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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER DUILDER DELCAR TION
<br />I lErcby altim !od.r lcMlty oap.rjury rhlt I d .x.no fmm th. Co Eclors Lic.ni. l,w for rn followirs E.sn (56.1011.5
<br />Butindi and Profc,si.n Codc): A.y Cny or Co! y which EquiE! a n€mn fi! co.ittucr, !hd, in!rev., dcmli.h.r Epa'r sy
<br />mcturc, prior ro ill i!$e., .l$ rcquic th. lpplic6,n ,or $ch pcml r. ,ik o iieGd 3larcm rh,l tE or ltE i! lico*d pum&r
<br />lo rhc lmviiions of tL Conrrct6 s Liensd Lap (Ch6prcr s, Comctuins *ith Serion 70{0 of Diii.ion I ol d. Busin s! and
<br />Pmf.siom Cod.) or rl[l lr G .lE i-q .x.o!t th.rcfmn B.d rh. h{rir hr iE rlL8.d qan{,lion. Aly viohlion ofs.dion ?01 | .l by sny
<br />applicr for!Fmnsbj6$rn al'I'licd ro a cieil p.Elry of mr mEthM fivc hltdr.d dollo((1500).
<br />_1. ai o8.r ofll'. popcny. o. oy .Dplor!.! with w.g6 .i rh.n eL omp.nerio,r. wiu do tlE wo& a.d lh€ $rid@ il ml
<br />inlcn Ld or oileEd for sL (Sc.?044, Bu.ims dd PofRiiotri Cod.: Th. Cohlrlcloft Liccnk Lrw (I)s mt .pply to !. o{rr of
<br />lh. p,Dpdy who toiLt or nrr!68 ih.@a .rd st .td $ch ftn hitr.lfor h.ftlfo. rhou8h hi. or h.. own ..nployn(
<br />pmvll.d rhrt sh !npr$r@.t! E mi d..d.d oolH 6r &k. l[ hs.6. th. b{ildim or iEpmEnE r i. sld *ihin orc rr
<br />ol6ilthrb4 {E ol*ft Auil.tr will lDvc tl' h!d.n ofporiIs lhd h. or dE dit mt t{ild 6 iniiiw tlE llopdry tr ilE puqE of
<br />I, own.rofth.r,m!.ny, am.xcluiiv.lycod.oding wnh hc.B.d c..tmcrom ro connrud rh. pmjd (Sa.7044, Busrns
<br />ard Pofsnn Codc:-l hcComrrclo.,! Lic.ns. Law docs mt !rp,y ro nn owrcr of pmp.ny wno tlild. or impr.vc. rh.r6n.
<br />lnd who odEcG for mch pmj.ck wnh 6 codD(6(s) li..okd puB4ln ro rh. Conlh.lols Li..* Lnw).
<br />-l
<br />m d.npl u.da Salion- B. & P.C. fo. thi Een
<br />ua86!8!:gU4fN$Art9!
<br />DECI,A8AIIAX
<br />I h.r.b, amrm und.r Fmlry ofndjury or oflh. folhs ins ddrmlionr:
<br />-lh3rrmdBlllrinrainaC.nificlle.fConsenrhS.lllusurclhr$orke^conrpcnrdion,aslmv
<br />cd forhrSc.rn,n lT00 orrhe
<br />11\y (tdc. ritrrhcleriq'r c.trhe $.ltlirshtrhrhc ncaa '.riied
<br />' 11 hjrc rn,l (
<br />'ll ni1'n' r'n s ur 16' crnincR nn 'ntunnc.. ,'s rqoned hy st{r bn l70o oirnr Lab.r codc, ntr thc nstunmrce of
<br />layo"^mni.. dri Isli.y nunhd e.:
<br />')-zq- zr>LO
<br />-l.cnifyrhal
<br />io rh. p.rfomN. of rh. e.k for shich this n.rmit h irsu.d,l3h.ll mt opLyony p.Mn an rny h0nmr
<br />$ !s ro tx€m $bjftt '. rh. wortd' dnp.dd ioo l,B otcaltlomi., Md lerc ihd if I st$uld bc.om $bidr to th.
<br />$0*6' omn€ffition Dmvisio.s ofs*lion 1700 oflh. tit r C.d.. I shall, fonhwid comply with llsF pmvisiotr! .
<br />WARNINC: l:ailue to kuE *ort.6 otr'r*etion @vmsc is !nla*tu|, ond 3h.ll subjd an dDlotlr ro diniml psEkB.nd
<br />civil nmr rp r., onc hundrcd rtolqnd
<br />Sftrion llo7il of r & I f,tn Cod. inr.re{
<br />,,",. /- I G:W
<br />in.ndirion ro rhc cod ot Mrioi\ d.nug$ 8 phvid.d lor ilE
<br />I hcchy !0irn hdd pmtty of DcrjGy th{ I an
<br />of lh. BuriN ard Pmf.rciom Cod., &'d my I
<br />porhonolCharrcr 9ld'nnrn.'hs * h sdrhn 7000) of Divrion l
<br />G o 9u
<br />o*" o i - ttzZO
<br />I hcrchy afinmundcr Fcmltyoin rjuryIh rhcEhrcon(
<br />issucd (scc loq?, Crv. c.)
<br />kndins ase.cy for lhc n(lonna,rcc oflhc ert h, wh'.h rhr ,).mi is
<br />AITIICANLITIiCIABAIIO!
<br />I lEr.try rflim und.r pcn0hy olp.rjuryorc olnr lollowinS ddlaBri.nsl
<br />Dcmlnron P.rmns A.b.sloi Noldc.rion l;.d.r6l R.gulat ioN OnE 40, PdO
<br />Rrquir.d Letr.r.f Nd.afidiin
<br />-r4lcniry rh.r tlff.dml EsuldrioN Ee&dhs rr
<br />Lffi:cdty",*t I tnft Ed tt* .pnr'caxnn &i {a,c,l
<br />b.slos rctu)v.l irc nol arplicahle lo lhis ,mj..l
<br />inlomrion h oad.I alE io onrlly wnh all Cily lnd County
<br />o.diMm6 Bnd Srat. trws El il'8 to buildin8 and h.r$y r horn rqir.k div* olrhis Cny dd county to drc uF,n lh.
<br />aln!. mcnrion i pDpe.iy for
<br />Appllcrnl or AEetrt SlEn!ru.e:, o",., r /' / (? -Z-O
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping /-, z-?,tBdf /tl
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pi ping
<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 /-?,2 -t-o bt* /o>
<br />Final Gas Test
<br />Meter Release
<br />r'-2?-20 W6tlo>
<br />N otes, Remarks, Etc.
<br />-x
<br />Fill Line/Back Flow
<br />FINAL
<br />4't
<br />I
<br />=
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