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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUII-DER Di]LC,{RATION
<br />I h.r.hy rrfi,m undcr !.nahy ,,4 perjury lhll I un cxcmpr lrom thc Conlnctor' Liccnsc ljw rbr lnc nnk,wing aa$o (Ss.?0:ll 5
<br />Busincss nnd Piin*rhn Cdh) Any Cny or Cornry which Equtc\ r Fmir b .on{dcr, alrcr, impnM. d.mrirh or Ep3ifuny
<br />srtudurc. nriorx' irs nsuancc. iho.cquncslhc lrplicnnr ntr su.h pcflnir lo lilc r sigrcd sarcNnl Ihol hcor shc is li.cnsd pusuanl !
<br />ro rhc |m)ririotrs .l rh. Contacl.r's Licctrscd hw lChapr.r 9. G,n ar.nrg uirh Scclion 7(Xl0 ol Divitun.i ofrhc Busincss ond
<br />Prolcs{nr.\Conc)orrh,rlIorshchcxcmurh.rcfiom.ndrh.tu\nrorrhc!ll.!L{cx.trrprion.Anyviohln,nofScc'ion703l5h}dny
<br />rftlic.nr nn. |f,rn subjc.hrhc !!plicu' rotr.ivrlp.nalryor.or nknc rhm fiv. hutrdrcddolldn(S5{D)
<br />J.lS. * "",* "t,;.1,"ytr r m! rnrl,,ru' (irh wJscs as rh.n sE coo,pri. n'n. sill (k, rlE sort and rtr nflruc is nur
<br />itrrc d,{ollcrcJlitrq[lSA](}1-1.8u\imsandPrul!$io.tCdlc:IhcContacusLiccnscIjwdoc\nolalplytoanownerol
<br />rhc piorr y w)s builds or i'np',)vc. rh.fr)r, dd wtu' ,lm\ \!ch k) hinNcllo.h-^clforrhooBhhisorh.rown.mnbrccs,
<br />poridcd rhrr such i'nprotrmnh @ mr inrc ndcd or ollar.d lor s lc li howcrr. lh- hliklin8 or iryr ovcnEDr is sold wirhin onc }t.u
<br />oicnq'Ltiul rhr Orncr Euitlo $ill hrvc lhc budcn orfrcvirS rhd hc or \hc dil mt toild or irivntrr rhc ImtMy for rhc FUrIn{ ol
<br />-1,
<br />!s owmr of lhc prcpsry. am crclusiEly conlracling wilh li..tred conr0cbu lo mrslrdcl llE FDicl (Se. ?044. BEinss
<br />ard Eoftsrbn Codc: Thc Conr6roli l-kensc Lls des mr lpoly lo m ornq of pDFn, eho builds or inprovc. rhc.mn,
<br />and who contEcls for such rmtrls wnh. Conhclo(r li@n*d !ur@ lo lh. C.ntucbls Licns L3w).
<br />:-r-..> ? / ,,t /,,2 -/AZa-..adtrfin&-gtltrffiimtf/-
<br />DEIIAAAIIO!
