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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DEL{AXATION
<br />I h.Eby lftum unds Fn lly ol p.ilry thlt I m cx.nfl 6om rhc Conlra.tots Licne Lrw for thc follo*hg tten (S&.m31 .5
<br />Bu.incis dd Prcfe$ion Codc): Any Cny or Coumy vni.h Equica r F..nn to @nnru.r. dr$, inpoE. dcmlih or GF( lny
<br />situcitr , |rior ro ir3 irs.m, .ls Equircs rlE eptli€&r lor such pcmir ro fiL. tigEd st .mnl rhll h.or slE b lierEd puNrn
<br />16 thc pEvish i ol tlt Co tuld s Liensd L!{ (Ch.pl.r 9. Conmming with S.clion '7000 of Divisir. I of $c Busimls r'!d
<br />P,of.$ions Cod.) o. lhal lE o. she is excnpt drEtom dd lh. tEsh for th. alh8ld crdpron. Any liohdon ofsc.rbn ?01L5 b, ol
<br />+pli.a for 3 psmir subj.rh rh. aDplic&nl ro, civil pcultyofnot ma$a! livc hundEddolle (S5m).
<br />-1.
<br />* owNr ol th. preFny. or ny cqllorr.3 *ilh *!8cs s rhcn sh comp.nsarioi. will do tlE *ot sd rlE 3trElw is 6t
<br />inredcd or ofrcrcd for sl. (Sc.7044, Ausinds a.d Pr.r6skrns Code Thc Coitr&toas Li*nc tIo &'cs mt !lpl, lo an owftr of
<br />ItE FDIEdy sho boiu3 o, irllreB dEe'l. lnd wl[ dc sEt wlk him.lf or h.slfo. ihmueh hir or hr own .nplor{s.
<br />ptolidcd rnor slch inqrovmnh e nol inl.nd.d or ofiord for sL. Ii lEkE rhc bulldins or iqmrmnl h sld w nin onc F{
<br />of.onp[|rhn. rlE Ovncr Bui!.r *ill hlw rhc bodrn ofrNang rhlr ,E or sh. did mt hrih or irproE rhc poFry lor rh. ,rrlDs or
<br />-1.
<br />asoercroflhc Iopcnt. m cxclusirly conrr&iiog with licen*d coitr(lon lo sn$tod ttE pror(l (Se 7044. Blsims
<br />!.d nbft*im Codc: I hc Conxlcrol s Licensc tiv docs noi .rtly to !n ownr of rropcny vh. b.il& or iftpovcs thcr.on.
<br />!trd *ho snln.ts lor su.h ,,mjek wilh a Cont ncto(O lkcnsd pllsMt to thc ContEclols Lic.nrc L{w).
<br />I rnclcmnr !trdcr S(r
<br />,,,,.-7 Itll8
<br />WORXERS' COMPENSATI(IN
<br />DECI,AM]XQ!
<br />I h.Eby smrmundcr p.nrlryofpE.juryor ofrhc followin8 delmliom:
<br />-l
<br />h!!e s,rl will miolain ! Ccnifr.r. or CoD€.t ro S.la-lnsue ftr h*ss onFnsrion. as pmvidcd ftlr by Ser6n l7il0 of thc
<br />Lrlr tu, L,0E pqfo,llffi of dE wort fdahknrll. F:nn is hsEd.
<br />_l havc ond eill nuinl qorkcrs .omr.na{rbn inslratuc- as rcqutcd by Sat ion lTlD of rhc l-abor Codc, for lhc I,crformncc of
<br />rhc work for shich rhnt).rmn is is{cd. Myw.rks dnnprnsrtioi insurancc cMicr ! policy nun$.r arc:
<br />_l c.nily tlEt inlhc Frformrcc oflhc wort for whkh rhir pcmn i\ b\!cd. I shlll nor crplo, anr I.Bon in any mnftr$ trs io bc.orc suhid ld lhc erkc6 d,npenetion laqs oioniiornia, dd .BE rhnt if I should h.mm subj.cl lo rh.
<br />wo {dl .onFnurion pmviibns of Sedion l7(I) of rhc Lshr tu., I shlll, fonh*irh conply wirh thoe povtioN..
<br />WARNINC hil$c lo r.urc w{trkcs comr.nrarbn ovchg. is unhwrul. nnd rh,ll sxhjftr M cdpl6rrr !o cininal p.tuhics a d
<br />.ivil fincs !p k, om hundrc{ lhousnd dolltrs ($lfD.ooo), in addirion b rhc c.sr of.o6p.nsarior. damA.s as tovid.d fff rh.
<br />Codc, inrc(n ard lrkrmy r L.s
<br />D"",:l-8 '^ff:v-"J,.?!}.',v
<br />LrrEriuiLtaxrn lcroS
<br />DTllANtrIrcN
<br />I h.r5y qflirm ui&r ltnally ol p.qory lhlr I .d lkln$d ondcr Fovirion of ChrF6 9 (olrlrrBing wilh S.db. 7m0) of Divisiotr l
<br />o{ llE BusiEs &d PDfc$ioN Cod.. !t my ticcnc i. h tull foE rnd .ftcci
<br />cQNSrBllCIlOliI[lDtNc.trA[NlI
<br />I hcEby ,mnn rndcr F rlry or tdrjrry rh&r rhcrc n r onslrudnnr hJirs asctrcy ntr rhc pc{oirmRr of rhc rork ror whi.h rhG rLinln is
<br />t\!cd (sc..l(})7. Civ. C.)
<br />drfuc^tfDliclrBAlloN
<br />I t$!.by 0flinn u0dcr pcnrhy.rrrrjury otu or th. nnlowins dcchftlbns:
<br />octrx,lirnri ltnni^ A\h.{o\ NorificDtion ljcdcnlR*uhrnnrs (Tilc 40. PM6)
<br />Rcquir.dIir.rof N.iifiMr l
<br />_l ccnifyrh0r rhclcdcmlrcBuldions rcgrding Ntriosrcnn'vrl@ mr {rlicablc r, rhi\ tftrj&r
<br />Ff*.nn, *, ,*r. *oO,nis aptlicalion and slarcrhar d.,hovc nrr.rndi.n ir.orccr. I a8N ro..mrly wirh.ll Cirydnd li,nnry
<br />ordiner{ ad Starc ljqs Elaring ro buildinS .onsrdcrion. di h.bh, aulho.iz rcpre$nrolivcs of rhir Ciiy aid Counr, to
<br />dbovc nantioncd polcny lor inspmlion DurFs€r.
<br />,{Dplicanl or A*cnl Signsluft:.K MlNtsl f,trvt Vu
<br />:11 t,
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ping
<br />Gas Pi ptng
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />rqanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL e,1t- t0 0c{ulz fvD
<br />Notes, Remarks Etc.
<br />-t
<br />o"*.)1
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