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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNT]R BL]II-DljR DELCARA fION
<br />I hcrch dmrn und.r n.nilrv ofr(tury rlrr I .m €rcrinr lnnn rlE (onrn.k,. l-n.trs. lnw litr rtu nnhrrry reivr {Secrl) 1 5
<br />rusDcas ilxl rroic$nn Code) 4., c y or counr! *hrh r.ylur.s i pcnM kr ..n(rud. 1116, imprc\e. cmolmr .r kp^r !
<br />ntu.nc.,.lso r.\lutr s thc irrlr.nl ior such n n.ir kr lile! srRd {,rotunt rhd hcorshe s lrc€ns<l !(rsMr
<br />ro rhe norFions olrlE aontrrcrtr s Licensed Liw (Clmnrcr 9. Connncrcins Nirh S$rion 701)0 ol l)ivLs'otr I .frh. lrunn.se rnd
<br />Prolirsionr Q{lel orrhar h..rshc sercmnt rlRr.lnnnand rlthask forlhc allcscder.n,rrkr nyrkrl.rronoiSccrionT0rl 5trtrny
<br />rDplt.N for i lernnr subjers th. apnncidn'i.'v'lnenrh!ornorN*cirm h'. hundr.ddoll.nlS5r)0)
<br />-1,
<br />,s own$ . f rl€ rmp.ny. or my eDrlolees tr'(h $rses rs rficn el. (,npc8.ron. u'rll do rh. ruk aod ltE (drur 6 n
<br />i .nldl or o,Icr.n tur sl. (Sa 7014. BunEss atut PDLsnoN codd l h. ('ontnck , LiccnE La* 6cs ton dtnlt t, nn o*B ot
<br />rhcpnpcny who bu ds.r ihpnn* turs'L Ml Rk) &,6 su.h s\yt hDscll or her€ll.r rhfl'ogh hm or h.r oqn.nDbyc*.
<br />,mv .drh suc[ inrmvcrcnBremr idqlql r.lI€En t).$1. l( lFwcr?r, rrk hu'l(lins or rnDm\ttrEnr nsold{irhi', nc)mr
<br />olcomplerionrheOtrnerlluil.lqqillhzlerhchurdcnofrmvin!rlDrhro.drdd n l1u'kl or innmve rlE pmpeny lir rh. ru'F,r.f
<br />2t4"".**,,,'*n-"-,,"n.\c'1.L.J.nr',rr,n!q l-h..nq.,i."ff.*'^r.(dru.rrh.rh)errs.c n{4,llunrcs
<br />m{l Pn,Gson C\der Ih.Qnrlr.clois Lic.ne€ tiq'(locs nr.prlylo inowncr.flr.nenywho huildsor imnro!6lh.rdon.
<br />.nd *hr flmlmct! l such ,'Djelr wnh i annrmdo(r) licms.d puMnl l.
<br />I mexrftd uflLr S*r
<br />*,,2 /tq I tqr/"--t t
<br />I kr.by .lliro uoder p;ahy olpdjury on. oithc folloqins ddbrslions
<br />-lhivcdndw'llnrinrrmn(cdrficateolcnnscnrtos.ltlnsu,efo.rvorkeBco.lPdsrionnsnmvidcdaorhyS(1ifl3700.1rh.lllir Ct.lc, ror rl'. dlom,m. o f
<br />'h.
<br />vort for q'hich lh. pcnnn iq iscd
<br />_l hrv. n will minrain wort.B enpc iation itr$r.e.. &r r.quiEd by Sdion 3?00 ofth. Labor Codc, for rh. Frfolmm. of
<br />lh. worl lor which thb nemit is ia{.d. My oorldJ @mpdqrion inflEn.. 6Eir ard IElh, nunh.r e:
<br />Poli.y Nunt r:-lxpir.s
<br />lafrrn'ryrhr mrlrn(,,tr xtuct'Irhc$,{l,,trql'tr1'r[]spctr!rr N Nsucd,l slD Ll tro( .{rIl,)y n.y ntn.n inrnyn,rn.cr
<br />s) s () hsnn. euhtd ro rh. noAcrr &nrncnsrr(,n laq s.f( rlrn,mr,.nd.Bre rlmr rfl shoukl h.ron. ruh){tr ro rhe
<br />w'lkcrs' conrFnqlion pR,v'str,ni o I Sdhn l7r)0 .l r h. I-ak* (-.d.. I duu, ,onhNirh comply wirh rhl* t'rclisk'ne .r
<br />W RNING: Iailur. ro scurc {orkcm omp€flislion covcngc i d dphlg ro sioi@l p.oxa.! 3.d
<br />ro oft hu4rcd tfi.usnd doU.B (tloo.(x)o). i.iol! d.m6e.s .s p.oYid.d lor $c
<br />.frnn under renahrofpcrFry rhd Lh l&r*d ud.r B)vi 6 I (snn.rcr! wirh S.dbn ?000) o t D ivti.n l
<br />ol th. Busims.nd PoaNhnsCodc,a my licc { is intullforc.and
<br />Co n.tor:_
<br />cQtirauql!)llBltdll-aclilcr
<br />I lrrbyanirnrnnder peMllyoflerJuryrhir rhcre tr r mnnturrtrin hnnry rr.n.y,ir lhe pdn)m3ncc orrhc wo* lin s[ich r[is,'(nrir is
<br />Fsucd(Sr 1097. C,v C )
<br />AITITCAILDECIjAAUAU
<br />I hd.$y.Jrmunds D.ully ofn.rjuryonc ofln folLains deladtioo3:
<br />D.mlni.n Pcrmir3-&bdlG Notificrlion ll.dcml Rqulorhr, 1-l irlc,u,, Pnn6)
<br />#':,',"];:
<br />ted€.al r.gnlalio.s Eerniin8 sbcros mI ryrlicabl. ro rhis pmjecl
<br />cold. I aaR lo 6.l,ly
<br />oftln,n..s aftl shr. Lawsel iryrobuildi
<br />J-
<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 Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<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
<br />Final Gas Test
<br />Meter Release
<br />FINAL
<br />Notes, Remarks, Etc.
<br />1t
<br />ahov. mn"nrd limrny ror iv'ion
<br />app!...r or A*.trr slrdtr*n
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