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PLUMBING.INSPECTOR BECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under f loor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarilier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <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 />Rough Plumbinq >B*a <br />Final Gas Test I <br />Meter Release I <br />FINAL au 8 $cJ1 <br />Notes, Remarks, Etc. <br />OWN!:II BUILI)DR DF]I-CARATION <br />I ncrchy ailnn undcr p.nairy ()r pclury rh I d.rcnlr ri.'n rh. contlcros Liccn{ Lar hrlhc lblb*ins rcuqin is!.ro.ll5 <br />Ausincss d Ptuf.*ion C.d.): Any Ciry or Coumy which r.quircs a tcirnil lo consrtucr- rlrcr. inDrov.. dc&ri1h ur {nrn rnY <br />$rucrurc. t or ro rts rsu.n.c. rl3, rcquncs lhc lnplicanl r.r uch r^-.ro h rik s sigoctl sdnr rhd h.M sh. is lic .J ; !; <br />ro rh. pn,vnions or rhc Crnrk,.tr\ l,i..trsud txw (Ch{r.r 9, ConnnctuinB snh Sc.tn'tr 7(x}r ol Oivkion.l ofrhc 8u\inai\ nnd <br />Pofcssionr Codd,orrhrrtr.r(hc iscx.n4 rhcrcftonnnd rhch.sis io! lhc albscn cxcmprion Anyviohrtu.ofS.cri T0ll5byrny <br />applicanr lor 0F.nrir suhjsr!rhc ltpliunr ro !qvrlpcmxlot.or Ntrc lhnn firc hutulicd dollr^ (s5mr. <br />-1. <br />6 o{Er of rlE psFny, or ny cnploJrts s n N!8cs 6 tlrn $k @mpoBdaon. aildo tlE wnt !n dE srnr|@ b ml <br />inrcldcd m oficrcd for $k (Sd,7044, Busift$ od P,Dfc.sionr Cod.: TtE Conr&ltr s Lirn$ L{w do.s nol q,ply lo an owffi of <br />lh. |,DrEny who b{ilds r iqms rls6r s,n who dc sh wd( hinElf or hrelf or rtDlgn nae q lE os..nployc.s. <br />povilr<l rhd sh inpolmil.i @ rcl iiror.t d6roittd6rsh. tt howsi lh. building o inprlwm n$b*ilnhorct@r <br />ol otr"bliotr rh. OwBr Euildn *iI h.w th hrd.n ot Flliig [Er lE or sne dij mr tdi]d .. i,qroE rh. pmpqly ltr tlt !'qr$ of <br />l. ei owmr or$c pop.ny, s .rcluriv.ly .onm.rin8 wirh li.cnEn contrucroE ro @i{rk| tlE lmiir (Scc 7041, Busms <br />ad Eshsbn Codc: Ttc Conrrmro* Liccn* trw do6 Bn aprly ro o owoe. oft o!.ny who builds or inqrots rho@tr <br />and eho .ot|imk fo. skh ,n,j.cls wnh a Conrm.ro(sj lacn$d punua ro rhc Co.rerq ! Li:c.s LrvI <br />I ancxc,nFl undc. SNlio <br />Dor.: Oan. <br />UABrc8S-.(AMPTNIA.IION <br />0[cLA8A:tr!]N <br />I ncrcby rffirnutrdcr I'cnlltyolpojuryo.e offt aol[,win3 dccl&ari.ns] <br />-lhnvca <br />will <br />'ruinruir <br />a Ccn in.dc or C.nsc h Sclflnrurc for workc( conlr.nsolion. rs rmvidc'i for byS<rbn l70o Dtrh. <br />trh, Codc. lor rhc nsli,rnwrc of rhc vork fo {hich rhc Dcrnrir i\ i\rucd. <br />I havc and sill Minrsin *orkcr( .onlpcnstrr ion insuranc., as rcqutcd bySecrion3T00oarhc l$o. Cod..lor lh. P.donlmc of <br />h <br />I <br />rlv <br />_l enirr'hdr anrhct.rtormnc.of'hc *ork lor whichrhh pcrnit h issued,I shaU.or enplo, aoy F,\rn in rnymlnmr <br />s N to lE.m slbi.rl b rhc $odcs cotr{Ensrinn lawr or Ctrliromi( dnd a8nc lh,l if I should hC om subicd lo rh. <br />*ollsl omp€ncrlion pn)lnt,nsof Scciion l7{$of rh( Ltrh,I stull. ronhsith onply wilt rh,s pn,lnions <br />WARNINGT F,ilurc t surc w.k.s comFnslhn o <br />.ivil n.es up ro orc huodrd <br />'housnd <br />dol <br />DDCI {&rrroN <br />I h.Eby !flirm uidd pcndly ot 0.rjuy &'r I m lieBcd ud.r FDvtion ofchlplq 9 (ollmkinS sith S.dbn '1000) of Division l <br />ol Ihc Busiftss Md Prcfcsio.s Codc. ltn m, li.c.se n in flll <br />5? <br />c()Nsrru(:Ttl}N I FNDIN(i A(iltNcl. <br />I hcrby llltD undcr r.hlryofFrjuryrh, h.rc is u.on{nrrion hMing uBctrcy for rhc Frao.nrine orrh. sork for whi.n this lEmrit is <br />nsucd(S( :1097. Ci! C.). <br />A@ICANTDECI.Aa^Irc! <br />I hel y afim und4r ncnalry ol pcriuy om of rtE loll6win3 d.chErions: <br />Dcmlirion PcrmnlArbcslos Norifiqrion Fcddl R.glllli6ns (Tnb 40. Pan6) <br />-Rcalircd <br />lxuo of Notiiicdbn <br />ire nol npplicahk ro rhis pmj.cr <br />I c.dilythlr, tuvc rcd rhk <br />o,timmcs .nd Slalc ljws <br />,bovc m.dokd pmpLnt for <br />hmmnl, wirh lllCir, Dnd Counr, <br />rrhr cnv d counrvro cdd dE n <br />"",. lr4-t{ <br />I <br />Back Flow Device <br />sarbn 1076 ol ln. trhor Cod.. inr.r.r <br />".,,,Lr-4't(' <br />Lcndcis Addrcs <br />- <br />=