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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIINl]R BUILDTJR DELCARATION
<br />I hcr.b, rltriin under pcnalr, ()f Frjury rhlr I nfl cxcnlfl lnin rhc Colllra.ttri l-iccn-^ Lrw hr rhc iollosins rcd{'n (Sc..7011 5
<br />Ausincs{ lnd Pn'fcsi{rn Cbdc): Any Ciry or Counly which rc{unr\ J lfrn h .onsrrucr. alrcr- inrPrrc, dcnDli\[ or EI{ir nny
<br />nocrurc. r.ntrb irr issu(Rc. rlso rcquircs rhc aprlira ror $ch lrnnn tu filcr sisncd ndcmnr rlu h. or \h( i\ liccn{d Pur\u,nr
<br />b Ihc nmvisiou ol rhc O'nlrocr,\ Li.cn*d LrQ ((hrl)lcr 9. Conrmcmin! rirh sc.ti,rn i(xx) of Divi\t, .l orrtu susin.s\ ann
<br />Pi'fcsliotrsCodc)orlhlrltor\hcncxcnlllhcrcironondlhcn!si\rbrrlk,ll.scdcxcnUtion.Atry!n,ldn,nofS{rlon?Oll5hvanv
<br />rppliu tur tr Firnn strbllcls thc llplic! n, acililpcnulr!oinor iitrcrh,tr filc huMr.ddollaF(SJ{x))
<br />-1.
<br />ns owoer ol rhc prcpcny. .r fly c.ulolccs *irh wlscs a\ rh.n vnc .o llf,nsdion. Eill do rhc *trI ud rh. nmruE ii tror
<br />inrcndL{ orollerdf,rsLrS.r.?0+1.Bu\inc$rndl!rrc$i{,n\Cod.ThcContrcktr\l,icen\cljwdo.snorlpplyx'un.s.rol
<br />nr pn)rdy who builds or inumr\ rh.fr,'.,x1sho do.{ suc[ wnk hnnrclfor hcr\clror rhhu8h his nr hcr own cnrrh)y.cs.
<br />pruviJcd rhrr\urh i'nrn,h'rnr1 rE .or i cndcrl orafilrcd n, q'lc ll h.scvcr, rhc hrikiin! r nnnnvcm.r i\ q)kl sirhi .n( )tir
<br />olconrnhrion. rhcOwmr Aui crwillhrlt fic hrdcn nr rmvi.8 rll[ h.orsh.dil 'x, hxildori'npmv. thc pmPty lor thc puqx)* of
<br />-1.!so*ncrorrhcptu,r.y,!rcrcl'Nivclyconlruclins$irhlicc\cJ.otrlrrctoFro.on{tudrh.Pn,ic.r(Sc..'7or1.BNi".\rdd Prri$iotr Codc rhc Conrra.kn s l-ic.nsd lrwd.cs nor aflrlyh !t o{ocr of nrrFdy rln huildsor nnDrcvc\rh$..n.
<br />and *ho conrrirr\rar\u.hfn,j..h sirhrConlsclo(\) liccnscd pursud turhc(]'nt!cn,is l,itti\. Lnw)
<br />_l !m.xcrpl undcr Scclio A & P.C lor rGi.nw,n
<br />Dol.r--
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<br />Owner:
<br />WOf, I(FIiS' COMPF^ISATION
<br />IECIdIAIIAtr
<br />I tftby s,Iim !n hr p.mlty of FFry oN of th. followin8 dctls,ra.m:
<br />-lhrvcd.dwillnuinhin0CcnificutcofConsnrt'Sclflnsunfttrw.tkcsconPcnsnrion.aspt'vidcdf.rhrSeclioi.lT0)ofrhctihtrGxtu, nlr rhc rstutuftc of thc solt forwhich rh. pcrmil is h\xcd
<br />-t hevc and willE,inIlin worlcB conpen*ara.n i.!umcc. rs rcquird bt scctioo 1700otin llhorcodc. fot thcldiolll@cof
<br />rli"al-My sorkd .onpcnsrion insuramc c!rt, dd Flk, nrnrh(r se
<br />?\i (e \\'t-rK
<br />w o tl
<br />-l
<br />enirt i h{r in rhc r. ortume of fic work ror which lhis r.rnril t ksucd. l shull not .mplot any pcron in .ny @mr
<br />e us lo bccom sulijd ro lhc qorkcs'comtcnsslion lsw! of Cllifomil. ,nd ,g@ lhll if I rhuld h(toG slbid lo llE
<br />$oiidl comFnern,n povkions of Sdion l70O of lic L.lnr C.d.. I sh,ll. fonh*ilh comPly with lho$ rmvlsions .
<br />WARNING: Faillrc ro s.urc workcrs'compcnsolion colcEsc n unhsful. rtrd $all subjccr 3n 6ploycr k, sininll ncnohics ,nd
<br />b oft hrndrcd rhou{nJ doll[s (SlO{).o(x)). i'r 3ddin)n o rhc danEgcs as pmvidcd for tlE
<br />:luc 6 il Ttt'r.
<br />I hcmt y .nirm uDdsr pendry of Frjutt thol I m ,fChrfln 9 (commrcins wirh S.ctun 7tD0)ofDivkt,n J
<br />ot rh. Bxsims Md Pmfcssions C:odc. ,!d my lkcnp k in rull Iorc ud cfccr
<br />G'^nro q'\'eoQ
<br />lIo rulu.on,""oo"
<br />coNs-l RllcTloN I-FNDINc A(lIiNCl
<br />is\ucd (S.c .lr)97. Cir C )
<br />AIS,ICAILDEILAX{UI.IN
<br />I hcrrty aJiitu und.r ,.drlry ol pcrjury orc ol rhc nrLrwins dslnrn! ions
<br />Dcmlition Pcrrnih Astrios Nolificlriotr Fcderal Rcs!lorioi\ (Tirlc40, Pd6)
<br />_Rcquilcd lrtrcr.f N.rifi cdrhn
<br />-l
<br />ccnilyrhlrrhc lcdc ral rcsuL r nnN n8onlin8 {strno\ rcn&v0l rrc or amli.trhlc ro rhis Irmjccr
<br />fFr *n'rr,no, tt^" -l,r'^ JmlrrDn xl nr,c,hr rhclhovc n'ronn,iiotr i\cotrr--r.l lgrNr..omplywirh lllc(r!turcdutrrv
<br />odinomci and Shrc tlw, El,lin8 lo boildins onn
<br />rhovc Bnriomd DnDcny to, insp.dion DUrFEr.
<br />Aptll.anl or A8enl SIAno(uE
<br />-""iJ{ffe"1$'"P-*'''^
<br />UNDEB GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underf loor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trapi Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Linei 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 />Rouqh Plumbinq */f /t,6 ,a<r
<br />Final Gas Test
<br />Meter Release
<br />FINAL f{ub/r9 5\)€6
<br />Notes, Bemarks, Etc
<br />t i&r's Addrsr
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