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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTSID/SIG,
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<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-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 />Sanitary Sewer/Cap
<br />Back Flow Device
<br />/A
<br />Rough Plumbing 6-224r y{/-N
<br />Final Gas Test V
<br />Meter Release A
<br />FINAL 7-"!-1V
<br />Notes, Remarks, Etc.
<br />orvNER B(rll-DlrR Dr]r-cAR,\'l l()N
<br />Ihc.chyalln undcr !.nilrr oirrjlry rhrr I u crcnllr ftom rhc conttr,s l,iccn\c Llw ttrrh. t,ll,wirrB rcaq,n lscc 70.115
<br />tlu\inc$ rnd Prctcssni Codc)r iy Ciry or Cuunry whirh rcqur$ , F-rnil lo conntocr. ahcr, nnt('!c, dcmolish.r rcFir rn)
<br />{tucrlrc. pid t' ir\ irlunk., ll\o r.qunc\rM nptlicitrr lu {chNrnrirlo llfu tr sig,td n .NDr rh[ hcor shc i\ Iiensc.l puAr3nr
<br />b rh. n(,visi,nN ofrh. (i, rn.h'\ l-iccnscil hs (Chrrrcr 9. Connncncirg wirh Scclion TlXt) of Dnisi,)n I ol rh. Buliks rnd
<br />I'roliNnn\ Code)orthrrhc o!\hc l cicnrnr rhcrctromlnJ ihc h3\i\ f{x ihc rllrtdcrcnlt)rn,n Anyri(nnrionolSccri$71)-ll5brrny'
<br />rtplicanl tu!ncflnir s!bjcc( rhc ipnli.rtrr k, r .n il p. rlryul nornnrcrh r li\c hufrncd dollrs(35(X))
<br />-1.
<br />N ov*r ofrlr pmocrry. or ny cnpto)eq qirh wagci &i rh.i. $k 66Fnsadon. *i[ do lL *$t ,.d llE lltrEl@ i! mr
<br />iikftLd o. ottcEd fr elc (Se.r04{. Busi,cs md P,oa.rsioN codc Th€ conu&lo. s Liccns t3w dds Ml qpply lo M oqftr of
<br />rlE FDrEty who toilds or itr?rnB t!@n, ard who d6 .kh M* hiru.llor hcelt or thmusn nis or lrr oM cn1ploFs.
<br />pmeidcd rhar $.h inlpoErcnl3 e ior imdld.d orotu li,rsl..lt howffi. rlt ttriuing d ltr+a@mfl is $ld within oft rla
<br />6f.onpbrion. ih Ovrcr Bujrh. will lErc llE burd.n of pmvinS lhd lE or dE dil rcl hlild or iry"ow ,E I,ol{ry 6' rlE 0!4m ol
<br />l. &ro*m,ofthc pmFly. mcrcltsiv.lyconlJldin8 wilh liccned co r&ro ro con.lrud tlE pmiccl (Se,7044. Busirc$
<br />.,n hoft$i,n Cod.: Thc Conrrkroai Liccn.e kw dNs nor applyro a own$ ofprcD.n, wno buildsor inpmv.s lh.rcon,
<br />ud ,ho .oirhcrs fo. su.h pmicrr wiln r Conrrn tor{s) ltcnscd puBldr to rhc Co r&ioa! Lixtrr trw)-
<br />-l
<br />m cxcnpr undr S6lion-, B. & P.C. for lhlr EMn.
<br />IIIBtrEES$AMIEB.iAION
<br />DES,AAAION
<br />I hcEby amrm und.r pcn lry of Frhry om olllE followin8 .kchnlioN:
<br />lhNc rlwillnui rfi(.nillcrrcofCotr!.nrn'scllln\u.ctur$orkc^.onDcn\ddn.as trovidcdli,rhyscrri(n17(x)otrhc
<br />t ft, C(rlc. i'trrhclcrtunnin col rhc Lvork l()rwhich lhe Ennil i\ i$!cd
<br />-! h.v. lnd will minlnin rorkcF .on!*Barion insunftc. rs EquiEd by S.{ion 3?0O of lhe L!6or C4dc. i), lnc ,Erfo,il@e of
<br />ih. wort for whih thn p.mn is issen. My *ntc6' con$..s,rk . insum oEi.r arn polcy trlhbd @:
<br />Policy Number: Erpic.
<br />I cnifyrh.l inln tErfornMa of lhc wort for whth lhis rc.ftil ir irsucd, I sh,U nol cnploy any llc v,n in lny mnncr
<br />s sto t .om slbj.rr lo rl* volt6 @npcnsri,n lav. oiclliLmir. lnd aSrec thal itl sholld lEcom subi.t lo ltr
<br />wortsl comFnslion pm,isiomolS€crio.1700oflh. Lrk, Codc,I sholl. fonhwithcodrly wnhlh6e !&vi!ionr..
<br />WARNINC FniLur b {.urc *ork$l fl cowagc is lnluwtul. ud shau sublri an .nplorlr lo simi.al FEltLr..d
<br />civil fincs rp h onc hundr.d nx'u 00.000). i. oddirion h rhc coir ofc.r{En$riion. damgcs !s provided tor ihc
<br />S.cli{)n.ll176.f rhc l.nhtr C( ..
<br />I h.rby lintr undcr rcnrlryol|Erjury lharI !D liensl iqionolCh+rs 9 (commncinE *ith Serbn 70ff)) orDivtion 3
<br />6r rhr Buriftsr dnd Pblc*ions Codc, ard my liccns is in tull (orcc ud cft*r
<br />2to1
<br />I hcrul,y alfirm un'tur p.ndlryDlr.rjurt
<br />nsucd (SN 309?. Ci! C.).
<br />n n kndins srcry lnr rhc pcrloirmmc oflhc uolk ro. whi.h rhk,,.mt n
<br />APILIIABI.IIE!.:LAB{IIAN
<br />I hcr.lry anim u ndcr pcnalr, ol pcrjut, otu or rhc rollowinB dLrlri' ions:
<br />Dc'frririon Pcnnirl^sbcnor Notincalio, &dcral Resuhrion\ l'l irlc,10. Pd6)
<br />Rcquncd l.itr of Noliicotion
<br />E8.rdins Nt slos Emval uc Nl rmlicahlc
<br />'o
<br />ihis t bj.rl
<br />n dd {rr. rhd rhc ab.!c inlarmrion ! con cr , o8rd k, dnnplt
<br />0uihorizc rc0rc\cnlltilcr of rhis Ciiy Md Countyro cnla uponrhc
<br />b.?,6.\X
<br />D1{ml
<br />Orr6:
<br />Lridcr'i Ndm
<br />-
<br />trnd.r'\ Addr$
<br />-
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