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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS oIYNER BUII,DER DI]I,CARATION
<br />I turehy rrltm uidcr Nn.lryol p.rru.y rhll Itrmcx.m lhnr lhc Conrxcnra t-iccn\c l-aq r(tr rhc finhsfu rcrv'n (5(1).115
<br />Bxsi'rcs\ nftl Pi(ni\\irr Codc)r A , Cily or On,nl, shiih ruquiE\ r lrrmir t, ..D{rucr, dllc!, Dt'ovc. dcnrlish or r.lrr any
<br />\rnrcrurc. p.iq ro n( ,sutrncc. rl\o mqutcs rhc +plicMr rff \uch tfnnn ro fiL. rirn.J nlrcmtrr rhrr hcor rh. n lico\t\] PuNuotrr
<br />t' rhc ftrni\i(lN ofuhc Conlru.tn s I icc.*d l-Jw (Chrnrcr L Co'n t cnr! wirh Scdion 7fix) ol l)ivisioi .l of rh. Bu\itu\\ ,id
<br />llotc\si,n,\ Codc).rrhd hcorrh. scxcnDr lhcrc,romnn'l rhcl[ris I rhc rllcscd crcryrn,n. Anyvn,hii,,nors$lion70.ll5byrny
<br />.|1fri.rtrr l,r, |f, nrir suhccls rh( irplicanr lo !cirilpcnalryoilor 'nn. rhrr lilc hutrdrcddDllm ristro)
<br />_1. ar owncr of rhc I)IoFdy, .r mt cnrtloF.s wnh saScs f\ rh.t blc compcnslln,n. wiu do rtE s.* 8nl EsnxluEi\ mn
<br />inr.nJcd or oncrcd lor slc (Se.7(}44. Busincss and Prcfe$ions Codc Thc (hrri.ror s l-iccnsc l-lw docs nol !,{,ly ro an o$ne. of
<br />rhcpnrF.ny wno bu ilds or i!lpro*\ rillmn, dnd *lx' d,B such wlk hi.rclf or h.sclf or lhmush tn or hcr ow. c,'plotcce,
<br />J,roridcd rhnt such inry.rcmnt @ mr hrendsd or ofte.Ed lor {lc lf. hotr!.i rlt l,lildins.t LrrmEmd hs'H *iriin mrlu
<br />oaonphriln. rh. owmr auiks will h!rc ltr bur&" of tmvinA tfuu h. or \hc dil mr huih or i,rq,mrc rh. FmFny aor rlE IU4nc.f
<br />-1.
<br />r\ owncrofrhc I,oNny, sndrclurivcly contu.(i.8 eirh licnsd contr.clonlo onslrucr lhc tDjdr (s.c.7044. 3u\irc(
<br />n l Plor.\dr Codc Th. co r!c!, s Liccn* Lov docs mr o,,plyto !nowncrorF)N y*ho buildr or inrlro!3s rhc,con-
<br />aM who ontrErslbr such pDj(l\ wirh a Coniradod$ ltcnrcd pnhxmr rorhc('ontrocxr's Liensc L!q)
<br />I aDcxcr,rlundcr Sccrion-, B & P.C n,thh rclso.
<br />lla85$5:.coMfENSAr1aN
<br />DECI,AMIIQN
<br />I hcr.by !fii ,n undcqE.lhy of rcrjury orc of lhr tollowin8 dcclurtuns:
<br />-l
<br />h.vr 0d will nEinrui. a CcnifE tt of Consc ro Sclfln\uE 16r w.rk.rJ con{f,nsrion, as lDridcd lor bySccrion ]r0oorrh.
<br />t{br coic. for lh. Frfommc of thc *oll lor {hich lhc pcmrir ir hs!.d
<br />_l h!rcsfld will msi sin worlcd c6opc.sa'ion iBummc. N rcqund 7u) ofrhe Llbor Codc. ror lhc FrfoflmNc of
<br />rhc Nork li,ahich'ni\ pcnnir ir i\\uLtl Myworkc^ d,nFjnerion
<br />ofrhcwork f(n *nich fik ponl k i\su.d,I sholl nol cq,lo, lny l.^on ininymnmr
<br />s e\ ro b.@ft subiccr k, rhc wo.r.B'ompcnsolion lars oac6lifomi.. lnd astc rhar il I should b..om subiel to thc
<br />erlcrs on{Enerion tovisiods ofsc.lion 3Tm of$c t tor Code.l sh!U. ibnhwnh conPly wnn$or tmlilions..
<br />w,\RNIN(;: !_iilnrc ro sccurc sorkcn comncnlirnn corcBsc i. tnhstul. rM(rll an c Dhrr. ro fimiml Fmlrts lnd
<br />mSca !s providcd for rhc
<br />I h.Eby affirm und.r lEnahy ol lcriury rhrl I nd liencd und.r p,lvhion of Ctaprs 9 (@nmtuing wnh Selion ?000} of Dilhion l
<br />oi rhc Brsims &d PmfcssioN Codc. drd my licctr{ is in tult ft,e 3d cficl.6)-
<br />cQrtl3rcuaL].lilllarillqf,Ilr
<br />I h.rhy a,nrm undclrnalty of rc.lury lhot rhsc n a con(dcrk. hnding tScncy for thc !.dornrncc ol rh. uort in. whi.h rhis F,mil is
<br />issucd (Ss.' :1097. Civ C.).
<br />L.nJcr'' NJnrc
<br />- PPLI(]ANT T)ECLAiATION
<br />I h.rchy dti,m undcr Fnllryotri.,jory onc Dtrhc iolnrqnrS dccl,,rrions
<br />D(nxntrnr Pcrmn!Arl)l{o\ Norificsti{'n F-cd.hl RceuLiirn\ ( l'irlc.$. Pnn6)
<br />Rcqun d kficrnf Notifiuri..
<br />-/*
<br />iry rhf,r rhc fcd$nl rceul ions Egordi.E ashcfts rconralarc nor trppli.$L h rhirrmiccl
<br />fi,vcinformdhi\comcl lasrero.\,nlplywirhallaily0trdCounlyrhrr ll{vc rcnd rhis rlnli.rii, rrlnr
<br />odin0mcs !.d Starc ljws rclaringro buiHine ! hcrcbyaurhorizc rlnrscnrarivcs orrhk Ciry0nd County
<br />(2d$vc mnlioncd pmpeny aor
<br />Applicnnl o. As.nl SiB trlu K
<br />N
<br />3q
<br />UNDER GROUND I
<br />Waste & Vent t-o qlls
<br />Water-Under floor \II
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />tvlain 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 />Rouqh Plumbinq "1\rb\6
<br />Meter Release
<br />FINAL wL)\\g\)v .]JLqM I
<br />\Notes, Rqmarks, Etc.
<br />&D Slt4ltt ,tt41t'o Pr.ln{- N lara 41t [h'". v 6',*& to d<c
<br />ID/SIG.
<br />?.ttlhmr
<br />Final Gas Test
<br />dollan lSl00,010), in oddnion
<br />b
<br />I
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