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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnlerceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pi ptng <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />P{rap/Drain Line <br />Main Drain/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 />Rou gh Plumbing I <br />Final Gas Test /1 /.t</tf z >WtI'/,lt <br />FINAL u/t</r{) <br />Notes, Remarks, Etc f- r-T-v <br />OWNf R BUII-DI]R Dt]LCARA]ION <br />IherchyriirnrunderpenalryolpcrJuryrh0r l\n.acm fr-.ll1rhc (o racro,i l-iceN. kw litr rhc nrb*in! r..r)n (tuc 70ll5 <br />Btrrin.* ind P!,f.ssrrn C(xle) AnyCrr,or Counry chrch r.qurcs a p(mn b conntud. nhcr, imrrove. denmlNh or q,.t any <br />srruc'ur., rorro ns iseu.nce, 0l$ r.qutr.r th. arplc,nr ntr ,u.h pern ro lilc. sr8n.d sbranent Ih.l lEor sh. h lic.ns.d pumrlll <br />ro rh.,mvhions ofrh. Contetoi, Lic.ns.d tnw (Chn cr9, Coom.h.in! w(h S..tir'n 7000 of Dilision I oalhc BusnEss and <br />Pnrf*son, Codc) or dhcorsncli.xem rl'.rclrom ond rh. nnsis lor rhc .ll.sd cxcnntion Anyvn'hrionofs.cli,)n70lrl56y,try <br />anplrcanr tur a I]e.mrl subjedr thc appliclnl k, !civilp.nally.lnol Dorelhan fi!e hu'xlrcddoll,^(s500) <br />-1. <br />as owr of rhc pol).ny. 6. ny .rplorca with w,g6 ar rh.t sL onlp.Mliol\ will & tlE wfi lrd ttE {rudE b ml <br />i .id.n or ofr.Ed fff sL (S*.7044 Bu.iEs and PmGrsios Cod.: 'l'lE Conu.crol3 Lt.e tle &'6 mr aoply lo .n ow ol <br />$.pmpdy who buildt or inp,ova rlroa od vlF &6 sch md( hime.lf or hcelror rhouSi hk .r h.. own.mploydn <br />povid.d rhd sch inpmlefii. e hr n ad.d orofl.r.d for sl., It towcvn rlE htrildoS o. inqlownr Lt sld within om,Er <br />ofor{,Lrbll llE OwM Buil&. will hiw lh. burdm ofpmvinS 1h,1 h. or $. dil mt ldld or irrpmw lh. ,mpdy t)r rlE priFE ol <br />_1. di 6\lm oflh. toFly. m dcluriv.ly codEdoe wirh lic.r*d od6clo6 ro oNlrud ttr lmj.cl (Se. 7044, Aurirc$ <br />ard PmE$ir.Cod.: Tn Conraclols Lic.nrc l-.w do6 mr q,plyro of,osncrofpropcny*ho buil& or ioprcv.s ih.roo. <br />a.d et6 m Ecri for och Fftjc.ls wrrh r conrEcro(;) licd*d Dufla,r ro rhe conlr&lols l-Lmr. L.w). <br />-l <br />m .x.mpt und.r S€Iion-, B & P.C. for lhi, dron <br />!48tr4BECO!lf!:!5lI!O! <br />DISJAAIIA! <br />I hcreby amm under rlcMlty of p..jury otu of ft. folloeitrs dc€la6ri6B: <br />-l <br />h.E &i will minlain a Ccilifrcar. of cotrrnt to sclf-lNrc lor wt6 6 pm$tioq d pmvid.d for by Sclion 1700 otthe <br />Lsbor Cod.. for rh. p.rfotu of lh. hrk lor qhi.h lh. pdn ir is.d. <br />_l hav. nnl will mainlain worters .onrene(ion iB@r.. ,r rcqut d lry serbn l70o ol th. ljhor Co&, for lh. Frtomncc of <br />'h. <br />wort for whkh Ui. Fmn ir iinr.d My wmkdl conp.tretion ia{mm. cmi.r .rn polcy numh6 m: <br />-l <br />c.nrfylhot in the pofo.m.c.of lhc work for whi.h rhi p.rnir ir i!su.d.l shnll m. mploy.ny pcM. in dnym.nrcr <br />$ ar b b.oe sbjd r. rh. wo.l(6' mm!.nstion lam of Calia.mia r.d aER thDl if I should h.cotu sbFl lo dt <br />w.*crl mnl).nsrion tmvkionr ofserion 1700 ofthc l-abor C.d., I dsll. lonhwith dnrly wiln lhr povisiotr!.. <br />WARNING: Iailur. l. su. r.rlcrl omrEtrstiotr cove6s. is unla*tu|, Dnd shall $bj..l an .n,io)€r ro <br />t1!(ld.8alt9[ <br />I hcphy amrn unJ.r penahrofp.rlurvrld I 3rn I'Ltnkl und.r pnrrironolchrprn q (.omnrrcin8 *irh Sccn.n 70(,0) ofDnrion ll <br />ol rh€ liusire$trnd l'rer.ssions Codc. and myliccnse N in llllforce ffil.lkr <br />I lErchyrfltn ondcr Fnahyolp.r!ry rhal rh@ $a conntudxrn knding rlcky n* rhc rrlommnc..frhe work tu \'hich thk I'cmir t <br />ssucd (Se l0q7,CN. C ). <br />atrucadf,DfctAaAlloN <br />I tfthyd,lim und.! r.ntrlryorp..jur, on. of rh. finbwing dccla. ion( <br />Dc blition Pc.nits.Asb€slm Norifi€lion Ld.ml R.sulalions I l irlc 40, Ps.la, <br />-Requn <br />d LcncroINotifi eliofl <br />-l <br />c.flrly rhrr rh. lcd€nl rcsularions Es.rdins srlrslos r.m)vol!!e nor applicdhl. h rhir tnrjer <br />I <br />DlZ,fr <br />POOL/SPA <br />Gas Service <br />Meter Release <br />F