<br />I tcEby artrm undd Fn.lly of Fjury om of ll'. lollowirS delaElhns
<br />-lhrvc0nd
<br />willnui ninrCcnilic,rcolcon*nroS.tl-Itr\urcr(trworkcn.onlprtrsolion.$ providcd for bySe-^li.n ]7(D olrhc
<br />tibor Grlc, f.r rhr pcrfonM c of rhc wulk for whi.h rlr lfrnrir k issudd
<br />_l hlvc lnd pill nrirtlin vorkcF .o'nDcnsolion insu,ancc- &s rcquircd t y S(l ion :1700 of tl"a Liho, Codc. ror lh. p$tomkc of
<br />lhc *ork lor which ltus ,cmir is hscn. My *orlcr' onpcnsofi,n insulucc cnicr a.d policy numbc, sc:
<br />Policy Ntmh.r:-Erpies
<br />-:r4Y{rnn! rhrr
<br />'n
<br />rhc Erforrun.c ufrhc {ork tu whtrh rhn pcrmir i\ issuM, I \hrllnor c,npby rn! pcrn,n in dny aroncr
<br />$ 0s lo h.clxrE subjcd b ihc workc6' con[ENrl idr l,ws ol Crlihnriu. trnd l3rcdhur il I should l{conE suhJ.cr h rhc
<br />*oll{c^ (onrrtrsli('n pnvisn,ns ol'Sdiotr 3700ofrhc Lltxtr Cl)dc.lshnl, tunhwnh corrly wiri rlms pftrri\n,ns
<br />WARNIN(i: Flilrrc r., sccur. wor*c6' ..dpcnslrtun cdlcns. is unlawlul. uid \hau subi.r r! .nr!o)rr b dimind !.flllics nnd
<br />ro onc h!.drd rhousnd dolld lsl00.0m). in rddnion ro rh..o( of@ q,.nqrion. da,nScs as providcd fu thc
<br />inrfts ed albfty s les
<br />I hcrchi nnuM.r!.nihyo,r.rjuryrhilIsmliefls.Jundfr$vis$nolChlDrs9(connNncirgwirhS.crion70{x))oll)ivisnrn:1
<br />of rho ausnt* od Pdfcc\iuns C.d...trd nry li.cn\c i\ ir n'rrn-d . r.rir'
<br />Liccnsc Chss:-Liccnsc Numh€r:
<br />D.l€: Conldctor:
<br />IQISIAICIIOIIIEIDINCAADN.CI
<br />I hcrcby 0firmund.r lEoih,olrciurylh lhcrc n ! consrru.rion hndin8 sscrcy fo, thc Pcrforrom ot rht eork for which rhir psmir i\
<br />issucd (se. 3097, civ c.)
<br />ARI.TCANLDECI,IBAIP!
<br />I horhyrfi mxoddr pcnxlry of prrjurt orc orrh. loltowing de.hrarions:
<br />Dcmolirion Pcrmirs'AslEsros Notificarion rrdcral Rq!btn,ns (Tirlc 40. Pun6)
<br />-Rcqutcd
<br />Lcrrcr nf NoliIElrion
<br />_l ccnify lhar rhc fcdcral r.lllarionq rcg,rdiog ,sh.sos r.nbral d. .or atplicablc ro $is proj.cl.
<br />fdl*t , ,rn , *," ."0 ,nis .ppli.orion ,rd sardhd rh. nhovc inromnon s cotrccr I aEre ro enl,r, sirb au cny lrd cbunr,
<br />onlina.c.s.rd srrrc trws Elrring to buildiB consrdction. lrd h.Eby sutnorir Eprc*allti!.s ofrhis Ciry ard Cou y ro .nrd u
<br />,ixrvc nr.tiomd floptny lor irspcdion puqns..
<br />,\ppliM l or '\[$r Si[n luru
<br />UNDER GROUND )
<br />Waste & Vent {AlKl/N q4gL rlvw -rE .
<br />Water-Under lloor /t1
<br />Gas-Underfloor
<br />Buildino Sewer
<br />I nterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent ulo,l,o.*. /.it/>
<br />Water Pipinq D[*tlI n l!\wr""
<br />Gas Piping
<br />Roof Drain
<br />l)il|tw-n l\,r1411(2 e)
<br />Rouqh Water Heater Jl
<br />POOL/SPA
<br />P{rap/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 VLtll('t'/r\wL'1,\./
<br />Final Gas Test I
<br />Meter Release
<br />FINAL tl*ltq1q t4rw&?)/
<br />u'1Notes, Remarks, Etc.ll
<br />COMMENTS
<br />Area/Storm Drain
<br />Tub/Shower Test
<br />B. & P.C. for lhis rcusn.
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