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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />Ptrap/Drain Line
<br />Main Draini Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release )
<br />FINAL @ltv/>t/n M
<br />Notes Remarks, Etc
<br />OIVNER BUILDI'R DI]I,CAR l'ION
<br />I h.rchy s flinn hder prnrlry nr Frtury rhnr I eicnpr fn,n rlr ( onra.roN Liccrse l-aw lor rlr lollowin3 r€N,n (ss ?0l l 5
<br />llusincss .d Pmlcssnn Codc): Any C y o. County Bnr.h r.<tunes 0 |.mi ro $!d cr. rlrer. impmv.. &noliih or r.r.r .ny
<br />{tucrun, pror t, s rsuan&. aler tqurcs rh. +phror ror .uch !.m ro rilc , si8ncd n €mc lhal lE or sh. ie lc.nrd pum3nr
<br />ro lh. rmvisb.s ollhe Contra.loar Lic.trscd Lrw (Chanler r), CoDnnencrns * h sccnon 7000 .f Drffn I olrhc Busincs. d
<br />Pm fc$bns Code) or lMl h.orslr h excmpt rlrrcnoo ond thc b0sh lo.thcnllcsed er.mpti.n Anyvi.l.rionofS.dion?0ll.5nyiny
<br />TDrrgir lnrdrc4n ahlccrs,ttr 'nl,ihrnrntactr'l|eMlryi'lmtnna.rhJnlrrhutol-Rldcllnnr\n3,,
<br />X-d.Y**r*.r-*") nrnD e,nrr.).cc tr{h u..,-!c\.i,h.r e e.. mr.na trn.{'r,r,, h.s
<br />'k
<br />*rr ,h. {d.rr F ri
<br />im.dl<l oro,Lrcd tu' el.lsd T044. Buarksirnd Pnrrerno8 cdl. lhcConrr6crDisLic.tr*L.ud.csnorsr,ply!oanow'Ero,
<br />rlF ph,icny n'ho builds or oDmves EE( and F (l)es such trlli himrlf or hcFcli or rhdulh hii or hcr own cmtloyecs,
<br />I'm\ Rlrh such imtmk'Eikmr, nrcrtled q o0LE{i nrs[ Ilih,k\r,rhchu,kl'n*ortr pft*tftm ($ld trirhi|one,sr
<br />olconlFl€iFr rlE OwE Duikls *illh1rc rlE bldm oi pmvm-s lhn tE or she dd mr huikl or mpmk rhc nmr.ny itrrlE ntrryh*.l
<br />-1,
<br />ar owmr ol rlE Fmp6ry, ,m cxclGively conr.lcrins wirt licm€d d,r6do6 ro c.nntud rtE pn')..i (Sc ?044. Busifts
<br />..d PmEacsn Cod.r 'rh. Conl.aclor's Lic.nse Law do.s.or applyro.nowner of pron.n, who huilds or i6trov.. rh.tmn.
<br />.nd qho o.rtuti for $.h lojd3 qi$ . Coir6cr.(i) ltcdsd nu6d lo rh. Conhaols LG..* lnn
<br />I'C
<br />)(o*,o*fi t
<br />rr(r\lr\ll0\
<br />I hcrehynmnn under lcnillyolpe4uryotu.rrh. fi,llowina declar.ro.s:
<br />-lha!?
<br />a' willolnrsrn a ccdilicare ofcon*nr b selllnsure InrNuk.E' conipensotion, ac pmvidedfo!bysccxonl7lr0olrlR
<br />tnhor Cod.. rhr
<br />'he
<br />!.rtnmmce oflhc wo* nr{nich lhc lcm n h\u.{l
<br />I ha!. and will naiotaio sort.rl comrEBorio. irquEm., .s Equt€d by S.clion 1700 ol thc Llbor C.d.. for th. Ddfomtft. or
<br />th.q6rkfo.whichrhkpmiririsrd.Myworkdr'6n.nalionitr{rlm.ericrsdpolicynldb.re:
<br />C.f,'er:
<br />l, LB \n.'.h l r. \ (_-
<br />{tl1 r,-,1 "., r,1.n,r.{r..,T.,,r,r."q.,r1,\r..F,r..n.,m ,...,u.J r!,,,,1
<br />' ii_It, ' h.n1tr.q'hr..lL. rl'. tr,1|a.'r.{rF(n'.nna l.{",.rr'.rl.i"nn,. n,i lsre Lr
<br />m. .nrL, r.y p.mn in any m.er
<br />ill rk,uld b.com. stl,jd b rlE
<br />siGl c.mp.norio. pmvisioB of Selion l70O of lh. tal$r C.d., I shtrll, fonhwilh comtly elh rl$c pmnisions .
<br />wAnIlNG lj.iluE ro w& wo*cF @dp.Mtion o!@sc is unldstul. a[l3hall $b]et af, mploy.r
<br />x
<br />I h.Eby lmrm undd podlry of t.rFry ihar I an lic.r*d u.d.r tmvirion oach.pt6 I (omn@in8 with
<br />of lhc alsiNr lnd PDfcisiotri cod.. &d ny lt.e is in tull f.e ,!1 .fet
<br />Lic.M Cl,s:-LiaBc Ntib.r
<br />-
<br />D.i.: Contn.tor
<br />q)xiraucraNl.lrll)llc_alilM:I
<br />Iherchynmfl!und.r!.n.lryolrcrJtryrhdrhseFanrnsrtuclionlend'ntsrB.cyf
<br />'hcpe.fomnmc
<br />ofrh€wo.k for$h'chrh( D€mi F
<br />iscu.d (se 10s7, cir c )
<br />AXTIICANLDICI,ASAITA!
<br />I lEEbyafiinnund€. l.n tyofp.rJuryon of thc follo*in8 dallmtions:
<br />D.mlnion P..on+Ash.nos Noancalion r.&el R.3rl.l ions ( l ill. 40, Pad6)
<br />-i.quiEd
<br />L.(.rolNorifi colion4ify thal rh. fcdcral reroLtiors Esulins es6.stos !.m!al ar. nor .rtl'cdble r. rhis FDj..l
<br />$.l I h.v.,.ad rhi.r applE rion dtd ro sdply 0nh
<br />^ll
<br />Cry ond Counry
<br />ordimnc.r and Sial. tiws ebting lo
<br />i,v. m. .onLd pmf.d,lar
<br />Y(pp,canr or agerr srsmrurt:
<br />hm'r'€e mnebntrt)
<br />Gas Service
<br />rhou.a.d doll6ts {S100.000), in
<br />;2<*'
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