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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain Drain/Pool Pipinq
<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 />Meter Release I
<br />FINAL
<br />Notes Remarks
<br />-+
<br />OtryNI]R UUTLDIR DI'I,CAR TI('N
<br />I hc.ch, alrtr urdcr Il.nalr, {)a Ptrjrr, rhar I m cxenr t'rcn rhc Conrrlct,i l-i...\c ljs for rh. r.lk,wirt rr.$ (sc.70rl5
<br />Bu\nr\s tr l Prcrc\\idr C, c) Any Ciry or Coxnry which rcqutc\ r plnnir r, .onefl.r. 0hcr, nnF)vc, &mlhh nr ENn rn,
<br />nru.ru.c. rior k, irs issuan... als lcquircs rhc,mli. l ror u.h,rnir k,6lc 0 ri8,rd nllcnrnl lhll tror shc is lien\cd pusxnnr
<br />b lhc pn,vkions olltE Conlnckr s Liccn\cd lrw (Chrfler 9. GnlnEncins sirh Scclion 7{xx) ol l)ivi\ion I .r rh. uusinc* rnd }
<br />Pr)lcs\n'n\ Cod.)orrharh.or\hc i\ercrlr rhcrc116mrnd rhu hr\is rurhcnllc8rdcxcnfrion. AnyvidarbnotSccriorT0-1l.5hynny
<br />+pli.rd tur ! lcnnn $bjNts rhc lpnliclnr b n .iv il tEtrrlry ur tror nnc rtu 6vc hutulr.d dollrs (Ss(xr)
<br />-1.
<br />3s owNr .f lhc pqany. or ny cq,loye. wi$ v.86 B rheir sl. co,{Ers.lion. *ill & th. vrt 3tn llt srtutua ii rcl
<br />inr€rxLd or ofcrcd for el. (Se.?044. Busin.s end Professions Codq Th. Conrlctols Liene kv &cs nor opply to e owNr of
<br />llE FoFdy who huilds or iqmw llEen. rd wlb d{B sh wd( hinsclf or lEElf 6r rlhusih his 6 h.. own .m0loyes.
<br />pbvid.d rhar such innbrcBnlsa mt hl.ndorofi.Ed ror elc.If. rb*.w. tlEtdildin8or iq,oEft it $ld ohhin orc t4&
<br />ototrtkrio.. tL Owrtr BtiBd -ill h& c hd.nofrwii8 rlEr,rc or dE dn
<br />'Dr
<br />hild or i!IDEllE popory lor tr p!ryos of
<br />_1. {r owner of rh. pep.n}. u .r.l8it.ly orlhdine }nh li.cncd .orrr,.!on !o snmd ltE poj€l (Scc. ?044. Burimi\
<br />arn PlDfsion Codc: Tnc Conlmlols Licens Llw docs mr Dpply ro eowrcr ofpmpcnysho blildi or imnr6v.r lhdmn,
<br />lnd *no onrErs for sh p6j$rs *i'h a Coirhcro(9 lieisn IlMn lo rhc Co.mdof i Li6!c t s).
<br />-l
<br />om cxcmpl und.r S@
<br />SO3f,E8!:CO'TPJNSAIIOB
<br />IECI.AMIIq!
<br />I lErcby affirm ondd Fnrlry of Frjury otu of rhe following dcchrtions:
<br />Ihrv.undqrllrui nin a ccniff, colCotrsc ro Slll: lNurc i{tr xtrkc( conrlrcnsaln,n. rs ptrrvidcdlorhySt.rii,n:l7(x)of rh.
<br />tjb.r Gtl!. trrhcfcnnnMn.c ol rhc work for*hi.hrh. |fnnir ( irsucd
<br />_l hlvc rnd sillmainrain so ch .onrpcniarnrn inslmhcc. as r.qoncd byS..rioi lTmofrhc Lrbor Codc, for rhc rcrformncc ol
<br />rhc w.rk tff wbth rhi\ F.rnir is issu.n Mt wort.B .r,rqrnsario. inurdm clmic. and Iblicy nu'nbcr m:- AoN R'* *tue<
<br />7- /-dot?
<br />-l
<br />ceailythar inIhe pcrfortunccoltheao,k for$hkhrhh,'.rm is nslcd. l rhlll nor cnploy 8ny !.Mn in trny manrcr
<br />$ as ro tEom slblr o rh. soltes @nqE.erio. laws orcslifomin. ud lgB rhar ill should tE om subj.rl lo lh.
<br />wortcB'conp.nraionpoviriotrsofS@rionlT0OolrhcLaborCodc.lrhall.lonhwilhsnlplywirhtlhspmvisions..
<br />WARNING: FriluE to $curc wo*cis' conDcnsol ion ovcmsc h unlawfll. and sh(ll suhltr 4.mplorcr to rimiml lrMhi.s ond
<br />civil ,ncs up ro orc hundrcd rhous.d dolks (3100,(x)0), in lddiri.,n to rhe co{ 6f coDlr(stio.. drm8.s as proviicd for lh.
<br />S&lion 3076 oI rhc Lihor Codc, inrcdsr lnd ! or*y s fccs
<br />t hwby .flnn undcr p..dty of p.+ry rhll I m lien$d'uds povisio. of Cha?rd 9 (ollftfting with Sdb. 7000) ol Divisio. 3
<br />of Oe BuriBs lnd Prcfca.ion! Codc. ,'d 6y ltco* a. h tull foe d cllel.
<br />B 3/
<br />D!lt: !7-/0-/6 c.*""",o.,)(
<br />CONSTRUCIION LENDINC ACANft
<br />I hcrby lfm uixlcr pcnrty of FrB, thrl $R t . @.sodbn kIding lgcmy tor llE pqfo,rr1lm of ttI mrk for *ht:h lhii pcdn L
<br />ksucd (Scc. !0r7, Civ. C.).
<br />APIIICANIDECIABAIION
<br />l,rrbyaltimu $ pctrrhy ofpcrjry otrc ollhc lolhRnrS dcclanlions:
<br />Dcmolnn,n Pcrntrs.Asb.$os Notiicarion ltdcral Rc8uldionr (I irlc i0. Prd6)
<br />-Rcqurcd
<br />Ilrrc. ol Nor,rmtion
<br />-l.cnilylhll
<br />thc ltdcral rc8uhtn,n\ rcSt ing isbcno\ rcn!)ral Jrc nor lp!li.$[ b rhn pm.J.ri
<br />:r(affiu,.,,r.^"*.t'rnrnnri.dn,nrdnrc,h,hcatrvcinr'onnrtiii\comcrInsmbcohrry*irhrrrciryrndcou.ry
<br />,nlfian(\ n'klshrr lr!\ Nld,n! ri hu'ltltri! !',n{fl.ri '.aJhcrubyrtrrhori2crcprc\cnrnriuc\orrhi\CiryrndCounryrocnrcrulr)nrhcoh)u n*nri{ucd Ftr,pcny ior irspccrn,n
<br />,1pDliotrl or A8enl Sigtrolurc -/?
<br />VSM'AEW)W
<br />Waste & Vent
<br />Fill Line/Back Flow
<br />Final Gas Test
<br />Etc.
<br />""'", ' 7'/0'/9 Appriorr,d
<br />IrtrJ.''\ NJ'r
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