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PLUMBING-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OlINT'R BUII-DT'R DIiI-CAR TIoN
<br />I hcrchy umm undcr Dcndly oi!.rjury thd I urcicnrl riom rhc Conrr{lo^ Liccnsc Lj* rur rh. n,lb*in!.ci$n (Sc.70315
<br />B!\incs\ afrl PDlcs\ion Codc) Any Cny or Counry *hich rcqun.\ r l)&nt t, .onslflcr. ,llcr. nnlr()vc, dcnsli\h '{ rcrun rny
<br />nfl.rurc. pri,trh irs issuln .. also r{quncs rhc applk r ror su.h pci,ni ro nb a sisncd ( .nnt rhrr tu or shc is licci\cd pn(lxir
<br />nr rhc prxhin\ ol rhc Gn B.k, s l,ienscd lis (chiirrcr 9. crnn Nn.ins w h sc.ri(,r 7ux) of Divishn I of rhc Busincs ud
<br />Itofcr\i,nN Cr c)or rhrrhcorshc i\ crc U rhcrcfr. rdrhrhNisl,rrhcrllclcdcxcnrpri.n.AtryviolirionofScciionT0.llShray
<br />rpnli.aDrfor r lcnnil {uhjsls rhc ipplicnnl ro i.ivilrcmlly., nor on,.rirn lilc hurlrcdJollL^ (5500)
<br />-1.
<br />ar owr ol $c rreFny. or my.mploycs wirh w.ec! a ltrir sk @nF8.lirn. wil do dE Ndk ard dE tur@t tul
<br />i.rci(lcd or or.rcd for s! (Se.?Oa4. Busimss sd Prcfssionr Codq TlI. Coirrctoar Li * kw do.. mi .rDly lo s owBr of
<br />rh. psp.ny aho hil.k or irr{,oB 't.6n, od who d6 s!:h s* himrelf or n rcror lhs$th nk or hc, owt cnplolcos.
<br />pmvid.d rhar s!.h in!ftrmnrs e mr hrcnd.d or ofieBl fd sL, U. hdsEi dE hihinS.r idprftdil is erj *iltin orc tsr
<br />of.oft{,bliorl tE O,.cr BuilLr wil l8w ih. budcn oaprcving rltrl he or stc did mI btild or inpreE dE pDnoly ld dE pn{tc of
<br />-1.
<br />as owmr ol rhe ImFny, .m cxclusivcly contadins qirh licen*d .onlIrto6 ll, d,rsrod (lE Inoirr (Sd. 7044, Busn.$
<br />.nd rt.fcsbn Codc: Thc Crnre'or's Liccnk trw doc. mi rtply ro m ownr ol0mpcny who builds or im,rrcEs rhc,eo..
<br />ond who ollnck for su.i pmjrcts *ith s C.ntmto(s) liccn$d plnua lo rhe CoorDcroas Liccnse L!w}
<br />I dncxcnu undcr Sccrio
<br />]!OBf,E8S:T!}MPJNIAf,ION
<br />DEC!.AAAIIQN
<br />I hcrcby ailinn unds lcDahy of pcrjury onc of thc followinS dslaBtiois
<br />Ihnvc rlsillmrirnonrCcnilicrlc.tc.ns nrSclflnsur.lbrsorlcG.on,nn\rrii,n-nsti('lidcdntrbrS..r(.1100olrhc
<br />lr}rtr Cdlc. turih.FrnJrnu N ofrhc work lbrshi.h rh. prn ir nsu.\l
<br />lharcmdwillnainllinworkcB.omp.f,soriooinslnnc..osrcquncdbyScclionlT00oflhcLihorCod.,forrn pc,aormftc ol
<br />ItF sort for snth dris Fmil is issEd. My wo*6' .orp.nsdio. insuM cMid ard lolicy nnmher @:
<br />-l
<br />ccnilr rhat in lhc t'c ormne of thc *o fo. shth rhis Ilcrml is nrucd. l \hrll mr cmpLy rny pcMn in lny nanrcr
<br />e 8{obNom birr ro th. mr*6 onp.osarion hws olcaliromil ad .8N ltul ifl should b.mm subjed lo r,r
<br />w.rkss.onpcosalionpDvisi.6oiSetionlT00oflhcbho,Cod..lshell,aonhvilnomplyqilhrhsphvhions
<br />WARNINC Frilurc ro s.[rd w.rkcs .o rfc sdn,r.1,vdragc
<br />ciql finc\ ut k, nc hunJn'J IhrL.Jn'l,lullr,\ '(lrxr.rxrx. 'n
<br />shrll suhjcd an dnplolcr to siminal Fmhics od
<br />Sd! io. 1076 or thc L$or Codc, i.r.Esr a.d dbrcy'
<br />DrLr- App[@rl
<br />DICIJAAIIAN
<br />I hcrcby ortrm u.dc. pcMltyollcrjury lnd l.m lietr*{ undcr pmvision ofChrpt, s (comtun.inE wilh SNrk'n Tuxl) olDivision l
<br />of rh. Ausircss and Profcsrions Codc, and ny liccnr in tull rord axl .fl(r
<br />Li..n* Cl.ss:-lien
<br />i{!u.d rsc. 1097. cir. c.)
<br />-l
<br />.cnify rhrr rhc rcd*d rcErldionr rcn,lal d. nor Jltlic,blc lo thistmj(l.
<br />!bo!c infornEli.n isconc.l.I asr. b.ompl, wilh lllCil
<br />-l
<br />ccnify lhlr I h.w rcod thh lptlicllion
<br />ordintrrccr lnd Sllrc tiws reldins h bui rcF€r.raiivd of thk Cny and
<br />lbow nE n'rcd pot ny6r
<br />ApDlicrnr or A,t$r si*nnlu
<br />n
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{rap/Drain Line
<br />Main Draini Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release )lt
<br />FINAL 4 //o//tT 2fft7.)
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />TOP OUT
<br />POOL/SPA
<br />Back Flow Device
<br />Dale .*"*".(
<br />l.n,lr,'. NJrB
<br />trdd's AddFs.
<br />-
<br />AIELIIANI"I,ICI.ABAII!]!
<br />I horby anirm undc! rcnalty ol'rrjury.ne ofrnc follo*ins dcclurrrions:
<br />Dcrmkion Pcmrnl^stEsro\ fiolilication I{neol RcBulll ions (Titk 40. Pan6)
<br />-R.qutcd
<br />t.ncr olNorifi cllbn
<br />I
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