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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS or!Nt)a allt,tlEll t Dl_cAll^l'roN
<br />I h.rehy amfln unner pcnally of ncrjtry rld , rnr etc.,fl lmnr iht Contr.cto6 l.rcflse LiN tor lhe Lllosin! reihn (s{ 70115
<br />Busin.$ r Pnrlc$m codc): Any ( iry or Counry w[ich rcqtrire! 0 p.r!]ir lo coDdtucr. .x6. nqn'v.. d.mnhh or rcl.r .Dy
<br />struclurc. pnorro ils issuance, nlso rcqutcs rhe.prlicmr lirrslch pem b iltasigned sartDenr rhar heor dtc F licenred ,uNanl
<br />lo rh. pn,vtnnr olrhr Cd.r,rcro.! ticen*d tjw (Chirrer 9, connncDcin8 lilh Secrnn 701)0 olDiyr(,n I .lrh. Busincsr.nd
<br />PF L$lros Code) or thd hr.rsh. n.r.npr rh.r.fnnn dnd rhc b.$s turrltrrllcs.d er.nrplion Anyrioltrroh.lsdri.nT0ll s by itry
<br />sFrhm4lt?ftr r I{m cuhjar\rhc anlircrnr rn.'.,qlt.hlry., r{ nrrcrhr fi\. hunrl'.dJi,11tr.(\ro"r/
<br />Zl, * .**,"i't'.nn'n ny,"rrn) rnrlo!..s I' q'r-*(e rs rh.t sl. comr.hrd ion, wdl& rlk {hi( inl rh€ nrucru.c is I
<br />inreid€J or.,ficrcl r,trsl.(s( 7lil4, Bu{".\iJnJ rn,rrin.nsc.de Ihe( onlracl't s l-ic.n( l,awdosd,nilytu.nownerof
<br />rlEnmpcny who hullJs or inrrmrs rhtNe,nd \1yt ocstuchso*hnnr.lfurlEmell.rlhouslrhnorh.ro*ncnpn,yc.s,
<br />nnndcdrh.rsuchrmprorcnms.rFrinr.ndedorofis.dlor{leI|ho(d?r,rhehuildinrorrmnnnmEntis$klwirhilr.nelur
<br />.t.-.n{ldra rtu oq kr Brild( uillh,w rh. htrdm.rFivin8 rha lror lhc dd rn burkt or inr,,nnt 'tllsn ny tur fit purtntof
<br />_1, NoNn.rofrt pmD.nx lhcxclusivclym dtins rirh lic.ded @nr@roar.6nrdd th. pmj.d (S<. ?0,14. BuriK
<br />6nd Pot r!{ C6d.: Th. Conlr.ctol r Lic.ns. Lrw do.s mt apply lo an osn( of pmpcnr wh6 builds.r improv.e thcron,
<br />6nd who conlocli f{,r sch pmJccrr wirh a Conrturo(, li..nicd ll! ufl !o rhc Co.lr.clorr LrcNc t!w).
<br />_l am ex.mF und.r se!II
<br />Lo Lo".*.11)
<br />DECIAIAIIO!
<br />I hftby 0mro und.r p.Mlty of!4ury on. ofth. followins dtclelions:
<br />-lh:rer
<br />lsrllnr'nrxinaCcdrn.flrofConscDrtuscliltrsrtrciorsork.rscotrT.nsrrnJ.,rrptr,lidtdlorbys.trionlT(l0oarhc
<br />Lnhor Codc, nr rhe rslhm$ce.f rhc *ork ftt wh'ch rhL l).rm[ n {cu&l
<br />I haE snd will nainr.in pork.d coqEmarion iN!mnc.. 6 ..q!iEd by strbn lT00 of rlE Lthor Cod.. for lh. pdfo.rrrse of
<br />the *ort fo! *hich this pcdil i3 iNEd My worlf, Fmp.ndhn ln{atu. cmicr dn nolicy numbs ec:
<br />Policy Numbc-Ext'ires
<br />-l..n,Iyrnar,nrh.
<br />!.rformm. ofrh. vo* aor whrh rhis n rmn is iss.<|. I sh,ll nor .otloy .ny !cm. in anyn rc.
<br />m .s to b€em sb].cr lo lhc triGl hmr.nqlhn hB ofcalaomia, 6nd rsE. rhal if I stFuld b.se sbj..l ro 0E
<br />w*c6 onD.nsfllion pmvisiotuols.cri.o 3700 ofrhe lrhor c.d.,l shll,lodnwirh comnlywilh ttFspovisions
<br />IVARNINC: |.ilur. to sur. srk s' omp.Mlion ovds. h lnlaq,tul. .nd rh,ll sbrcl er oplorq lo simiMll.E[i.5 and
<br />civil finca ur ro on. hu.drd llDu€.d dotlm (ll00.o0o). in,ttdnion ro rlE coi ol comp.nstion, .t tug.s t. povid.d aor th.
<br />Sdion 10?6 offi. Labor Cod., inl.r.( !.d allonty i
<br />FeJro,"n, / - /9170 Zo ^*9q/<s e?
<br />r ri:I rw:rr rtn uurr_r
<br />DICI.AtrAIDN
<br />I herehy rntn und.r p.Elryolp?rtury rhd I .m n..nkl utul.r Drovision olchnFld I (snmerrns *[h s€t.n ?001r) oiDivknn ]
<br />ol rhc Susincs, .nd Pmfcssions Codc, afi! my l$c.sc n in []ll i,nce dl elf(r
<br />l-ic.6.. clsr
<br />-Liccac
<br />Nlmll.i
<br />CONS'I'IIIIC'!'ION Lf, NDING AGf NCY
<br />I h.eby amm und.r !.Mny ol p..ju.y rhat th(. is n con(ruclion ledins cgcncy lo. rh. pdfomnc. olr hc trn* fo. whi.h rhis Fm'r 6
<br />6{td (s(.l0r?, civ c )
<br />aSfugANLD[CLrlEAIlO!
<br />I h.e$y alI@r undo pdaky ofr,.rlury on. of lh. folhwin8 ddlaEt ions:
<br />Dcmlirhn P.mns Arh.rto{ Norili.anon i.d.6l R.Snbrions ('rnlc40. Pan6)
<br />-R.quiEd
<br />L.trtr olNolinerirn
<br />-l
<br />c.n iry rtdl th€ Ld.El aslln! io6 Egrdos a3h.n.r Emohl .r. m' inDlic$lc to this PoFr.
<br />lrfcdr' I (hd I hk Edd lhts ,pplrartrrn arxl $ar. rhd rh. sh)lc rfomulion * cordt I aBB ro smDry wnh lll Cny rnd Counry
<br />dfu'Mnftc.nd srsr. Ij$ FLr,ns h burldrns coNrucrnl\ and hcr.bya(ltrria r.pE.nlariv.s .f rhis Cny tnd Counlylo 016 !l(.llE
<br />ah.r€ menrtnEd lmpeny litr inspe.rtrnl
<br />Appllcrtri or ,\Brtrr slsnh.u a.a9 2o?o
<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
<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 />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 a '6lzo Dh.nn a .f-r'1
<br />Notes, Remarks, Etc.rI
<br />UNDER GROUND
<br />Fill Line/Back Flow
<br />E
<br />LetrJcr r
<br />^Jdi.{
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