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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNT:R BUII,DER DET-C RATIo!i
<br />Ihcrch,rlltru ur n"Drlryorn rjury rhrr I rm cxctrU lnnn rhc Coft&ui l.ic.tr\e l-rN tu! rhc rolroNin! r.rk,r (tc..7oll5
<br />Bu\nrs\ arkl Pnntsi,r C.dc): Any Ciy or Coutrry *hich rcq!ir.\ r Frnir k, .otrnru.r, ilr.r, nunc. dctrx'li\h ,tr rct'n ry
<br />(ru.rurc. l'itrlo il\ hsu0ncc- ah. rcquirc\ rhc arplir]ni ibr n'ch lrrnir k, hlc0 si!trcd (rlcmtrl lh hcor rhe il!i..nscd ,)ur.tr r
<br />r. rhc nmvi\i,'n\ ol rhc Conrrnctr'1 I-itun\cd tr* 1Chrfl.r 9, Connn.n.ir! wirh 5.rri,,n 70(D of I)rvri.tr I oi rhc llu(inc\s rnd
<br />Pn,ltssiotrlcodcrorrhrr lEor shc $cxcm rhcRioma rhc 6!ri\ turrhcrllcgcd crcnrtr n AnyrnndionolScclioT0.ll5hto,
<br />trr,plicrnr larr |rnnir !ubj..rsrrr rttli.afrhrc,vrlpcnrlryornortrFrdha.(ivcl,undrcddollr\($5m)
<br />-1,I
<br />ovs of th. pmFny. d nry.nplolcs wnh eagcs 6 $ct eh @nwnsriotr wil dr th€ wo {d th. nrrw ls ml
<br />inrcid or oficrcd fd $le (S(.?OU. Bu.ift$ Md Ptote.sio.s Cod.: TIE Conlnclol! Lkcn* L!{ d@3 ml a0Ply lo e ovM of
<br />rlE |,DFny who loilds or inplM! l,Elqa &d who does su.h v4ri hntucf or hcrelfor lhmlgh his or lEr o*n ctrgloyci
<br />polidcd rh.r such inlprow6 s e mt ihrodcd orotrcGrl for sL.lL howcw, rtE toildiu or impmErrr is $ld winin.tu rq
<br />of.orgLtiotr 0E OrM Builrs M! hrE tll btrftLn ol pDving rhd lE or srE dil ml hrild or ilrprct lhc I,DtEry ror rtE pnqE of
<br />l. asowftrorth.pmFny, amcxclosivcly conlradinS *'ith liccn*d co d.r66 to mnsru.l lh. Fjccl (Sc.7044. Busirar
<br />ond Pmllssion Coder'Ihc Co @k, i Lic.nrc lnw docs nor sptly ro.n owncr ofnropcnysho buildr or inpDfts rh.r.on.
<br />rnd wno onlmcls for such pDFts wirh a Co rrcro(, ltcncd po^uni io
<br />'tF
<br />c.nt..iols Liccns L.w).
<br />I mcxcmDt unds Scctiotr . B & PC fotlh^ ma.on.
<br />]IAB6EBJi:COMTENSAIIAN
<br />DICI,AB{III]N
<br />I nceby afatrm und.! pcnllry oa FrIry onc or rhc folLwinS &{btr lions
<br />I hrvc dwillmainhinnCcnilicrlcolcon\c b sclr ln\uru a(tr workcrr .oorF.\d n,n. 0s pmvi(lcd in hy sdr i(,r r?m or rhc
<br />Ijhtr C, c, ntrrhc Nni'nn,Nc olrhc *ort hi $hich rhc lx-rnril n isocd
<br />-l
<br />hovc lnd will mintlin wortcr' d,hpc.r.tio. insuBrcc. as equncd by Sdio. 3?00 ol thc Libor C.d.. lor rlr')crfolrure of
<br />lt wo rbr which this pcrmir i. isscd. My work6 omp.nsrhn i.surunce clEier &d policy numb.r dei
<br />S+.rIr Frv. J
<br />5lz6/tts
<br />-l
<br />anif, thar in rh. llciform..c.fth. work aor whkh lhis p.hn h ksud, I shatl.ol csplo, !n, Fron h.ny trmncr
<br />$ * to tEom subid b rh. *ork c'omFnsalion laws of Cdifodia drd agc. lhar if I should teom subj*l lo rla
<br />workdc.tnpcns0rio.ImvisionsofScction37lnofrn.tjlnrtu.,lshall,fonhwithorglywilhlhospmlisions..
<br />WARNING: Failurc to *-urc w&cn @ pcMrion 6wogc h unl.wtul. md shall subj.ct u cnll'lotfr ro oiniod FExi6 and
<br />.ivil fincc ur ro onc nuturcd lhousand dollds ($lfii.o()o). i. addiri.n ro rhc cosl ofonPcnsolion. d!tugcs !s !.otidcd lot lh.
<br />sRrion 30?6 0a rhc L!L, code inrcEir and .r.,cy
<br />I]ECI,IAA.IIOU
<br />Ihceby0flirnloncrpcndlyorlcrjuryrharl, licctryn utrdcr tmlisn,n olChaflcr 9 (.ommncnr8 sith Scdion 70({)) olOi!i\i,)n l
<br />ol rhc Busincssond Professiori\ Codc, ud
<br />'ny
<br />liccnk i\ in rull r .c md cffctr
<br />R )anq3/"
<br />coNglBlJgltaNu;llllM-aq[Ncr
<br />I hcrcbyiliir undcr n(n0lryolpcrjury rhar rhcrc ir r cDn{tu.rn i ktrdirs rscmy Ii)r lhc Pcrli,rnukc ol dr w rk tur wIich lhis pcrnrir i\
<br />isrucd (Scc :1097.Civ. C ).
<br />d.IrIICANTDEIIABAIIO!
<br />I hsrny dlmr undcr Fnrlrt orF ju.y oN ofrtE rolhwinS delafrtion\:
<br />Dcndilion Pcrmils-Astcstos Nolificalbn Fc.lfial R.8!brn,ns (Tnt,(). P:'n6)
<br />-R.quircd
<br />Lerlcr ol Norifi cdin,
<br />_l.cnify rhar rhc Ld.rul rc8ulnri(ins rcBnrlin8.nxslos rcmo\nlrrc ior rpfl(ahl. k, rhi\ !roj{r.
<br />e4lcunilyrh l hrc rcid rhi\ 0mlicarii'n dd i rc rhtrr
<br />'hc
<br />ubvc irronnd i.n h cor.cr Lsre ro .o , s rh rll c(y nnrl Counry
<br />odtnrnccs i.d St.r kws EL(itrE ro tuildii!.on{dcrn,n, drl hurchy lurh,izc rcprc.cnrrrircs orrnt Cirrafti counrr lo cnrcr up.n rtE
<br />rh,vc mcirn,nrdfl)p.ny Lr iNpccr
<br />,{ppli.nnl or A*enl Sianalure
<br />Zart *tbllo
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq 6(tr//,6 9\ 6$
<br />Meter Release
<br />FINAL 6/rl/n ,><,
<br />Notes, Remarks, Etc.
<br />D,", -71?-9116
<br />o,r. - -t!!t!2LL& o"ro,r*
<br />-7 /.)C.t IQ
<br />Final Gas Test
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