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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 Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{raplDrain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler ,.<
<br />Sanitary Sewer/Cap)-n^lql y,wL
<br />Back Flow Devibe-/
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />Notes, Remarks Etc.
<br />FINAL
<br />O1VNER BI. II,DTJR DEI,CARAT'IoN
<br />I hercby rtlirm under peulry ot ,)cr!ry rhar I m .xempr imm rh. Conrnclo6 L,icense l-aw lor rlE iollow'ns r.*rn ( se 70r l 5
<br />Buriness rid trotusnr. c.dc): Any Ciry or Counry\hi.h rcqutrcs a p.nnir l. con(dcr, rlre, inrrort, dcnmlN[ o. lq)0tr ony
<br />{flciurc, prnrro q hsu.occ. .1$ rqur.e th€ 0p,!l1c.llt nn sucn D.rmir lo file r rsral dir.rfttrr rhlr lEor dE k |rc..€d Nm!"r
<br />hrhepn)v'rnniolrh.C.nrnclo.sLicen*dI-.w(Ch.nr.r9.(onnrc.ir1SwhSeclon?000olDilnonIofrhctsunn(crnd
<br />Pmf.ssi(,ns cod.,orrh.lhcorshc hcx.mpr lherctromrnd rh.hasis forlhc !lle-!.dricnrron Anrvd,Lonolscdtn?0ll Sbyiny
<br />npplic.nr lnr i rc.m( suhJ$rs rh. lpr licaor r. a c'vr I p.nalry or mr mr rh.n fiv. hundred dollm (s50q
<br />-!.
<br />s osr of rh. prcp.ny, or oy .nploFs wilh sae6 B rlEi. $L of,rFMlion. vill do $. hlt tnd lh. .lrldw i rn
<br />inr.nkd.ro0.Edfor$k(5(.7044,Buiift$af,dPmtdiodCod.:'llECo.n[solrLkcNchsd.6mt.orlyloMo*kol
<br />th. lmpdy wtb hild. or in{,nH rlE€,\ di wt6 do6 sch mrt hims.lf or hmclf or thmush hh or ho oM .nplora,
<br />tbvi(H rhll sct irlNtftfl. e rcl iolad.d 6r6tldrd tr sL. ll h6wcB. irE llilding or inprov.rr.d n Fld *ithin orc Fr
<br />ofotrpkrio[ rh€ O{Nr Blil&r will haE rh. bu&n ofpmvins rlEr lr d 3h. di, Dl l[i8 ff iqmw fi. pmp.ny firr lh. Nir.* of
<br />l. as own( ofthc pmp.ny. m crclu$v.ly co.raclins srrh lien*d co @roR to snstruct tt !oj.d (56. 7044, Bnso.n
<br />ad P,of.ssi.. cod.: t h. Conlraclor's Lic.nrc L.w do.s mr.pply lo rn owncr ofproD.nywh. buildr or mfmv.s lh.rmn,
<br />lnd tho @dmds lor sch poj..rs *irh a cdn|tcr.(, Ii..tr*d t lrlMtu ro rh. Contncloas LtdF L.*)
<br />-l
<br />an ci.nfl u.d.r Seio.-, A &P.C fo.lhir Edmtr
<br />Drre: ortr.r:
<br />.:4A85E8S:.CQ!4ENSATTONofc!,a8aua!
<br />I hfic6y alllrn und.r p.ony of pdjury o.. of lh. followin8 d..laralioN:
<br />_lhirc if,dsrllDiLnra'na Ccn'licxtrorc.n*nr t) SdllnsuR lnr\orkers co[p.rsil6n. rs,]ovtrlcd itrhyS..rnnl7([).irlt
<br />horCode.lorrlEps,nmanceoflh.sItrk fitrtrh(hrh.ncnn'\ i\slcd
<br />Udxkhndc1lmu,nhrl.ro'c.nq*n$rhnrniuhtu.,atr.qu.dhyS(rnnI?OootrhcL!h.rCrd.,llr s k lin $h'.hrhr p.m r. Fqu.d Mvuorlsi onr.nernzNu (!sndaddicyrumhnk
<br />,*"-121-4.ltD, W1JCe.!IS/^-) - t.""*'""-'rtif/7'rziseie n/i'
<br />l..nr,) rhar rnth. p.rl.rrumcolrh. wrrk lor whrhrhFrErnru n *,a.,"*, ^r.*n,/*r**n
<br />,,q/7'
<br />s as to t roft cuhid lo lhc woit6' snr..srion hws olcdl,fom6. rnd uE ihd ia l stDuld b€.or
<br />hrk€6 ohpcrer ionl,mviroN ols.cxon 1700 of th. l-olrr c.d., I s1Ell. fodnwiln smply *ilh llss
<br />wALNlNc ljxilurc ro sur. *orken conllcnsrrtr'. cor.rilc and shlll suhiet ao oplolrr to cinidl pqnl'id and
<br />iMdr.d rhonsnd dolLrs lslm.000).ds'ms.r m tmvid.d for rh.
<br />I hcretynmrm under penxhy o i p.rjurr rhd I am lrerEd pturirion olCnapld 9(comftmins wilh Srtion 7000) olDivi.ion l!
<br />ot lh. Ausircss ond Pof.$ioN Cod., aryl my liccrs.
<br />CL?/q7*
<br />cltllrBulll)rll;lu$Gicr!(I
<br />lhcrchyamn!undcrp€ndtyofrcrlryrhdlrh.rehacoo{rucrionlcndh!altnoyaorrlrcfdnms.ccofthes'orklixshichrhiiF-rnririr
<br />isrurd (s.c. 10s7, Civ C ).
<br />AIIIICItrLD}:CLABAIIOA
<br />I h.Ene ofiinn und.r ncnolty ofDcr,lry oru otlh.lollo*in,r d(ladi.ns'
<br />l)cmhrn P..o i Asbc.ros Norilicotion lrcd.nl RcEUl.rio.r(lnt40. Pan6)
<br />_R.!!r.d L.(d of Norifi d0n
<br />I ccnily lh.t I h.v. r.ad this !I,Fl cor.cr I a8xc lo omtlyvnh rll Cily and Co!trly
<br />6rdrMk6 rnil sbrc Lawr Eldmr E r.g{arnB dlfir Ciry ..d Cou y to .ntd upn llE
<br />dbovc nEnri0nLd nnrl).ny,ir
<br />PLUMBING-INSPECTOR RECORD
<br />Gas Service
<br />/,\
<br />r
<br />\"v{M)
<br />I .cnit lhd rn f.n.d rcslLliotrr Esddins &ch.shs r.msl lrc mr lptlicabl. ro
<br />'hir
<br />p6jd
<br />^,44/e
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