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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG"OWNER BUII-D}:R Df, LCARA ION
<br />I h.rcby,tnrm und.r pcnany ol perjury rtd I m cxcnpr lron rh€ CohtrcloK t-icense l.aw nrrlc lollowm3 r..$n (ss,7011.5
<br />Busin.ss ond Ptulcssion Cod.) Any C y or Coonr, whrch r€qrrcr x dnnr ro mnstrucl sltr. mp,orq d.@lirh or Eprt my
<br />situcrur.. pnorb nr ssuanc.. als rcqun.r th. rlplr. fo.suc[Fiinf h filc a siBn€d srar.mdr rhd h..r sh€ is liccnEd putaanl
<br />ro rh. rmlisio.s of th. Conrairofs Lic.ned l-nw (ch.tlcr 9. Conm.n.rnE wnh Sdion 7OlX.r ol Dilni.n I ofrh. ausin*s and
<br />Pbfr*ions C.de)orrh, h.orrhc N.xrmprrhcrefmm.nd rh.n sis nn rh.all.scd.xcmflnn Anyvmh'ionols.crnnT0ll.5hrony
<br />applicr lbr r p.iind sbjdts lhe arplicanl lo a.ivllpenallyofnot morcln'n,i!. hutolr.J dollars (5501,)
<br />-1.
<br />s owRr of th. pmFfty, or my chplorr* wnh sasc. s th.ir rlc onFMli.n, will do tlE wdt &d 0r dn&r@ i! m'
<br />i,r.flLd or of.rcd lor sle (Sd.?044, Buri.d .nd PofdrioB Cori.: -l h. Coftaclois Lic.d€ Lle .lod mr q'ply to .n owM of
<br />ihc potdry who l,naldr or apmE llE6E rnd who dH Mt md{ hiN.lfor h.Nlf6r trcn8h hit or hd own .mnlor..st
<br />pmyidcd rhar $ct impoc*i'l3 e ht htcrd.d orolr6.d for Eb l[ hoqt6. tlE t{iltil'8 or ir{!ffir'l is $E ailhin oE yw
<br />of@uFkrbl\ rlE O,n.r Bliud sil, hrE rlE h,rl.n drptunns tld lE dr rh. did mI l ld or inp6v. !h. pmDqly lbr lh. purF* of
<br />-1.
<br />reonBofrh.|lmpdy, e.xcluriv.ly@ retinS with lic.ns.n coiltuclof ro.oBmcl rh. pm)ecl (S(.7044, Butins
<br />6ri Po&si.n Code T hc Co nclois L iccNc L.v doci not lpply ro e ownc. ofpo!.ny who huild, or impo!.s lhoo4
<br />and *tb onrncrs for och pmjdr wnh a Colnfuro(o lic.N.d puBurnr to llE Co'nracrol! t,iene L!s).
<br />_l d .r.Brr undci s(lon_, D. & P C for thB r..$
<br />Dat: Orn.r:
<br />!!185[AE:COMIEN!AUA!
<br />.DEC!|8AIIO!
<br />I hd.b, .lfim u.d.r F@lry.f Fjury om of rh. lollooinS d*lsdio r:
<br />I hrre mlwill mrinrarn r ccnificart olc.nrm r, selllnsure nt $o,ksr !. pensrnn,, ns nnnalrd lorbtSc.tm:17(10.frh.
<br />lj&tr (-odc. nr nr nerloanaDcc oilhe *ort rirr uhrch rM p.nnrr r ffned
<br />-l hav. and will dainrain woi(.r! c.mn.ns.tion in$mme, .s r€quircd hy Sd n,n l7m o f rhc Lth.r Codc aor fi. prfomm. of
<br />rh. qor* lor vh'.i rhis ocmn is,sfl.d. Myworkdr omp.nsation rNu.me ori.r a.d !.licy.uml'.r N:
<br />knrcyNdmb.r ' trrtr.q
<br />X.cn',yrllnrnrhcnsl"i,(.menfrhcN.rllitrtrh(hrhFrcm ic ssu.d,Iqhrllnor eflDloyanyne*on i. r.y rtrno
<br />(o rir,tr$m.uljd,.'r\.* 'k r' .o'nrrner'cn l.'ur ^t ('il.icrnr.L and +r. ri
<br />'
<br />r I .h'ulJ hd"N <uhdr b r h.
