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PLUMBING.INSPECTOR RECORD
<br />APPHOVALS DATE tD/slG.COMMENTS OWNl]|r BUILDER DOLCARA'I'IoN
<br />I hcrchy nitr urdcr pcmlry of Brlur) thd | 8n crcnllr Iion rhc Cotrrtr.irtra l-ic.trt tiw f.r rhc f{,llosine rcNr (S'c']0.11 5
<br />Businc\\ ud Proli\stun cdlc)r Any Ciry o. 6unry thi.h r.qoncs i ,'crmil ro lrrndturr- llrcr. iq)rovc. dc xnin' or rpr M!
<br />dturru'!, |,nnb ir\ ssuflr.c. rho rcqutcs ihc uptlicdni lni ru.h Fnni ro,ile a sisncd {arcm r rlDr hcor shc n licciiscn lB\uqt
<br />k' rnc r(trniotrs ol rlE ConrrncroCs l-i.cn{d LaB (Ch0prcr 9. ConlncncinE sirh S.cri.n ?(xD of Divnn,n :l of ihc 8tr\nr$ rnn
<br />l,m,tsi,nr\ Codc) or rh l( or \h: ncrcnu rhcrctiorund lhct'!\h tu rh.rlL8cdcxcn9lnnl Anyridrrn orsstion?0.1I5bvuv
<br />lpFlic.trr nlr a ll.nnir subtc.rsthc applicllr ro !cililpcEhyoln.r nbrcth 6vc huftlrql dullr( ($5(D)
<br />-1.
<br />n\ ow"cr orrhc ptuFnr. (tr,nycmtli')e\ {iih wuscs !s rhcn vrh.onwns n r. silld, rb. work,xi lhc nMrur. h n,
<br />inrcndL{ or oflarcd foi slc ( Ss 7044- lltrsi',.* r d PnJf.*n,ns Codc Thc C.nlrucntr \ Liccn\c bw de\ nol aml, k' si osrk! ol
<br />rhconli.ny *,ho In,ildsor nnlk^srhcElr. duhanocssu.nsorkhinrsclforhcr$llorrhroughhisorh.row.cn!'loyccs-
<br />f,vnhd rhd {r.h inrlrlarcnrnlr e nur imcndcrl or ollcEd tu *rL ll &)w.vcr, rhc huildin8 o! hDmrcnEnl i\ nnd wnhinonc vls
<br />ofconrrkri,., rhi Osncr BuikLr sillhlrtrh.ho.dcnolr !in! rh, hcorshcdil nol htild or inqrn,v. rh. Pn,Fly for rtE Nrlr*.f
<br />-1.!so$ncrofrhcI[t
<br />y, am.rctusiwlyco mcting Bith li.en$<l conra.bm loonslMt tlt,lojccr (scc. ?044 Butinss
<br />ond Rof*sim codc: Thc Conhcrols Li.cne kw do.s nor 0!ply lo an o*rer or por.ny sho builds .r imlrov.r rhdon.
<br />and who conlacri f6. .uch pmjels rilh a Co nclo(s) ltc.scd putrudrl to lhc Contra.lor'e Lteok kw).
<br />B. & P,C, fo. this rcason.
<br />woxxr.ns.coMPF{sarIoN
<br />DEgldS{IIl}X
<br />I hercb, affirm ufl4cr Fnrlry of Fjury onc of rhc followins d<laarionsl
<br />I h0vc ord eill nuirrli. ! Crdirr. c ol Con$trr l(' SclUNut. l& *o!kc^ co\${rion.0s pmvnhd ror byScclim:17(I)olrnc
<br />Lxhtr (idc, tor rhc F-rlbnuncc of rtu sbrk fd*hi.h rhc Firnir is irsucd
<br />-l
<br />hovc ond willnrainrain w.r*cs .onpcDsation inslmncc, ai rcqlncd bt Serio.l?00ollhc Ltb6l Codc. fo! thc P.rfomsc or
<br />rhc *oll for whi.h thi! p(n t is h$.n. My qorkcG comllcn$rion insu.nncc cmicr md polk, nnnb.r rcl
<br />-lccnifyrhar
<br />in rh. p.rformncc of lhc vork a.t which rhis pdmn is ksucn.l ihlllnol.rDloy anv rccon i. a., Mncr
<br />s as lo b.sm ruhjd ro thc workc^ .omr.nsalion laqs ofcllifomi!. Md ,eE lhol I snould hc.oi* iubj.ct loll'c
<br />rorlcs comFnsarionpmvhioniofsNrhn 37mofihc t toi Cod..I rh'll, lo,rnqnh omrly eilh lh6s pmvisions
<br />WARNINC: Failurc lo surc *o*cB comp.Ndn n ov.d8c t unh,hl. and .hdll subjd an cmPlovcr ro diniml FMIies $d
<br />.ivil fincs up ro om hundrcd lho!$nd dotlm ($loo.mo). in lddilion lo rlE @{ of .onFMlion. dlmgc. as PmvirtJ ror rlE
<br />Serio. 3076 of rtE bbor Codc. im.En tnd dromy s fes.
<br />UCEISIDI;!.INIBAIIAA
<br />0EC!.A8A[AN
<br />I hcrcby.rtrnu.ncr Fnahyolpcrjury lhrr I rnr lienscd undcr rorhion ofchlptcr g (onnrcncins wilh sccliotr 70oo) oloiliiiotr l
<br />dr rh. Bu\in.s ,nd Pmfcssions Codc, erl my liccnsc is in tull rbte .nd clltr
<br />Drl. Contm.lor:
<br />gaNsrBlI:IroNrENDni{ii$.sNcI
<br />I hcrchy ulrjrm urlcr p.mlrtorFrjuryn rhdc is 0 omrrud i,n hnding agcn.y r'or rhc pcrlo,mtrt .r rhc q o lor $hich rhn Frnrir s
<br />isrucd (Scc.1097. Civ C )
<br />tJndcic Nrmo:
<br />-
<br />APPI ICANT NECI ARATiON
<br />I lurby dtinn undcr Fnalryolpfijnryotrc oithc iollosinB dclTalions:
<br />Dcnn,lirion P.nnii$As$c\ros Norificarion F.d.ral RcSul0riotrs (litlc40.l'un6l
<br />R.quircd Ixncr ol Nolifrurion
<br />-l
<br />ccnily lhd lhc rcdcrdrcBul0lions rcsadins usbcsros rc.oval arc nor 0p/kablc lo rhis nruj.cr.
<br />IcdilyrhrrIhj\cr. rhi{nptltarn,nrrlidr.rh rhc rbvc itrl'onn iM n cor..r' l l8.e ro onrply {iih rll Cirt !!d Coutrry
<br />nrdinrnc.\ and sr rchssrchriogrobdi i'r!con(ru.rion.turdhcrchyrurhorircEprdsurlrivcs(,,lhnCiyandCoutrryrocnrcrunonrhc
<br />ltnrc Nnrio.cd ropcny tu insFcriu nurF)\cs
<br />Applienl or AEenl Slan{lue:
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Tesl
<br />Rouqh Water Heater t.?/d//t a rl/vr*l ,7/
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq I 7/Or?c'rr1/er4-1 v
<br />Meter Release
<br />FINAL I 7/d/r&Y';vnttk llr->_-
<br />Notes, Remarks, Etc.
<br />Waste & Vent
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Final Gas Test
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