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PLUMBING.INSPECTOR RECOBD <br />COMMENTSAPPROVALSDATEID/SIG. <br />UNDEII GROUND <br />Waste & Vent <br />Water-Under floor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Draini Pool Pipino <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release I ,..,N <br />FINAL WI ) <br />Notes Remarks, Etc. <br />OWNER BUILDEN DELCARATION <br />I lEcb, .f,irm undtr Fully of lErjtry lnal I an cx.npl fiDh rh. Coil do6 Ltcn* Ljw lot thc following Easn (Se.7oll.J <br />Alsinc$ lnd Prolcsshn Codc): Any Ciry or Colnry which rcquies . lrmn lo .onsrucl. .116. imrroiq d.mlirh or EFn 4y <br />(tuctrrc. pri,r ro its isiu c.,lsrcquiF.rn .rplka fo.3kh Fmil lo fiks sisRd nlrcmnr rhll lE o, d* i lienFd FUNrnl <br />ro rhc,ovhions ofiE Conr&rofi Liccnsd t s (Chrpr.r 9, CommminS lirh Sftlion 7(x)O of Divi.i.n I oldE Busi*3s.rd <br />Pof.$ions Cod.,6r thd lEor slE is cxctr{,r tlEcliom. rhc b,sis for rnc rllcled d.nDlio.. A.yviol,lionofstrtionT0Sl.Sby!i, <br />a,,Ilicrnr for a l,cmh subists thc lmlics ro a civil !.elr, ot nor mE rhu ,ive hundEd dolles (t5m). <br />l. isosnc'olihc pr)Nnr, r r.xchtriv.ly .ollirNr n+ *nh lr.c0{.(l u{n.rtr k, dnr{td rh. proId r Scc r(!-l.ltr*itl\ <br />rnd rvho cont&r\li)r\u.hpnlccrssirhaConr.rcnfl\rl'ccn\cd!trhtr {rJrhcC,nnracrtrsIiccn\.li*) <br />I rmrxcn,pr ufrlcr Sccr <br />woxl(Ens' colllPFNsaTl(lN <br />DECIdBAIION <br />I hmby aftlrm undcr !.n*y of p.rjury om oalhc fotlowinE d(hnlions: <br />IhrvcandwillnEintrirrCcnific.lcofCo.s.nl!,Sclf.lnsurcibrworkcB.o6pcns iotr..s pruvidcd nxbyScction lTmorrhc <br />Lh,lBitr, h rh. n r,nnrrncc al rhc w.r[ lnr trhEh rhc ,lcrtrnr r a.ucd <br />Z4 rro' c ura *irr -, n <br />" <br />rn *-lcn cnmlcn\sr <br />'on <br />in\urrrc.. rr r.quimd hy sccl ion lTtD oa rhc khor C.dc. io, rhc p.rtorrumc or <br />sut/7va v /- t -zt <br />-l <br />.crrify rhrr in rhe perfoosftc of rhc qort for etth rfii3 p.rdn ir i*ucd. I shdll mr .nUby .ny pcrsn in lny mnmr <br />e !i 16 lism ruhif,r 16 rhc s*.8 @mpcnrdion hws ofcrlifomi& !.d l8r lhtl if I stolld tEcom .!bi{! ro ttr <br />so*s onpenerion povi\b.s of S6rhn lT00 of U. tjhor Cod.. l sh,ll. fonhwilh mndy {ilh lltc PDvirio$.. <br />WAXNING F.iluE lo surc hrtcs' mnDcnsslion ovcnsc is !.la{aul. und shlll sub.ic.r an mplortr ro ftinrindl lcnlhis and <br />civil fin.s up b otrc hundrcd lhouend dollas (Sl(x),(rr0), ifl addnbn ro <br />'hc <br />on of .oflr,. nsal ion. damScs N,troeil.d f.r lic <br />Scction .1016 oi rh. titxtr Oxjc. inrcrcsr nod omy \ res Z; A,*/ -?t- z<) <br />U!lL\!!l!.]A!d- <br />Ihcr.byrllr nui cr |xnnlryoftctu.yrh I am licctrwlund.r pnvi\i(nrofCn!n!c.9lcomnricin! sirh sc.rim 7000) .l Divisi.n l <br />of thc Bu\incs Md Pfl'tc\si,,i\ Cod.. d nryli.cis. n in rull ftr.c md cffccr <br />C c2?>a{ <br />D^,.. / - zt'26 <br />CONIIBUCIIONIIN]UNG.&GENgI <br />I h.oby ifllnn undn ,rMlty ol l)(rirtry thd rhcE is sconsrruclion hndins lrcocy tbr rh. pqrDnN.c. olrhc wurk ror whi.h rlk Firnir is <br />nsucd lscc :1097, Ci!, C.). <br />APPI (IANTDI'(]I ARAII{IN <br />I br.by rninn u Md lrfr lr! of l'.!ury icor r r(nk)trnr! dc.lnrdion\ <br />I)cn!n(i,rn lti,nii\ A\h.\ro\ Nor'll.rri(r Fr crrl Rogohri{ N l1 [.10. I'Jr) <br />Rc0uncJ IrI.rol Norill.rrir <br />I.cnrlyrh rhclcdcrilr.AUlrri,, \rrg dirershc(o!rcNnrlrr. NrrnflicrhL. n, rhn p(,jc.r <br />rho!. nrnrion.d pmr^-nr lnr iisFcrnnrlurt,s$ <br />Appliā‚¬nt or Agent Signnlu C (on q.D-/ -Zg-zo <br />gtflfltlllNEttT L <br />Orn.r: <br />c*'*". /=% <br />Gas-Underfloor <br />Miscellaneous <br />t,