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PLUMBING.INSPECTOR RECORD
<br />OWNTR AUII-DDR DIJLCAI'{'TION
<br />I hcrchy illirr n dcr pcn.lly of pcrjury rhl( I am cxcmpl fon rhc (t lmcron Li.cnrc lis nx rhc nnhqine rcN,n (scc7).r15
<br />B!\incs rnd Pnfc$ion Cdc) Any Cily or C('unly *hi(h rcquncs ! pcnnn k, .on\ltucr. ulrcr. impn)k, dcnr,lish or tBltr iny
<br />nrudur. I ntrr. ni i\\urn.c. also rqutc\ rhc rtdi.anr lff \uch t^..rmn b nknsrtnL{ sdcnrtu rhd hcor shc n liccnscn lunuinr
<br />ro rhc pnnisions of rl.. Conracror\ Liccn\cd lj* lchJplcr 9. Conmercin! *irh Sccrn,n 7ffD of Divnn,n I ofrhu Ausine$ .nd
<br />Pnrtsl r codcrorrhrt hcorshc it cftnrr rh.r.fton lnd rh.bd\ir rd rhcrllc[cd rxcnrfli0r. Atryv,lnti,'nol'Sc.rir70.]l 5byrtry
<br />!pplica tor 0Dcnnit suhjcdslhc !pplicrnllo!ci!ilDcmlryoi.orrrtrcrh!nfivchundrcddollir!(t500)
<br />-1.
<br />3s ownd of
<br />'hc
<br />ImFny. or my cmployes wilh wag.s ,s lh.ir $lc omp.nslion. will do fic ,sk od llr smE,lE ir Nl
<br />hr. H or oilcrcd for $l€ (S8.r044. Blsiftss od Pmt sions Codc Tfic Coarracrtr r Li..N ke &as nor rpply lo M o*ner oa
<br />lh. p6Fny who brilds or impoB 0Es( ad erb dd Mh mrt hin*lf or h.sclf or thmuSt hi or lEr oPn chnlorcci
<br />lrotidcd lhar slch iml'ltmnrs N ml hrcnncd oroficnd for eh. ll howwr. rlle t{ildins d inpoE tnl ir $ld wihh om Fo
<br />ofonplclion. thc Owncr Buifi.r will hlt llE budcn of povinS thll hc or stc did mr build or inpmw thc l,orEry for r,t p!4i* of
<br />-1.
<br />!s oqn.r of thc popenr, ao ciclusirly conrEding qirh lietrsn co'firlou ro cotr(rud rlE pEj6l (S4. ,044. BEiE$
<br />and ADfe{ion Code r Thc Conrmbl s Lic.nsc riw do.s nor rytly 16 d o*nd ol prop.rry wno builds or improvcs ficrcoi.
<br />and who contBcrs for $ch phj.trs wirh a C.nrm.Jo(9 liccn&.d plBunr lo thc Coirodofs Lietr{ rle).
<br />-I
<br />m .rcnfl und Ssrion-. A, & P,C, fo, ihh Ersn
<br />SOAKEBS:COIIIEMA.IION
<br />DF(]I AILAflON
<br />I hcrcby rflirm under Fulry of rojury o.. or th. rollowirg dNLhtioBi
<br />IhJvctrn,l*illn nrrinr ccd ili.nrc ol ( dN.f n, sdll li\ur. ntr sorkcN c'in$fsrrof,0r pmvdcd lbtbysc.ri,)n.l7lx)olrhc
<br />litrn Lixll. nnrh.If,rtonun.c olrhc Nork lor *hich rhc |xnnir i\ n\u.J
<br />_lhN.andritlmolnloinqo*c6coq,€nsarioninsunncc,usdqutcdbySccrion:lT00ofrheLrborCo<lc,fo.rh.lcrformnc.of
<br />rh. wolk for which rhn pcmir is irn cd. My *o*ft on{rcnsalion insunne drifi rnd ,oli.y numh.r m:Mr/wst Cuh ln-r
<br />ts^hJNCol q 0 +o t.l .11
<br />-l
<br />ccniry rhar in rhc l).rt maN of 'k w6rk f6r shich rhis Froir is h.u.J. I shrll mr cmploylny pcr$n in lnymtrrcr
<br />s a to b.mm subr..r lo rh. m*s' conEnsdion hws of Cdifomil. .rd a8e lhll if I should l).roe subid lo tlE
<br />worksc onFnsltion lmvisions of Sction 3?0o of llE L{bo. Cod.. I stull torlheilt cotrll)|, wilh llos tmvirions.,
<br />Sc(rtrnr ll)76 ol nr I-rtxrCo r. ri.rcr rM dktrkr'\ lur\?.Z.lrl ^,,n-*_
<br />I hcrchy rl&nlndcr pcnalry of t-jury rh, I dn' li.cnrd !nd.r ttuvhtu. Drchap'd
<br />ol rhc Businc$ ond Prcl'cssions Codc. ud my liccns is itr tull {oN o.d cffccr.
<br />(onmminE wilh SNtbn'701)0) of Divnion 3
<br />ooqq81
<br />+.2.16 ."",-",""_t
<br />CONSIf,UCIIONIENDIIC.ACIM;I,
<br />Ihcnhyaflnmundfir.nrlryorpcrjuryrh lhcrcisrsnstu.rirnhnding.B.mylorlhcpcrfo,nunccolrhc*o iorwhi.hlhhFrn rn
<br />i$ucd(s(. .1097. civ. c.).
<br />mplywilh trll Ciryand Counr,
<br />Cnyed Counry lo cals ulon ltr
<br />lbow nEnlkrrcd pmFny for insFclioi purposs.
<br />/\i+lirHnl or Axdl Si*nalu
<br />APPROVALS DATE
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 7/lr/l,t ?bkt
<br />Final Gas Test
<br />Meter Release
<br />FINAL b/h-/16 506t
<br />Notes, Remarks, Etc
<br />Dowtrt,l
<br />ID/SIG,COMMENTS
<br />Dorr Oqner
<br />L!nd( rN@.-
<br />AIIIJIINII2IICL .SrllIl)I
<br />I h(Rhl Jlirn,unJcrIIirLlyol trrJtrr!o Lol rhr tul[,$xr! dr.lrni(trr
<br />l)cnr,liri,,0 I\1nr r\ \h.{.\ Norili.xri,r l,r1l.'rl lt.lllrrkr\ r'l rlr.1o. l'x'r6)
<br />k.qutr.d l!rrcr.l Nd'li.rr on
<br />*", ?.2.14
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