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PLUMBING-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test o 1/r9, 5.bt I tL.J,]41
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<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 />Rough Plumbing tls 5 bea ,Lnr{\
<br />Final Gas Test
<br />Meter Release
<br />FINAL zLtl)q frvb/t-,n)
<br />Notes, Remarks , Etc.
<br />()1lNI.lR IIUILDI.IR DEL( ARATI()N
<br />I hcruhy rlrnm umlcr DctLnly ol pclry l l ur crcrnr ln,n rhc Gnhcda Li.ctsc l-iw rir lhc li'lhsirS rcNnr rsc(?trll.s
<br />Ilrsi'rc\\ r liofisi{r Cdlc) ny ('iry or Counly shi.h rcqnirc\ a p.rDir ro .on{n,.t, nllcr. iDnntrc. dcor)li\h or r.pin itry
<br />{ru.ntc. prinro ns s\urtcc. rln' rcqtnc\ rhcnt),rlkr r f,r \rrh lLn n, fl.r \igi.d {nrr rnl rhd hjor \hL 6li.ct\cd NnuiN
<br />t, rhc nnnni.ns oi ric Conuacnn \ Li.cn\ed ljs (Chrptcr e, ( onnncncirs Nilh Scctirn ,{x}r .f Dni\i.n .l of rh. llustr\\ ind
<br />Prcr'r\\i,)nsCod.)or lhnr ln orshc is *cnrfl rhcrclioD.trd rhc hNis r'or lhc rllcscdcrcnr!rio0 AnyriolJlbnolScdionTl).ll5hyrny
<br />rppliudn,3!Lrnrir\rbjccrrrhcrpf!icrnri,rcivilrcnally.lnornererhrnfnchurcdrloll$lS5m)
<br />-1.
<br />&e owrer oatlE prcFny, or my cmplorEs $irn w{8es 6 dcir $k onpcnsarion. wi[ do tlE wo* lrd th. srrElr ir mr
<br />inrcndcd or .,tcrd lor elc (56.7044. Brsim$ ,nd Ptofcsshn. Codc Thc Co d.rols Li.tn* Law des nor rtply ro M o{mr .f
<br />thc l,ollny vho hoilds.r impmrcx ltEmn. .rn who dGs skh *ork himccll or h.Mlf or rhmu8h his or h.r oen cmplor..s,
<br />provtcdih su.h inpbrcft8 @ mr hrcndcd oroftEn for slc. lt lF*B. rh. buildins.t ihpmEm ireU wini.oe }td
<br />of coq,bion. tE Owr Buib.r *ill lEw l,E hld6 of Imving du lE m shc dt ml hiE or itrpmE thc ttuFny for llE p{rFs of
<br />l. f,i owicr of rhc DrorEny, !m cxcllsivcly contretin! with li.cnsd contrados ro coNrru.t rtr Dmi{r (Src. ?O14. Bu:inc$
<br />lnd hoissi.n Codc Ttu Con'ru.lol s Liccns. Loe dms mr ,Dpl, ro !n o*n.r or tmFny sho builds o, improvs thcrmn,
<br />,nd qho ontmclsfor such toirk wirh a ConrEhnsJ ltcncd I'uGunr rorlEContEcrm e Litns L!*).
<br />-l
<br />omcrcmDl lnds S(tiotr- B. & P.C. aor thh Etrson
<br />Drl.: OMer
<br />1V(rRI((ES. C(lMPElSAltON
<br />IECI.AXAIIOB
<br />I heehy alfirn onder Fnoh, of pcrjury om of lhc following deliralions
<br />-lh.Bs,rlsilldinl.in.C.nifE.ofcoMrroS.lf-lNrforDrks@nEc$.rion,Iprovir.dfo.bys..lbn3700ofdEr$q Cod.. fo th. pqf()llrec of ln. *ort fd wtth tl* pdnjt ir Is{.d.
<br />_l hrvctrnd willmintoin workcr' comr. nsor ion insuhmc. er rcquired bySccrion:l70Oof'hc t bor Codc. for rhc pcrformncc ot
<br />lhe work for whi.hlhhFrmil is issd. Myworkns $np.nrdrion insur c..ricr and rolicy.umhr m:5>tT€ F ut q
<br />0 L .20 D(- o( -2o( I
<br />-l
<br />€crriry rnd in lnc pcnormncc ol lhc {ork for whht lhis p.rmn h i$u.d. I slEll not cftPloy an, ,!c^on in lny Mtur
<br />$ s ro tr{ft subirr ro tlE wo 6 .oFlEndioo hes of Cilifodic. rnd aec. rh,l it I st uld baoB subiar lo rlE
<br />*ort6 coq)cnerion novhioB.t Sccrion 1700 of rhc Llhor Codc, I sl6ll foflhwnh conply wnh thos pmvLio.s.,
<br />WARNINO: Faihrc to surc worlcd NmFns{ln[ covcflSr h unl,wtul, lnd shall subicr .n c'n lorrr to sinidl lttullics r.d
<br />civil fincs !p to onc hundrcd lholsrnd dollaK ($100.000), in addnion lo lhc con of coqrcflstion. dlmscs ar provilcd for rtE
<br />sccrion 10?6 ofrhc tihn Codq i crcn lnd dtomy\ t{s.
<br />o*"..D <'( r(, t e,o /+ 0k..4 T0r'cr'J c7.-
<br />I ICI,tNS!:t) f()N t lt,\(It)IlpEl;td83raN
<br />! hlrbr,ford undcr !.n!hrofprrjrtr, lhar l rn liensd umlcr omrision olChlprs 9 (@rnEncin8 sirh Serion 7(xx))otOivNion ]
<br />ol thc BusiNs .nd PmL$iors Codc, 0rd my liccnsc is ;n tull roftr drd cfccr.
<br />.lt 7oq 12 r
<br />o*,,, o +/t./ , ? conro"ro.r fr-tlt; tn I ull G+! s:z
<br />I
<br />IANIIAIJGII!]NIENDINIiJJiENCI
<br />I hcEby ofinr u.d$ I.hlly oi pcijury lhlI r hae is ! on(odion Lidi.8 rScnry n)r thc rc oirN'Ec of llE *ork for *hn! rhn Fnil i!
<br />hsu.d (sLr 1097.civ. c )
<br />AITLTCANLDEII.ASAIION
<br />I hdrby rnim undcr !..dlry or Frjury ok of rhc followi.g d(lelrn,nrl
<br />Demhion Pcrnih'Astf,slos Norific ion Fcdcr0l Rc8llal ions Onb 40- Pan6J
<br />-Rcquircd
<br />Lcllcr oI Ndifi calion
<br />_l clrli,rrh.r rhc tcdcrul rcsnhrt,na Esddin! lstf,(o\ remrvll lrc nor {nlicabk ro rhis pn+.r
<br />':llccnrr,thJrI htrtr rcid rh,{ trfllrcnrnn md nokrh rhc .hiv. inrd,nurion i! const. I tlsre ro comfly pnh rll Cny and Counl}
<br />ordinlnrcs $d Srorc tiws rchr ins ro hu ilding cotrsrrudn'n. I hcrchy uulluizc lcnrsntarives oi lhn Cir y ! Counlyrocnr.ruF,nrtr
<br />Jb.\c mtrrnncd pmpcny lh nstaron puqro{r/.-),, /,
<br />^Dpri.o
<br />orAsor sk*ruE: * /"y'<.,,.n'O<1
<br />tlU t^i^r.- t U/i.,<.t..'
<br />(2
<br />I
<br />DATE
<br />L.ndclr AddEq
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