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APPROVALS DATE ID/SIG,COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under lloor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <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 />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />a.1r.,*dl.Rough Plumbinq tl?>lt4'T >r-) <br />IaFinal Gas Test I <br />Meler Release lt <br />xv4euy'.:7Z)FINAL zl1lufi <br />Notes, Remarks, Etc.{ur <br />O\INT]R IITIII.DER DI:LCARA'TloN <br />I lrrchy aflnr undcr nrnrliy ()f p.rjury rhd I dn crcnfl fn)trr rhc (intrttrf l.tctrr b{ for Ihc lalh*nrs rcrwr rscr rlrll 5 <br />Iluriric* d Ptult*i( Codcr Atrv Ciry or (tuniv trhEh rcquncs r Jrlnn o conntu.r. rlr.r, inf!o\.. dcnnni\h ot EDrn lny <br />{nr.rurc. Dri.r h n( is\udncc-rhorcquncrrh.q,fliurkrsuchpcrn,iin)iltrsilncd{dcnurl rhd hc ot shc i\ liccn\r{l PU^uMr <br />h r|[ t(,vntr,r .l rlf, Coitr.rors l-iccn*d lrn lChd0rcr q. Conrmcncing *irh Sccrion 7(XD of Divi\6n :r ol rhc llusilrc\\ atrJ <br />xptlicanr lj]r r pc.n rrusjcc(ihc tpli..n'br.ivllpcnnnyolnur Drcihn lilc hundrc,ldolh^(S5u)) <br />-1. <br />s ownlr of rhc prop.rly. or dy cmllorrrs wirh saEes &, rhcn eb corpcnslion, will &r llE mt ad llE stftrN ie rcl <br />ink.d.d or o,IcEd for $k (s€.7044, Bu.ies. lnd hofGsioos codc TIE conracrols Lt..$ Lrw &ei .or +ply l. M owrcr of <br />llB pmrrrty *ho builds or irpm6 tlffi ald who d@r tut sit hituclto, hcMltor lhFUBh his or trcr o*n crPLyaca. <br />thrid.d rhar sh inp6vttrds a mr inlcidcd oro,tu for slc. It howq. tlE t ilthg or inprDtd h $ld {irhin orc )ut <br />ofonpblbn, rlE OwM Buit{rcr will hM l1l hndo of prcving tnd lf, or slf, did nol build or i4mvc UE ptupcty ftn trE purPos of <br />_1. 6 owtur of rhc topcny. !m .rclusiv.ly conna.rine wiri liccnkd conrEcroR ro o..rrud dE prcirr (Se. ?044, Eusims <br />a.d Pmr.ssi,n Cod.r Tnc ConrGrol s Licc.$ ljw d6s mr qrrly to 6 own$ of pop.ny sho builds or imprcrcs lhcr.oo. <br />and who .onttuds for iuch Imirk wnh r C.nMo(s) lt.n$d pu6ur.l lo th. Conl&1tr'r Lie.s t w} <br />I nr.r.nrr und.r Scrrn) <br />D.t.: <br />I h.r.by rfi iinrndcr fl:hlrr.rF*rjury <br />-t <br />havc,rd will minl,i. ! Ccni,lcltc of CorE b S.lfinsuE for worids onqr.$rbn. a. Fovidcd for by Stclior 1700 of llE <br />Li[or Code for rh. pcrtol111.re of lhe ro* t6, whbh rhe p6mi ii irsu.d. <br />-l haw a.d will mainrain worlcs coqosrrion insurancc. $ rcquiod by scrion l7O0 of rh. tihor C.de. ior thc p$fomrcc or <br />thc qort aor ehich lhis p.rmil is isucrl. My workcs cohpcnsorion insuotc .adit d l[liy numbcr m: <br />WARNING: Frail!rc ro soF e*$ .ompcB,rion cov.6!c is $hwtul. ond slEll subjccr d c'r9lort. ro GininalFmltis 8nd <br />civil litrcs !p to oic hlndEd rholsnd doll&s {Sl0o.00O), an oddilion lo lhc cosl of comltnslion, .t!ru8cs 33 protid.d ror fic <br />Scction 10?6 of rhc Lstnr Codc, inrcrci dod <br />ultr^&uraN <br />I hcrcby arfi rm und.i ri.nalr, orr.riury In'visionolChapir9(com'ftRinr snhSccrion'7(XX]) of l)i!ni{nr.! <br />ol rnc Bu\inc$md Prrt$i(,nscodc. dd my li.cnsc t ir iult lor.c trM.flccl <br />Dol.r Cont <br />CAXEItrIIEIIONIENIIIXG-{OIINI} <br />I hctohyrinNu dcr Nn.lryolpcrJuryrhar rhcrc hrq {rucrt,nlcningigcnclinrrlt'Frli)nDn.collhc$orkitrshi.hrhnNaniris <br />i\suc(l (Scc .1097. Cir C ) <br />ATIUCIXLDES.AAA.IION <br />I hsdry affmr undc. !.nalty of pcrjury orc of llE follo$ins d$lantionsl <br />Dc'reUion Pc.tuk Arbesld No'iflcrlion tu r.l Rc8uLlions ('rnE 4{L Pan6) <br />-ReqoiEd <br />ldrn 6rtJorifi dhn <br />@ nol q,pltlbk lo lhir nDixl <br />tomrion h.otr 11. I .gE to mnply *i$ . cnya.dCounry <br />nr,'ivcq ofrhh City 0.d Countyro cnrc. uFnrhc <br />,.*""u(,,n <br />r <br />PLUMBING-INSPECTOF RECOHD <br />Waste & Vent <br />POOL/SPA <br />Water Service <br />Poli.y Nu $.r:-Iifncsr <br />- <br />-l <br />ccnnyrhrr ir rhc pcrl'ornu.cc orrh. work ror which rhi! tcirnir is isucd. I shrllaor cnuloy any pc^o. io ahy,n.nncr <br />e as ro hc.om subjcd lo rtu qodcs .omFtrsolion liws ofcllifomi..,nd asd rhs' irl lhould bc.om slbjd to llE <br />*orl.r\ coop.nt{i.n pmvisio.s ofSerion IT()Ooflhc Lrtnr Codc.lshlll. ronh*nh conPly siln$os ptovisions <br />tJnds s AddE* <br />I <br />-------T------ <br />i-