
<br />Ihrvrrndwillmrniin!,rkcriconrpcnslli(,nin{u,!tu..tr{rtqundhys.Eri{r3700olrhchborCods.forrhcp.YfornMcc.f
<br />thc work lor ehichtht pcnnir is i\nin Mywoiksi conrFn\arion inur0ncc .nnicr md tolicy nu'lbd dc:
<br />Policy Nunrbc!:-tit,tcr
<br />-l..nityrhrr
<br />hrh.,'.rformrmcoathcvork for enich thisfrmir h issucd.l etull tul lmplotanypssn inanyMtrr
<br />$ N !o h.6nE subjccr ro lhc wo*dc con{.nsar io! hws 6f Cclifomid. and a8rc lhd if I sl"ould hccod subje.l lo df,
<br />workdc .ompcnsalion lmlisn,ns of S6lion 3700 of rh. tf,ho, Co<tc. I \h,ll. lonhwilh clnply wirh llr)* Pmvirions .
<br />WARNINC Fflilur. tu surc workcs'conr!.nsdion colcrulc
<br />civil fincs u, io onc hundrcd rhousnd dollm ($100,fir0). in lddiion ro rh.dunBacl ss pmvidcd lor lhc
<br />Codc. inlcrcsl lnd otlnmy'sfccs
<br />g 7 lr
<br />I hcEhy rllnnr u cr pculrr or lcrjtiy lhtrr I dn li.ctr$l und.r t,ni fl ofChlprr9{con@ncins whh Selhtr 7000) ofDivtion:l
<br />of lh. Busircss and Pmlcssions Codc, dxl nry liccnrc i io tull nre dt cflir!.
<br />gaNSIS!JCIT(!N!I:!DIXCA{jEIqI
<br />I hcrcby lild udcr p.itrlryofF.jury lhir thsc n a.on(d.tion bnnirs aEcn , for (hc r.riormtncc oilhc work f{, whi.h rhis Fi,nn is
<br />issucd (S.c. 3l)9?. Civ C ).
<br />illu( llfDI(Idt/rUQf
<br />I h.trt,yrljiruurls p.nrL{l rl firNrt otrr ol rhr n)lIr\ ir! dc!lnrnr on\
<br />I).tr!)lri( l'crNi!t^\h.\l r N.riii.r i{r I.Jcrrl RtJ:tr[r(nx llrrlc J{r l', r6i
<br />Rc!uircl l!n.rol Ndiliurh
<br />I .dify rhar rh. rcdcol E8ular ions ESarditrB &rbcsros rcmrat arc rei dpPlrlt k ro rhis I,mFl
<br />-l
<br />enify rhlr I nok rad $is qDlk.rion .nd 3lat lhel lnc is corer I +d b.$nply wirh 0ll Cirylod Counr,
<br />ordimBTs ud Starc tiws Ehring ro hildnrSconshcrio(rcIrc*nrali\rs ofrhis Cnylnd Colnly ro c.rcr uF,n lhc
<br />rcPcny tu iNPccriln purF,*cs
<br />Applionl or,\I.nl Si8mlrm 7
<br />TYLET LlDo^_J
<br />€t7
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rapi Drain Line
<br />Main Draini Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool HeateriGas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release I
<br />FINAL 4 //// lt --*
<br />-ffi.|
<br />Notes Remarks Etc
<br />Area,/Storm Drain
<br />Tub/Shower Test
<br />Gas Service
<br />I
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