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PLUMBING{NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifler <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />Ptrap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing trYD!rn <br />Final Gas Test <br />Meter Release FE -l ?0t9 <br />FINAL /, oco, 06/ <br />Notes, Remarks, Etc. <br />Omd.Buil&r D..ltrdd <br />I h4.by .flifr undlr p.ndy of prjury rh.l I @ ddPl fm $. Cdtr!.l@' Licd. L.r for lh. rollowins ,6on (t r.70l I 5 Bain6r <br />ed Pmldion Cod.): .Any Ciry d C@ty wtich rlqsiB . pmir lo .orEEucr. .lld. idprot, .itnolhh or r?air ey strude, pnd ro iB <br />isua@, .ls r.quire OG .ppli@l fd ,uch p.rnil 10 fiI. ! eiSrcd 3trlhmr 6ar hc or 3h. i5 licas.d puElDl lo th. Fovision6 .f rh. <br />cdna.lor'i Uc6!.d h, (ch.9l.r 9, Cottr,M.ins ei$ Sati6 ,000 of Daviiid 3 of ln. Bcin.* ed Prof*ioG cod.) d t\.t h. <br />sh. i! q6F thfr&on 6d lhc bair fa lh. .ll.scd d@rti6 .Ary violriq of SEri6 ?o3l 5 by &y .pplitut fd ! Fmt 3ubjal! $c <br />alplior ro r civil p6!.liy of nol mr. dle fis h6&.d &lla (ltoo) <br />_1, d owrd oa $. F.t ny, or hy mploy..{ wiln w.s6 a th.ir lolc @mp.sdio, will do $c wtrl od $. $ructuc is nol in'.nded <br />or o.I.i!d fd ialc ( Sd.?044. Bsin< ed lrcfditu Codc Tlc C@r.ddt Li6t. t q d6 nor Tply ro u om{ ofth. propcn, <br />who buil& u inprovB $o@n, udvhodG iu.h vo* hirorlf or h.$.lf n thrcus! hn d hdoh chploy.6, provid.d lh s,ch <br />imprcvmat! m no{ int6d.d d or6cd fo. s.l. l( hoecva, t}c buildD8 o. ioprcv.ddt k sold qirhii oi. ,@ ol conrldioi. rhc <br />OwM.Builda will t.v! $. burd." of provin8 rhlr h. ofth. not build or imptuv. for dE purpdc of stlc) <br />_I, a oma of lh. p,op.ny. m .xclqivcly @r.Eti.B wirh li@.r?d.Mlr&b6 ro.dtud lh. pDjcq ( s6 70..r, Bsin$ ud <br />Profdion Cod.: Thc Cort-.aor! Licae Llw d6 ior rppl, to s own.r of prcp.rty *ho blild! d ihlrovB thdcon , dd who <br />cmri&G fd sucn Fojc.u ,ith ! cdr&w(3) licdcd Frr@r ro lh. con ..o''. Li6s Llw ) <br />_l m .xcmpt @.kr S6tion _,8.&PC as this raon <br />WOR(ERS COMPENSATION DECLART{TION <br />I he.by afim undd p.nrlty of pcrj!ry on. of rh. follNinS d.clmnons <br />_lh.Eedwillmi ii. c.nifid. of ce6r toS6lf'Ide td *0rt6'.mpc.sllioi, 6 Fovidcd ir by S..ti@ 3ro0ofth. <br />t{b- Cod., td dr. pqf@ac. of {rc wdt t6 whid ln. Fhit it ir.u.d. <br />-I <br />hav. sd will Binr.i. wdt6' @hposdio icume, a lcquiE! by S€ o r?00 of lh. Labo Codc, for tir. Frfombcc of lhc <br />*dt lor whid rhb p6mit ir i$!.d My wdtcE @mFnrdion insumc. csnq lnd policy nuBb.r . <br />Policy Nhbr ErpiB <br />1*,"*^, <br />nd b. emda.d ifrh. p€mn i! l& On. hundr.d don.E {$lO0} s lcs) <br />lhc pafomecc of dr wnk fo' which rhh pmn ir iss!.4 I shall vb.co. subj.d to thc uolkc6 on INr of Cdifhia. and !!rc <br />Labc Cod.. I shall. ionnvnh <br />dollm (tl0O,O00),in addi dhage a provi&d is th. Sarion l016 of <br />UCETSED-EqILIAJ]C]!$-qEEJ <br />I h.rcby amm 6da pa.lty of Fjry I m li@.d uid6 prcvLio. of Chetcr 9 ( <br />$c BGii6i sd PofNioN codc,liccnsc t in aull f6cc &d.fccl <br />of thc wdk fd Phich rhir Fmit ir <br />109?, ci <br />AIILICANT'S DECI./IRATION <br />D.nohioi PcmiB-Asb6b! Nodliorid Fcd.il RcSul.ricd, (Tidc a0. P.n 6) <br />_ Rqquir.d La14 ofNoriii.tlid <br />6b6r6 emoval rc nor +dt$k ro tht Foj <br />ab.v. hdlion.d pmp..ty for inrp.crionB <br />I <br />I <br />Water-Underfloor <br />f------r-----