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DATE IDiSIG.COMMENTS OWNER BTIII,DER DEI,CARATIoN
<br />I hc.chy alltD unncr pcmhy {,f pcrFry rhar I c\.nDr lnrn rhr Conrract,r' l-i.. s. tja nn rhc rhllowinr rcrsn (Scc 7{r.ll 5
<br />B!\n$\ trtrd Pdi\\n,n ci d) Any Cny .r Cdunrt $hich r.quir.\ r Firnir b con{nr.t. ,lrs. nnororc, dcmlish or Etratr liy
<br />slru.lurc. t,riortu ils issu,trcc,.ho rcquncsrhc ipnlictr tursuch0cnDirro lilc0 s srcd ( cmnr rh3r lror\nc L hcnscd Nhuir
<br />|o rhc pmvi\ions ol rl.c Conrrtrctr's l.iccn\cd taw (Chrplrr 9, c(,mltnci,rg wirh Sc.rion 7UX) or Divhion I oi lhc Busine$ lnd
<br />nppli.rnl ttr J Fnnit sub.,cctsIlN rprrlicinl tor.ivilNnrltyoIlx-'I nmrc rh r fivc hund'rd dolh6 ($500).
<br />-1.I
<br />owa of rhc,tuFnr. or m,.rplotEr shh wre6 e. rhch slc.onFrdion, will do llE sct a,n Eilr8re k tul
<br />inrci'd.d m oddrd fd sL (Se.?O44. Busire$ ed PrDfcssions Codc Tlr Cldrrrols Lirn$ trs &e ml rrply lo o owmr of
<br />lh. pmldy whot ild3 or inleK ih.6n. rd who do.s *h m* hiNelfo. h.Mlf o.Ihrcugh his or hd o*n crploy.rs.
<br />prcvided rhar sen ihnhrtunrr e mr hrod.n or ofrcEd fdeL.lt ho*lE. rh. brilduE or inFtMlml is $ld ehhin oE )w
<br />ofsq,hrhn. 1h. Owmr Builhr *iI lErc lhc hord.n of DmvinS ln,l h€ or sh. did ml hild or irpro* fic FDFny f.( dE pu.F$ of
<br />-1.
<br />!. ow.cr ol lhe I'Dpniy, am cichsiEly conrradins qirh liccnsd conrreron h onnod lh. tmj(l (scc. 7LV.l, Buinc$
<br />ard Pist{rbnCodc, Thc Co m.rcrt Lic.n* ti* dfti no! .tpl, to an own.r ol rop.ny q ho builds or inlpNvcs rhcfun,
<br />lnd who onltrrsftr s.h prci{l. *i'} a Conhdorl9 liccnEn r!M.r roihcCoorEcld s Lhcr* ti{).
<br />-l
<br />umcx.mfl !ftt r 56r
<br />TOAf,!&I:I:OI4IENSAIION
<br />OES,AAAIIQN
<br />I hceb, llfirm un&r t'.n!hy of pdjlry orc of rh. followins delimlhns:
<br />-l
<br />hlr a,n *iU minrain a Cdrifrd. of Con* lo S.lf'lNr aor Frkds @nFNlrk .. c FDviH for by Sc.lion 3700 of llt
<br />trbor Cod., aor l,r. !6fo,!rec of tt rc* aor wtth llp psEjl b iss.d.
<br />-lhrlc
<br />andsillmainloin workcr' coofcnsnrbn inslrdnce. as rcqlircd hy s..rio.lTmorrhc Lobor Codc. rbr rhc pcrfortuncc ol
<br />rh. sork Inr shi.l, rhis pcon i\ is\!o{l nly ..dDcn*urn,n in\unnc..rdi.rd plicynunrbcruc
<br />-l
<br />ccniry rha in thc pcraorrore of rnc wort for qhth rhis tEmn is isslc4 I shau mt cr{,loy any F mn in ony nurcr
<br />o rc ro b.om $birl ro rhe m.ts s,rF.eiion Uws ofcaliromi& .rd r€B lh if I should bccoft suhjel lo tlE
<br />mrk N 6npcn$rio. pevieionsofSc.lion 3?0o ofllE bixr Codc.l slEll. fonhwitt omply $irhrho* tmvtions..
<br />WARNINC: hilurc to $urc wolkcr' compcnsalion n unhstul. rnd srBll \lhicr eq)loycr to aimiml pcMlli€s .nd
<br />civil nrcs uF lo onc hundrcd lhousand dollaF (S ) in rddirion h rhc ro{ ot co r .hm8ls as pmYiicd lor llE
<br />S(rion 1076of rh. Iitbra.d. inrcrcrrand I
<br />'""''V/6 tE
<br />DI':( I,\RA'I'I0N
<br />I hcrcby a0nnr udcr Dcnahy ot Frjury rh8l I u li.cnrcrt undf Eovisioo pa chlprn 9 (co
<br />oi lhc Busi.css and Pmfcsions Codc. ed hyliccn* n in flll forcc Bn cre.r.
<br />qirh Sccri)tr TOiX)) otDnniir I
<br />(.-OG
<br />4.,t b::3 .-.
<br />coldltrlcllaNr[lur(iiu,llr
<br />I hcru$y dl6rn ond., Fndry or Fqury ih8l lhcr. k 0 onsfldhn LndinS agcncy fu lhc
<br />is\!.d (56.:1097, Civ. Cl.
<br />olrhc work lor which lhh Fanit h
<br />AITLICANI,JTECI.ASAITAN
<br />I hot+yllti und€r Dctr!lry oincrjury onc ofihc lbllowins dc.larations:
<br />Dcmlilion Prir.irs.Asbcslos Norificaliotr FeddEl RcPllations (lirlc.r0, Pani)
<br />-Rcqu
<br />ncd Lcllcr of Ndiirorion
<br />I ccdily lhd thc icdd.! E8ll.rions reBadinB sbestos gmvd rc not olplicablc lo rhh l)oirr
<br />-lccnilyrhar
<br />I huvc rcod rhn aptlicarnrn a.d {arc rhar rtc uh'vc in h com.r.I tr8e rocomplysirh rll Cirylrd Counry
<br />rpr.scnlnrirs oflhk ciry ord couir! ro cnrd lpon rh.ordimnccs und Stalc L.Bs rclrling
<br />rh,vc rdri0rdfn,p.nyl{n
<br />t
<br />UNDER GROUND
<br />Waste & Vent (/u/lz 1\+r
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipino
<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 />Back Flow Device
<br />Rough Plumbing 4/u/lb ,t>6'6
<br />Final Gas Test
<br />Meter Release
<br />FINAL 1/40/14 5\{t
<br />Notes, Bemarks, Etc.
<br />PLUMBING-INSPECTOR RECORD
<br />APPROVALS
<br />TOP OUT
<br />POOUSPA
<br />Lctrdcl' Addrc*:
<br />-
<br />b! ild irg co nstrud ion, ind
<br />-,7,/ 6'/tr
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