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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNFJR BUILDDR DULC I'ATION
<br />I h(rcby xllnn utul.r pcnrlrt (,f p(rjury rhrr I dfr crcntr tiom rhc Conttrck,s l,i.cn\c lrw ror rh. f('lk,*in8 rcurin (Sc.70:ll5
<br />Bu{ir.\s d Pi(na\\trn C,'dc): try Ciry or CouirJ] shicl rcqtrnc\ r li.hrir tr ..nnfl!r. ,lrcr. inriovc, &,Nni\h or rtln atry
<br />so.rurc. ln h ir\ asun....\o r.quncsrhc nl)plicrir f(, such t--.nnirtr iilc a silRd {drtutu rhd h..r sh. is licctr{d furuJ
<br />k, nr pn'!i\i,n,s ol rh. Cinrrach \ l-ic.i\. |l* tchrfrcr 9. (innnrcnciu siih Scrtid 7fin nl l)iri\i,m l of rhc Bu\inc\s r d
<br />l,tofcssi.n\G)d.lorrhrrtrc.rshc i\crcnrtr rhcrclidnrnd rh. ba\is f,r rhc{lklcdcr.mptrn Anyvirnrln..fScclioD?0.ll5nyany
<br />rtplic"nrhrrpcnnir\uhtcc(rheapphcrnrh!civilpcnalry(ln.rnnrcrh livchundrcddollarslS50O)
<br />f(I i\ own{ ol r lrc l]rern y. or my cn,plqr.\ r'irl, wrs$ r! rhcn vnc .onlF-n$rn,n. + ir no rhc wort :ql rh. (urm i\ n.r
<br />n{.ftlcd oroilccdturslc(Scc7(}.l.l,Bu\itu\\xidPn,fcs\ii)n\CoJr'lhcC,Din'ckr'\l-'.cn\cljw odsnorrlplyt,.n.wtrof
<br />rh. F)pcny $ho iuikls or i,Unoils rhN[ fli wh)drts such*od(hnnccllorhcr\cl, orrhnu8hhh orh.rosncmployccs.
<br />t'n)vidcd rhrr nrh nnproknrn( rN frn inrrftLd or ofilEi lnr ek I ll hos du, rh. tdildinr or nnl)ovcmnr i\ q,kl wirhin r c )rr
<br />orcoDddin,,rh.Owncr!l!ild.rsillhtrkthrhurdcnolprovirurhrlko!shcnidfrntDiUori prorc rhc pn,Irny r(, rrt rqi* or
<br />I. L{ owM of lhc ,ropcny, ad cxclusilcly .oonld ing airh lien*d contlacros ro @osrrud IE pDjccl (Se. ,O{4, Busnc$
<br />ad hofssim Cod.r Thc Contctols Liccnsc k{ dms ml rlply ro !n oenrof!rcrcny who builds or impmv.s lhcrcon.
<br />and who sntursfor iu.h F.jccrs wnh d CootBdons) [ensd Fu^@t io rh. c. ocror's Li.cn$ hw].
<br />I rhcxctrrpr undcr Sc.rio II
<br />DECIdf,AIION
<br />I h.ehy alfirfl und$ Fnal'y of rdju.y om ol rh. lollowinB d..laarnlni:
<br />lhr\rJtlsillnrrinrd'rJCcdi,trcofcon\cn!k,Scllln\urclittorlcuconln(n\ nt'.r\ nn,v cd f{tnrSc.it[:17lO lrh.
<br />I-rtxtr(.lxic. ntrrh.p.rinNtrN olrfu sorl lar shi.h rlt rnnir i\ i\nied
<br />_l hlvc lnd will nrinl.in workesr comlc.sll ion insuraftc. a rcquircd by Sclio. 3700 of thc L!t$r Cdq lor lhe pfilomfte ol
<br />llrc mrk for whth lhk lEmir is isnicd. My workds mmp.nslhn in.u6m cei6 rd polty nun$cr m:
<br />{lr."nltyrr,or i',,r'"p",rn.Mnccofrhc work lor *hich$( p.flnt k issucd,l shrll.ot cnrrloyanyrc6on in onymrnm,
<br />$dst,hrcotusubj(rrorhcwo.rid,mpcnsarionlswsoacrliirnia.ddd8mcrhdirlsh.uldlEcdmsubjelblh.
<br />sorlc6.oopcnsarnrtovhn,niorsdionl7O0ofrhcLrl$rCdjc,Ishall.fonhwnh.onDlywirh'ho{pn,visions..
<br />WARNING: Filurc h €urc *orkc conpcnsllion mrcnsc is utrhwful- ud \hill $hj$l cmpl{Dlr r0 simind FtuIic\ rld
<br />n,n. datugcs as pn,vidcd for rhccivil 6ncs up to oflc hundrcd tholqnd dollas ($100.000). in addilion ro tnc osr of
<br />Surnr :1016 ol rhc lrhr C{xt.. inrcr.{ DnJ rttnmr'\
<br />ob/rz//3/ f-
<br />Dlil:I.ia fl)r
<br />I hcRht ftnn,undcrllnalrrofpcrjtrrlrhrr I d licctr\.d trtrdrr nmli\nrolChrfrcr9 (co nncmin8 wirh Sc.1t 7(X[)ol Div(ion:l
<br />ol rhc lru\nr\srnd t'rolc\\i,nr Conc- {rrnry li.cn{c i{ ir lirllnr( xlcrr.cl
<br />ta! aI]qrIaN.LENDllc-81iIiN1;I
<br />I h.\_h! afllrrn u.d$ lr rlryof|trjur' thrt rlri. i\d.onntu.rion Lidiigr[crkt ln rhcFnornnftc ol rh- work iorrhi.h rhi\ pcrlir is
<br />is{rc.l(sc. :1097. civ c )
<br />AIILICANLII&:LTBAIION
<br />I h.d,y sfiim undc. p.nany ofFrjury om ol'hc tollowin8 dftlsralhns:
<br />Demlirion Pdmirs A\b.sros Norificdriun Fcdcol Rc8ularions (Tirlc 10. Pln6)
<br />_RcquiEd bncrof tt rifrdkrn
<br />-l
<br />ccfliftth3l lhcfcdcra,rceuldtionsrcSading oshcstos rcnsvalirc nolapplic8blclo rhis [ojccl
<br />zJo...niry lhar I havc ead this aDDlicarion anrl s|6r. rhll rh.i\cotrcd lrErccr.conrpltwirhallCiryr dCounr,
<br />ordimn.r\ 3rl srrrc lrss rchri,r8 b build
<br />$ovc nrnl ioncd tmFny for
<br />'ct-
<br />0urhorL! rcprcs ariv$ of rhh Ciry .nd Counry ro .nr6 ur.n
<br />'rE
<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 Pi prng
<br />Gas Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trapi Drain Line
<br />Main Drain/Pool Pipinq
<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 />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL n
<br />, Etc. I INotes, Remarks
<br />ID/SIG.
<br />Tub/Shower Test
<br />Fill Line/Back Flow
<br />'{ tM
<br />contmtoi
<br />L.ndo r Addre*
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<br />*.@8-
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