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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DI]I,CARATIoN
<br />I hcrchy rlftm und.r |fntrlrt olocrjrry thd I cxcflnr fntrn thc Coftrkl1- Licctr{ Las lo, lh. thllorin8 rerqrn (Scc.1lll.5
<br />Busi.cs rNl Pnlcssion Codc): Atry Cirr or Gnllny w[i.[ r.quirct r lEirnil lo cotr{rud. alrcr. nnprovc. denFli\h or rprt rny
<br />srrucr!,c- flior ro irs hsuancc. nho rcquircs
<br />'fic
<br />lPt'licanr in such ncnnir ro lilc!sisDcd {arcmnr rhr hcor sh. is li.ohril Nr\uaii
<br />ro rhc ptuvisidN ofrlr Conkr.t, \ Li.cn{d Irq (Chnpr.r 9. Co'nmkinS wirI Scdion ]UX) oi Divi\ion I ol lh. Businc$ atrd
<br />Ptrni\\i(nr\Codc)o!thrrh. orshc iscrcn lhcrclionrnd rln h.\is tu
<br />'hc
<br />rllc8cd crrmplio. Anyvi('hlionolsccrionTo.tl Shrany
<br />!ptlicJ ntr rF rnir suhjlr( rhc rppli.nrr n, r.ivilpcnalryolnoi nr{.rhan fiv. hrndrcd doll&\(3500)
<br />-l.
<br />i\ owNrolrhc|nornr,(tr yenrploycc\ silh $iBcsr('hun sohconrDcnsdi{nr, willdo lh. work uBl rlrc ntoc'uri\ nur
<br />i rfr l or .iii.cd lor {lu I SE 704J. Busincs ud l}oaessionr (lic ]'hc Gnr'actr\ Liccn* tj* do.\ nor iprly ro an owmr or
<br />rhcrn,lEny wh. builds or inlatr$ rh.rsn. rRl who d*s sa.h woit himsclior hcr\cllor rhrou8h hn or h.r own cmphyc.s,
<br />pi{,tiJcn rh i nrh im0rovcnnr\ rc ftn in.ftlcd o. ollird rbr c& lt', homrr, rtE huitling or ir{)nnrnrnr G v,H wirhih .tu }td
<br />oronrfLri)n. rh( owncr Builds silllurvc lnc hmlcn ofrmwE Ihr hc or shc dil n.r ttriU ar inprcrc ihc rFrlny lor rh. Nrlx,e or
<br />-1.
<br />as own$ ofrhc tepcny. !n cxcloiivcly conrerins wnh liccnsd contrdorhcon{rud rhc rojel (sec.7044. Burinc$
<br />and hotusah codcr Th. Conrocror's Liccn$ L0w dcs bor dpplyro @osn.. ofpop. y who huilds or inlPrcr$ rhcs'n.
<br />dnd *no onrtul. for such pEj<ls *nh a ContEclo(sl liccnsn rrBuut ro $c C,nreror's Ltcos Lrw).
<br />_l rm .i.hpr und.r S6rk n- B. & P.C. aor this (&s.
<br />]IOAtrEBS:COIIEEISA.IIONlxlcl AR TIoN
<br />I h.Bht afllrm und.r p.nrlty of r.rjury onc ofrhc fdk,wing drtlnarn,ns:
<br />Llh.r c(xl.,li,r rhc,rdunMi.c olrhc eork lir shrh rhc |*nn n n\ocd
<br />_l hrr rnd sill nEintain qo*e6 corycnsarion insoEncc, .s rcquncn by Scrinn 37(x) of rh€ Lrbr Codc, Io, rhc pdformrcc ol
<br />rlE erk for *htt rhis pcm is ntu{. My *o m' mn{E.s€rion inslda ceh, ad lblky nunb( @l
<br />-l.caifylhol
<br />in lhe pcrfotrMmr.I rhc sork ro. shth thi\ Frmit h is\!cd. I rhrll n, cmploy,ny n Mn in my mnmr
<br />s as ro lt$m subjn! to
<br />'hc
<br />mlk.tr omr..s.rion lawsofcdlift,ni{ dd.8rc rhar if I stnlld tEsft suhjcct lo ttr
<br />vorlcn comFr{rkn pmvnioni ofsNrion lTmorrhc tjh6r Codc.l sh,ll.lonhwnh srrPly with lts$ povhions..
<br />WARNIN(;: frild'r t, \r.ur. s(trkc^ .o rpc \ riot corcrr8.bj*! an cmploFr lo simind lf,Mhili ond
<br />civil 0nc\ !p ro one hhd,cd rho!\a.d dollB (5!00-0(x)).r.o6F.srio.. drmg.s as lmvidcd for lhc
<br />I hcrchydfllrn und., l).n,hy.rl.rjxry rhd l0m lnrnryl uM.r pr.visn,n otChn0cr 9(.onn:rncing wilh Sction 70il)) ofDivi\ion l
<br />of lhc hNims and Pmfcssions Codc. ai ny liccns is in tu|, lorcc !'n cil6r
<br />3228e{
<br />D"E {-/LrE coorrr"ror,\ / .0ZA z2 D_u,*m*,O 6F
<br />COXSIBUEI]ONIIIIJINCII1iDN.(I
<br />i\srn lS.. .1(x)7, Civ ( )
<br />AIII.TANIDECIJAAIIIIN
<br />I Mydild undo p.trahyof pcrj!ry onc dtrhc folloeing &clor.rions:
<br />Ocmlilhn Pcrmils-A,t $os NolifEalion Fdcral Rcrubtionr (Titlc 40. Pd6)
<br />-Rcquircd
<br />lrlld oa Norifslbn
<br />-l
<br />ccnify lhar lhc fcd$al rcguhlions rcgordnrS .sbcsros rcnsval m rcl applicobL lo rhn pojecr
<br />-l
<br />ccniryrhur I h^c rcDd rhhdDplicurioo&d\krcrh6r rhe ir.oBr I dg,e k comply wirh rll Cityrnd Gunry
<br />odinarccs and Stlre Li*s Ehlin8 to buildirg c.rarivcs offtk Cirymd Counly ro cnrcr upon tlE
<br />ohove,rcnrioncd,mpcny aor insF.rion
<br />Applidnl or Ag.ol SiSEllr.
<br />,1 a
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<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 />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL q 'U/( 5 Y",t tttttA
<br />Notes, Remarks, Etc.
<br />Secrirn lo?a' olrhc ljhlr C.xlc, inrcd( lhd ino.E-y\
<br />*,.,3'-/ C'/*
<br />,^.,5)/C -B
<br />l'emilec n{m€(p.itrl)
<br />POOL/SPA
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