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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER I'ELC]ARATION
<br />I lEEby atitrm und.r p..dly of pcdry rhd I d crcryr nnm thc C.nnadou LicnF trw lor lh. follo*irg i€$, (Se.7011.5
<br />Businc$ atd Profcsshn Code)r Ary Ciry or Co! , which rqlircs { Frnn to oislel. !lld, in{hr.. .hrclkh or EP,n sy
<br />srru.r@. Fir lo ns ir$rre, also rquirGlfi. q,pliel for sct F mil lo 6le ! sigftd illtcm lhlr & o. dE b lim.s.{ F!r$!t
<br />ro rhc pmvhio.s 6f 0E Contrei 's Li.lnsn Lv (chEncr 9. Comdmins wilh Se|n,n 7000 of Divhio. I of llE Bulircss lnd
<br />Pmfcsrions Con ) or rhd lr or shc is eichpr th.rfiom and rlrc tssis for ttrc .U.g.d cr.nprio.. Ary viohlion of S6rion 7011.5 by 4y
<br />lprlics.r for . Frmn sobjds rh. apdi.lrr ro . .jtil pcnalty of ml mE rhrn fi* hundrcd doll&s (5500).
<br />-1.0s
<br />owncrof tn pmFnn or my cq,lotEs *irh sages ss thcn sb con{Ensarhn. {illlh rlE wolt od llf ctudft k ml
<br />intcftkn or oftcrct for slc ( Se.7044. Bxsines ed Profcrsiom Cori.i TtE Conlr0clols Llrnc Law do* rcr .pply lo tro owrci,oi
<br />rh. pnFdy who hoilds or irymB lhcmn, lDd ,ho dfts \uct s* timself or hg€lf or rhsush hh o, hd own cmployccs,
<br />pr6vidcd rhd such inlProwmnB m nor inrond or offcEd roreb.lt l$wE, rhc ltuildina o' i'r{mktu.r h $B Qnhin.rc }ea
<br />of.on9bion. rh. Own( Blildcr will hdE rh. bord.n ol rmving lhd hc m shc dn d hliH or idphr lhc popoty lor rh. plrpo$ oi
<br />l. rs owrcr ol lh. Imr.ny. trm crclusivcly conrractinS with liccnsn onr@toN ro consrtut rlt lDlrl {Scc. ?o44. Businsr
<br />ond holssir Code: Thc Conrr&rois Li.cnsc Law docs hr appty to o.*nrofpDFny who builds o! improws lhd@n.
<br />and who mnrEcls for .uch lbiets wilh a Cont@ro(*) lkcnsd llumuml lo llE ContEclols Lten* Li*).
<br />-l
<br />{nrxcmpl under Secrn,B &PC for'hisrcason.
<br />lhrlcr{lsillnBnrinaCcnlln'rcol(i,n\ctrrt'Scll:ltrsurcl.rNorkcr'.oDrtr.n\xri,n.r\!n,!iddhrhySc.rn:l7lx,.lrhc
<br />lrlrtr(i ..li,rrhc p.nnirrrtr.c.lrhc Bo lir Nhich rhc Nnnir LJ isucd
<br />_l hulc and *illmainrlin w.r*c6 compcnsarn,n ihsuancc. as rcqniRt by Serion 3?m ot tlE L!6or Codc. tu rhc Frro.@.. ol
<br />siq !d policy iu b.r @:for whjch
<br />'hir
<br />nmir is i3r.a My sorkdl c.mpcNriun insnrmeSk-k_ (:".rw\
<br />q zt,\x
<br />I ccniry lhar in rlE Fformm. of rfic wort for which rhiF pcrmir is issud, I shau nor cntloy .ny t son in lny mntur
<br />$ as lo bcsm subjcct to rhe wo*.* ompenirion lisr 6f cllilomii, ..d aeN lhll if I snolld lEco8 suhitr lo rlr
<br />*o*sl orrFnerion provisio.s of s6rion l7(x) ot rhc Lilbt codq I slEll. fonhwnh ohply rnh rhs ,o!isi6$.
<br />WARNINC: Failurc ro sm sdl..r @r{xnflion 6voec is unhstul. .nd slEl, subJccl !n cdplottr ro oiminal lEELiLs and
<br />civil nncs on ro om hldd rhous,trd dolls (Sl00,O0o), in addirio. ro lhc co( ofon\*nslion. dlegcs E l,rovn.d for thc
<br />Scdion:1076 ofrh. kborCd., inrcrcsr and lomytll.\t(
<br />DICI,AEAJION
<br />I hcNhr rrfiflnund.r pcMltyotprrjury rhlr I ur lntn$d udcr pmlisi.n orchifl$ 9 (conrnEncirs *iln Scclion 7m0) orDivtntn -l
<br />.r rhc Buiirrsq und Pm,.ssiors Codc. axl nry liccnsc is tull fne ud cfftr.
<br />\02\ro1
<br />\Vr,,'>.-o
<br />co srf,lqulrNtEdlrlNclcEir
<br />I hcRby rinrm undcr pcnlll, oI pcrjlry rhlr rhca is ! con(ocri,n lcding ,8.fty tor lhc I.rfonuncc ol'llE sbrk lor shi.h rhis F nir n
<br />issncdlsa 1017. Civ C.)
<br />dXIIICAI{IIII!:IAAAIION
<br />I lf,rcbyrurmu cr pcn0lry oltcrjury oN otrhc tnlosins dcclarrlion\:
<br />Dcmolirn,n Pcrmic Ash.{os Notil,.ition lr.dcralRcSuhnnr (IilL 40. Pfi6)
<br />-I{cqdncd
<br />I drcr ot N.rinc,rio'
<br />I ccdiry dar fic fcdchl rcBnhrnnls rcsudins osbcnor rc'mlalare nor rpplicdbL ro rhis pmlccl.
<br />-l
<br />.cnify ihdt I h!v. Bad rhk npplicar ion !d slatc thlt hc ltrvc informlion k .orccr I agr( ro oq,ly wirh all Ciry a.d Counry
<br />ordiBftcs lod Sr.r. Llwr ftl,ri.g ro hlildinS conslMrion. ud hcrct y oullFrir qftsc.larilcs dt rhil Cily ud Counly b c er !F. E
<br />ahovc mnl iomd I'lopcny for
<br />,\t,plic,nl or ,\B.nl Signntuft:
<br />!/\
<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 Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Bouoh Water Heater
<br />POOL/SPA
<br />P-trap/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 />Sanitarv Sewer/Cap
<br />Back Flow Device
<br />/^\\
<br />Rouqh Plumbinq 7-l'z"lu x.w)u
<br />Final Gas Test
<br />Meter Release
<br />FINAL ll7"lt4 rrt aufta D)r lNotes, Remarks, Etc I1
<br />UNDER GROUND
<br />Waste & Vent
<br />]!TBtrEB!-CqMf,IUSAITQ!
<br />DgluaAnoN
<br />I h.rcby dmrm undc, pcoahy of pdiury om of lh. followin! d.clmtons:
<br />L.nd.ii A(HES:
<br />-
<br />1.\r.\b
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