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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS OWNIiR DTJILDEII DELCARATION <br />I hcrcby drlirN utrdcr pctrrlry ol pc.jury lhal I lnr cxcnDr frotrr rhc ConrBck,s Liccn( ljw lirr rhc f(llowin8 rc,$n (Scc 7011.5 <br />tsusincs r Pmfc$bn Codc): Aoy Ciry or (i,diry qhich rcqunc! i tsnnir io ..nqruc'. rhcr. im!rcrc. dcmolhh or rcI}ln m! <br />{o.rur. pri,trn, \ hsunn.c. rlso rcquncs rhc ip|lici nr$cn ncnnn h n[ r siSmd srd.'tu rhor lr or shc h li.ctr$d Nrunnt <br />t' rhr pmvnion\ ol rhc Co trcttr s l-ir. {d Lrs (Chatr.r 9. ConnncknrS wirh Sc.liotr 70(l) ol l)ilisn,d.r ofrhr ausincss.|d <br />I'rurrr\i.n\Cudc)urrhdlror\ltriscx.nurhcicli{nnnr]rh.lrsirinrrncallcEclexcDprion AnyvblarioiDrsLttir?0ll.5byan, <br />rppli.lnr tu r lrnnir {brccl s lh. rlplicrnl lo !uivilpcnrlrroinor mErhrn rilc hundr.d dollff\ (Ssur. <br />-1. <br />I owner of rhc |,rc|lcny. o, ny .ntlor!.s *ilh *rgcs s tlrcn $b ompcNltbn, will do llE {6t old llr dtElc is Dl <br />inr.fldcd or ofrcftd lor {tc (S(.r044, Busimss lnd A,ofcsions Codq tlE Crnr6.roai Licc,s t w .rocs nol anply ro e owftr 6r <br />rhc FqEry vlb hrildi or iqr.m tlEm( !d who dcs Mh wd( hnelf or hc&lr6t fimr8h hk ot hcr own cn!,loyccs. <br />prcvidcd rhar slch illpl*ftirs e rcl iirdr,.d dofrer.n f., sL. If. howoE tlE hrildinS d inTotft is $ld wiltin orc,.{ <br />ol conphtion. th. Owmr Build.r will hrr Il* budm of prblin8 tlEr tr or slE dij mr tDild d irDrew 0r popciy for dE purlo$ of <br />-1.&io*turorrhcImFnr.dciclusiGly.oflr&ri.gwirhliftnsdco.rdo6'.sns1ncrlhcrroj.{l(Sd,7044,aBifti{tr'd Pir'ftssir Cod.: Th. Co.krckr'r L.wdcsmr.pplyro!noqncrofprclcnyrhohtrild*orimprowsthcrNtr. <br />and Rho .otrlmcG for such h o 6nrm(lo(s) li.rn{d poaldir ro rh. Conlflclols Ltcnsc tiw). <br />B. & P.C. lor ihk rcason. <br />]loBlixitstrQNrur ll()N <br />uElI L8[!]u! <br />I hcrcby aliirm undcr pcnlllyofpc{oryoncorrhc fink,winsd.cl dn,ns <br />I hrvc rlwillnNnk 0acditi.lrcoicoi{irft,Scllln\urclarsorkc^.onD.nsrlio..asltn,idcdIqb!Sc.tion.l7ulofrhc <br />L'trr O)dc. ror rh. p.rfonmrcc oirhe work rbr which rhc p.nnil i! i!\ucd <br />-l hrt and sill 'uinl.in *orkc$ .onncBarkln iBlmne, !s Equind by Seclion 3?00 ol lhc khor Code. tot rlE Frfo4r1@. of <br />rlE mrk tor phich rhar Dcmn B BsEd. My worte^ .onvxnsarior iNumc fftr dd poli.y runher el <br />I ccnifythd inrhcp.rrornmccoflhc work for which lhis rErmn is nslcd.l ahall.or.tll)loy any r.son inonyMncr <br />s s ro bccom sobi{r ro llr {0*6 comr.n\ ion h*r.l Caliromi0, dd oEB tfitrl if! should hccom $birr iorh. <br />eortcs ompenerion pmlirbnsofSerion:1700orrh. Lihr Codc.I sttrll.lonhwilhcomply wilh rlFe povni.n!.. <br />WAXNING: Ftrilurc lo sw workc6' cotr{Ensurion otnsc is urlrwtut. o.d shell subjcl 0n cmplo}s lo oiminal F.{lr.s dnd <br />civil finci ur ro onc thdrcd rhouend dollsi (5100,0(n), in rddirion t. rh. cosl of.on{ENali6n. d.tuecr !r pbvidcd for lh. <br />L <br />I hcrcby ullirn onncr pcnalry ot p.rjur, <br />'h,' <br />I a.r uDdcr pmvisbnoiCh!!rcr9lco'nnEking wilh sccri T(]0O)of Divisn,n l <br />!:olGIalcu0N.L[NDllG-&aENcI <br />I h.tuby atnnn und.r Fnalryoflx ju,yrhll th.rc n r con(dcttn lendinEagcncr loi lh.Inrdmm. ofllrc work nrrhi.h lhn Pcnni n <br />issurd (Scc..1017.Ci! C.). <br />d.tflttaNfDEclrl8lluaN <br />I ltctry allinn und& r..alry orr.rjuiy oft ol thc r'olkrqing d.rhftriflrs <br />Dc'enlion Pcnnit\'AshcskN Norirlcoliotr !_Licni R.suhrnnF (f irl. 40, PanO <br />Rcqun d L.xcrol'Notific inr <br />iiy lhai rh. rcd.r.l ESuhrions m8srdin8 isbcslos Bmvol sc nor applictrblc b rhir tmj.cl <br />ify rh0t I hovc rcad lhis 0fl,li.dion &rl srarc rh.r rhc ,t$vc informli.n n corcd t aer b @n <br />'ly <br />wirh all Ciry !d Counly <br />!frr srtrrc l,ws Eldins ro blild ocrion, od hcr.by amhotuc rc!rcscnlativcs ofrhh Cn, und Counrytu cnid upon ltE <br />&rv. mnrio d !tul.n, for instEclion <br />Appliut o. Aaent Si8null* <br />C)€* <br />UNDER GROUND <br />Water-Under lloor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Slorm Drain <br />lnterceptor/ Clarif ier <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Rouoh Waler Heater <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 />Waler Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL ffiw#,:frm / G/,Ll//7 /l/t,6€7/t(4 <br />Notes, Remarks, Etc 7 I <br />ID/SIG. <br />Waste & Vent <br />TOP OUT <br />Tub/Shower Test <br />Gas Service <br />Policy NunrlN <br />-[xpncx: <br />inrcr{ dnd ,lrurmt\ li{s. _ <br />of lh. Busincss md Prcfc$ions Codc. !d hy li.c.se ii an flll fo@ ad cft.cl. <br />t-iccntclrss: t-i.cn\. Ntrrh(r: <br />- <br />Co m.lor: <br />t ndeir Nam. <br />- <br />trndn r Addrc$: <br />- <br />I