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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ()\!NtiR tl lllltR IrIiL( ARA I I()N
<br />Ihc.cby alrtnr undcr n nohy oiI'c jury rhll I0m cxcmpr froo rhc Conno.tB Li.ctrsc Law for lhc fdlowirS rcnson (Sc.?011.5 r
<br />Bu\incs od Pn,ac$n,n Codc) Any Ciry or County qhich rc\tuircs a nca,ir to .on(rud. alto. improlc. dcmolish or Bprt ony
<br />rru.rurc. prid ro ns ii\uan&, $ rcquirc. rhc Bpdnr.r forsuch Fnnjr lo filca sirn.d rrarrmnr rhd hcor rh. i\ li.cn{d pu^xuni
<br />k, th. pmvhiotrs oflh. Conlmctols Li.cnrd Llw (Chaplur 9, conmcn.irg wnh Scclion ,fix) oi Divhion :l ol lhc Busincs dtrd
<br />Ptr,fc$ioo! Codclo!rhal hcorshc hcrcmpl lhcrcfmfl und rhchrsn ior rhc allc8cd cxc.rrrion. Any vnnlrion ol Sdi,n 70.1I 5 hyun,
<br />altli.ad r.r r p.nnir ,ubjeh rn. a,Dli.dnr !. rcivilFnalrroinor mrcrhan aivc hxndrcddolla^l$500).
<br />-t.
<br />6 o*Nrollhc pr.I!ny, or nrrcnuLyccs rith wn8cs.s rhcn $t onrFnsalion. willdo ltE wolk ond lhc (urE i\ nol
<br />inr.Mcd.rofl.r.dforsrlc(ss7044,ausircisntrdl,rofc*iis(:,)de:-thcGxnradofsLiccnsckwdocsn.rDrtlybrno{ncrof
<br />rh. pn,Ifnt sho tnilds or itr{,mrs rh(mNJd who dms su.h so himscltorhc.rclforrhnu8hhi(orhcro*ncmpbtccs,
<br />prolilcd rh"r \uch imrovcNnh m 'Dr inrcrdcd or olTcEn ro $lc Il h.scrcr, rhc buildi,3 or iny,mEm is $ld wiriii .rc )rd
<br />o, c.nllhrbn, lhc Owncr Buitfi *ill hlE thc b$dc. or pmvirS rhlr h. or shc dxl mt huiu .r in{,ow rhc l)fi,Frly ntr lhc lurFrc ol
<br />-1.
<br />!s owrcr ofrh. |'op.rry, .m crclusivcly conrr0ding snh lrn*d .onr&roB ro consrtud rlE |,mjed (se. 10.14, Busms
<br />a r Fb&dsi, CDdc: Thc Conlr&roar l.i.cnsc Llw dNs nor rpply ro !n owncr of pro,rcny *no builds ot imprors rtc@n.
<br />und Bno co.ra.ls lor $.n pmjck wilh. Co nd.(,li.ciscd pusu r ro Uc Conr&ror\ Li..n$ rjw).
<br />-l
<br />amcrc'npl undcr Ssr
<br />Owmr:
<br />Itott(F{s, coMPENsaTtoN
<br />DECI,AAAIIO!
<br />I h.Eby lmrm und.r p.Mlly of psiur, om of lh. aollovin3 deldiions:
<br />l-JhtrC,xlo. firrhc pc.lonnnncc ofr)[ qork l{{ *hi.hrhr prnnir is isucd
<br />_l tavc and will mathin sorkcB comp.nsation insuroncc, as r.quiEd 6y Setion l?00 of th. &hor Cod.. for thc Pcrforure of
<br />is n$cn. My wor*c6 comp.nsrion insumrcc cldcr und F,licy nlmbcr sc
<br />-l
<br />ccnify thol in lh. Frformm. of lh. wort fr whth lhk pcrmn k issucd.l shau nol.nphy rny FMn in lny num]
<br />$ 6ro lE otu subjrr ro rh. sqr6 @npeBarion b*sot&lifoni& and esB rh ilI slr{U lisft rubj€t roth.
<br />*o*s.ompcnsationprovlsio.solS.dionl?00oarhcLibo!Codc.lslEll.fonhenh@q!lyanhrho*povisio..,.
<br />WARNINO: raihrc to $orc *orkcr' compcnelio. .ovcmSc is utrl.wful. lnd sholl sunirt !n cmplorr to simi.al pcohi.\ and
<br />civil fincs up ro om hufrkn rhousnd dollar (lld).ilool. itr .ddilion l. rhc cosr ofcompcNation. dams€s dr nmlid.d for rhc
<br />Sc.ri.n 107r',olrhc Lrlnr Codc. n'.'ci ond athrmy \ lir\
<br />pul 11 201C
<br />IEII,ABAITQN
<br />I h.rb, aflinrldcr prMlry or pc.ju.r rhar I dd liccn{n undci provhioo oaChlprer 9(cooftncins wnh sarion 7000) olDivisio.l
<br />ol rhc Busirc$ond Prorcssions Codc, ud myliccnr is lull nna dncfi.cl
<br />lootl.qq,
<br />-.JBll{+2Slt cb.,n..r-V-+urn-
<br />COII,TTBIJCIIONIENDINCJiENSI
<br />I h.rcby alfr undcr IEMlly of pcrjury lh0l lhcc nsonerudion hnding lgcmy for fic pcrformmc of thlwork ior which lnis t'cmi is
<br />kuud (se. ,1097. ci!, c. ).
<br />^-tftlc
<br />Nll)Iieta8arlor
<br />I h.NbydlnNundcr acrrliy oll{rjry otrc oiihc lnlL.siDF dc.hrnrLotrl:
<br />I)rni,liri.n Pcfltrirs \bcdo\ N.lifi.rri,)i rcdcr!lRcEUhi.n\ (lir!c 10. PiO
<br />RcqriRd I.ncrol Norillcnr,n
<br />-l
<br />ccnirrtharrhc rcncrrlrcsuhti,r$ Nsrdinr rrh((osrcnn'vrl c norrmlicahlc h rhi\l,ojccr
<br />tEtnr, , n, , t* *uu ,n,. apnricrri,,n arir nrrc rhr, rrrc rri,vc inr{trroxotr x corccr r rsm r) rompry r h a, L ,ry ind c.unrt
<br />ltxrvc m ioncdrmpcnyfor irst crioo p!{mscs
<br />Applicrnl o. Agenl SignoIuF:#J\r i 1 2CI10
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<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 Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />It/ain Drain/Pool Pipino
<br />Fill Linei 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 btuil.,5b6b
<br />Meter Release
<br />FINAL 7/9/t,t ;\>{4
<br />Notes, Remarks, Etc
<br />Tub/Shower Test
<br />Final Gas Test
<br />l.\ -\a\
<br />Pemll@ En. {prinur_ ,_
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