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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 Pipinq
<br />Gas Piping
<br />Roof Drarn
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOUSPA
<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 />Rough Plumbing
<br />Final Gas Test
<br />Meter Release A
<br />FINAL I k)u.1
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCARATION
<br />InEbyaIImu Lr,.Elly of pdhry rhll I m d.nfl fmn rh. ConEcron Lican* L5a for lht followi!8 Een (Sd.701,.5
<br />Ausin.sr sd ibfcsion Cod.) Any Cty or Cduixy which rqriEs . Imit lo sd{tuc( .l'd. it\rbv.. &mllth or Epoir ey
<br />slruc1@. prd ro tu imaEq alFo ..quift llE applisnl for ruct t mil lo filc ! sisn.d nar.Mr lhtt h. or dE b liansd flMil
<br />ro rh. nmvirioE of rh. Cont6cld s Licn!.d Lrw {ChaDr$ 9, Co@mins *nh S..tion 7000 of Drbio. I of lh. Buin$r and
<br />Pmacsrions Cod.) or rh, h. or Fh. Lr dcn{)t lh.r.&6m 6!d rh. brsii lor lh. sll.s.d .iofliotr Any riolttion ol S.di,n 7011.5 by ey
<br />.flrlicad for a p.mn .ubjets rn lpplief,t lo r civil p.Bhyolmt ma rh.n fiv. hnndEd doll0rc(S50{).
<br />-1.
<br />xr o*ftr o l rhc ntult ry, or Dy .mploycc, * h $ ir.s is rnetr slc conrp.o$rion, $ill do rh. sttrk i.d rh. nrudurc ir frn
<br />inrdrd&l or ollirdl lor sl. (Se 7044, Burircs lnd tDfc$iotrs Csle:'lhc tontrrlut s Li.cm. Law docs Bn.plly k, tnowh.r ol
<br />rhcrFpeny qtn $ulds o. inIo!6 lh.@a tnd sh) do.s tuch worl hinstllor hcGelfor rhn,ush his or h.r own.nfloye.s,
<br />n( nl.d rh:r skh ihpmrcmnk.re x n'cnddl ronnd tuslc |l: tFs'cvs, rl! h! 'kl'ns .r 'n{tuwnEr Bskl'irhmoN,€r
<br />.l'cotrlPkro( rhc O$tur l]r'ldr wllh.it rh. bnr&nofpnrr'n3 rhir h.or$. did nn hulfl or nnnmk lh. I)n,pdy lir rlft NrF$of
<br />-1,
<br />as ovns of rh. pmr.ny, rm .icfusaEly .ootetine snh ti@*d .on'@toB to onsrucl rh. Inoj(rl (s.c 7044, ltusiB
<br />ard Pni*ion Cod.: Th. ConlBctols Lic.n.. L.w dod mt.ptlylo af, oa'n.r ofpD0.ny who buil&or inpmks lhcron.
<br />and who o B.k for sch Dmj..rs with ! Conrmto(, li.mrd poBu.r lo th. Conlrrctols Li.cN liw).
<br />I n.x.mpl unlcr SNI B.&PC lo! rhh retrsn.
<br />WOn(EliS'COMPf,NSATTON
<br />DECtdSAlt9!
<br />I lErcbyamrmun&r D.@ltyotidjuryoeof rh. tollosim dcht ioBl
<br />lha\t.nltrrll nN&ra(-cnricdeof(..n\enrt'S.lfl ruftlarvorkcB con,rensalk,, as rm! ed larhySeclknr:171)l)ol'r[e
<br />l-.bor Q c,li,r rltr,er,iimuflce.l lhe Nod( ntr uhrch rltr fqnnr is N{rc(l
<br />-l
<br />h.E a.d eill n.imain wo*.{ con .N.tion inturarc, &i r.qlircd by s(r ioo 3700 oftlE Lahor Cod., fot rhe llerf.r@rc. oa
<br />rhc work for which this F.mit i, Gs.d My sorlets omrcnsriotr in$6m orid .rd Ialhy nunbcr 6.:
<br />_l ccnit rh.t in rh. r,.rformonce oflh. work for which rhis p.rmn i. k.u.d.l stull ml cmDloy any pd). i. t.y mnrcr
<br />$ os ro h.etr $bjet to tht wo.t6' omp.ndion Lws of crliaomh, $d ase thal if I stbuk iEmm subj.cl to lic
<br />wo*6'omrcrerionro$iod.ofS(lionlT00otrh.tdtsrC.d.,lsl$ll,fonhwilhomdywdhrtnstmvirions
<br />wARNtN(;: I;oilurc b Kurc soricn s'mper$rnn corcmt€ rr lnl.wtul, and stsll suht{l !n mrpk,ltr ro mmrrl n mhies.d
<br />.vrl nncs up k, one hundrcd rk,lsid dollaGlsl0l).000)- ,n dlr'.D ro th..od .fconrnensirion, d.mrg ts pro\idcd for rhc
<br />sdhn 1076olrht L.ho. Co.le, id.rcstnndatoniey'3 n.r
<br />{pD[drl:--
<br />I lcrNsEo coN fRAcl (lta
<br />[ECl4BAllON
<br />I heEl,y amim uM.r pdnlry.f p.rjury thit I m liccned Dnd.r rmvhion ofchatrs 9(ommming snh S€clion 7000) olDr(b.l
<br />ol rh. Susircss Md Pmfc$nns Cod.. snd hy licens. ir in tull a.N alxl .lisr
<br />Lic.N. Cl.B:---!ic.c Nunb.r
<br />-
<br />caNirauuptrrEMBc-acl:lct
<br />I heby illiro und.r Fnalryofr.luryIhd ths. is ! mIstuction kodinS d8.ky for th.,€rfomncc olrh. work ior shicllhh p.n h
<br />iisu.d (S.c. 1097,Ci!. C.).
<br />AITLICANI.'IICLABAIIAN
<br />I lElt y 0fm und.r ncn0hyolp.rjuryorc oflhc nnb$ inr dslahrbn$
<br />DcnDlrridn P.rdirr Ash.st.s Nolilicalion l:edcr.l Rc3ul.tnns(lnle 40. tin6l
<br />_R.qunen L.ll& olNotrfic.lion
<br />-l
<br />c.fliry rh lh. f.dedl rcSuhri.E E8adins .sb.slG rmvsl 6rc er a0nlrlbl. ro lhi! lmjet
<br />I ccni,i ilui t tEw r.od lhis spplicrr io. a.d srat. thd rh. rtove i.fo.mtion is cotut. I ogd to 6mply {nh tll Cily and Cootrly
<br />ordimmB 0rd Shl. t m Ebrins ro b{ildi.8conto.ri6l\ rrd h.r.hyadtsriz.r.pr* aliB offii. Cnya.d Comty lo.rncr q,n ll*
<br />8bov. rcntio*d poD.ny for iNpftlhn purDoFs
<br />Appllcinr or Apent Sl8nrlure:
<br />E6EIX
<br />L.ndo s Nlme
<br />-
<br />Gas Service
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