<br />qoll.d L-nrp.nerionpmvhons ofs(lon l7(li)ofrtu !-.t r(.de.lshi L lorlhsirn coftplt w hrl$*nNvhio.c
<br />wARNlNcr lr.iluE ro Ku.. xortcG mmpenslion slemlc n unbwiul, and shill iuhjd .n oploylr ro dininrl ntrhi* .nd
<br />c,vn ims un r. ok h!nd!.d tlFtrsand doll.c (5100.000). rn !{ldirtr'n to rl[ coql olcoflrnensxon, datus.r a. [.vd.d a.r rh.
<br />Srrnin 10764lrhc l.ho, C.d., rnrcree rnd anNft)'c lec..>L +lvN\ & \L
<br />r r[rrsr;riior r ttX< trrtt
<br />lllcl SalIQN
<br />I heftny.mmund.r penrhyol'nclury that l.m licen€d uder pmfciinr .fch.trs 9(..mmercins wilh s.ctirn 7000) olDiriqnn l
<br />ol rlr lluqnc$.nd P resiohs Cod.,0 my liccnrc 6 n6ll forcc md e,I(r
<br />3(l-.ooq
<br />co!$f,ucllatr[Bltuclcfrcr
<br />I hercby afItrn und.r leMlly ot peolry rhd rh.rc ( a snntu rhn hndins as.rcy Io. tht ,,.rfomtue ofrh. mrk aor Bhich rhh D.mil h
<br />i$u.d (se 1097, Civ. (').
<br />Attl.lcadLJl[clds uQ!
<br />I try.t y rilm under pen.hy ot rcrjury oac oflh. followins del@'i.ns:
<br />Dcmlition P.rhirs Ar$.{os Norinc,rio. l:.d.61 R.Eulations ('l le40, n!.r4,
<br />-R.qrned
<br />Lcu.. olNor.n .rion
<br />I cdilyrhar rh. fedemlrcsulalioN rcsnins as&skx rc'$ql.rc no' amlictrhlc
<br />'o
<br />rhF n.qe.r
<br />SdJ€in,ry ru t r,n' " .-a rts 'rflici( i.. iln srar€ rrmr rlr iho\c inn{mrf on ir .oftccr I .srd ro conDly sirh rll c v aid counrv
<br />o,ilinamcsandsr,rel..wsr.ldinslohuildin-!consrruclion,mlh.rehyrlhorizcreri.tnrarircsofthlsCryrnd(bunrtro.6rstrnonnt
<br />.,.-.(url-$
<br />UNDER GROUND
<br />Waste & Vent trlltlR n 'av+4 ?1)
<br />Water-Under floor U'i
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent .t).^.w
<br />Water Pipino ,r> lL'l tw ,NT;u'
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test *ra,-d
<br />Rough Water Heater (U I
<br />POOL/SPA
<br />P{rap/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 Plumbing 4.rlLq T 1tftsaetY fzD
<br />Final Gas Test
<br />Meter Release
<br />FINAL Aluh.qlb wra4r:>_)
<br />Notes, Remarks, Etc.1,. 1
<br />.+
<br />COMMENTS
<br />Yl57rq Tol \
<br />,".",' \l \t [t" .*,-"-,F !f L'
<br />itnvc ftnrioncd DFneny tn' insn.cri,m,trros.s ^
<br />apDrc.trroraEmrs,En'tur.:X* \.\----------t
<br />P.rnh..nrm.o.,o L r&4Jc i4 '
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