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APPROVALS DATE ID/SIG.orvNI.tR iuIt,D0R I)tit,cAR IIoN
<br />I hcr.hJ_ rinnr trn{l.r !.nrlr! of t^.^rjury rhxr I rn cr.mnr li{)nr rhc Conkrcttra l-i.ci* lrq n{ thc loll,trvirlt Rr\r (Sc..7r:11.5
<br />au\irc\{ rftl I'r.1.((r Crxlcr An!CiryorCotrrrt qh(h rcqnnc! r lrfni k' lnnnr(. ilrcr. imnn,vc. Jcnn,lnh o' rprir 3nv
<br />k, rhc privi\ion\ ol rlx ( onrrdo' ! Li.cNd Lrq, r(hnlrcr q. (inn'En.i',! qirh Sc.rn,n 70lr) of Dni\ion :r .f rh. Bu\inc\\ iiil
<br />rfl'li.rnr tu' r p.x n \ubio.( r,r rftli. nr t, rciv,l prn lr!ofnor itrtrc rlir fi\c hutrdr.d duilrsrS50tr)
<br />l. r\ .*nc. ollltr pn'Dcnt. o, nrycnrtloycc\ sirlr wr8.\$ rhcir \ncconr|{osxlion. silldo lhcqorkuidrhd dtrtuto n mr
<br />i' cRl.at or ollircd fttr uh ( S( 71X4, ausik\\ atul lt,fc\\n,ns C(xlc: Ir Gn ricrors Licctrsc l iu do.! nar opdy ro in o*mr of
<br />rhcpmp.ny Nho huil& or i.lPnN.s rhcN)n. and wlr, dms \uch qork hinelfnr h$\clfor rhough hi\ or lE osn rmplovccs.
<br />pn)vid rlut {'ch nn,rtrqrnlsarc noli cntllororllrllorelc lr:howcvrr,rhcb ikli'rg or i'rrp'uv. rnr ir $krrirhi.onc }uu
<br />of.o {krhn.rh.Otr,E Buiu.r Nillhr\t rh burd. ofF,vinS rlurhcor\hcdil or huikl or nlllmE lhc rmltny liI lhc I'urllxc of
<br />rtr(l \ho.rnhr.^nr{rhlro}.er\\irhrC!![r,t(irl!) irrn\(,!Nr{]rtrrt,rl[C,nnr.ktr\Lie.NcLrtrr
<br />-l
<br />om cr.mpl undcr Sc.lion-. B. & P C for thir rc!$n
<br />.traxf,Exslr(1lrrlNta.rr0N
<br />IIECLIAA.IITIN
<br />I hercby afitd unner pcnrllyolpcrj(yorc oaltc lollowinS d(lorllio"s:
<br />-lhlvcund$illnurinr0in0Ccnifi.lrcofConscntkrS.lal.surcInrrorlc^
<br />onpenldk'n. ai pturid.d ror b! Scclion ]7m ol rh.
<br />Lhol'ott. rn.rl'c I'! n,ruRrnr'tE rcrt rn whhhrhc nnn N Flucd
<br />.!/-t hrlc anrl trilln'Jrnrrin workcF (nmncn\ r,n in\urorcc. ns requnci.l hy Sccrion l7m.frhc LnborCod.. for tlE p.rfofltum. ol
<br />lhc work for which rhi\ F,mir ii isscd. My sorkcr' sqf,nsrion insunmc croicr {td F,li., numlrac:
<br />."ti,y\,",b"-. ll,,lr7- Ari - {o8b:1/ t\tt* /?)'/'2oee
<br />lccdifyrhrr ilrhc lcrfornhRc ol r hc wor* nr qhi.nrhk p.nn[ ir is\ucd.l $0llnor cnrt,oyany!c6on inanynuimr .
<br />h a\ ro hccom sunjs' Io rhc sortq\ onpcns iotr loer oiC.lilomii..nd l8rc hlr ill should bcco'ft rubjccr r.rrr
<br />trodcs com|rnMrinn Imvnbni olscclion.l?u)nlrhc l-ilu (odc.l shall. ronhsiih ompl] wirh rlt,$ ro!irk,nr..
<br />W.{RNINC: FsiluE to soE rorkcA cotrpc.elion covcEgc is utrhw6it. und shall slbifl ai edplorr lo oioiMl FMts tuJ
<br />civil 6n.s or lo orc tunlrcd lh.u$nd dolhr ($ltD.@Cr). in.dditio!h. co( ol .onlp.n\!ri,,n. dnnrgci is fovid.d n, rh.
<br />S.crion 1076 of rhc LltDr Codc. inrccsr Md arrorry r
<br />b,r",/ /-43-to
<br />ol rh. Bu\ncsr Pr.l.\mn\(, r, tlnN l'..n!. n ln hr lkncc rnllril..r -76tag
<br />tolslalJclll)!.tENlllNlil(rNcx
<br />I hcrchy nillrm undcr pntrlly of pcdury thll lim h e mtrsruclion hnding aBcmy fnr tnc psfolmmc ot thc {ork fo. whicn lhn frmn is
<br />isrucdrsN. l097.civ c.).
<br />AfftlcltrlDElr &lra!
<br />I lrehyrfinflutrd.r l[mk) olt{rjry rnc.frhc ftlnN nr! dr(lrrrnfl\
<br />Dcrk)lni(r ldtrrir\ A\k\{o\ Norili.iii',n Fcdml RcFUlrrnnn ( lirlr q). P.nir
<br />Rcqui'.d l-.rrcr of Norili.rrotr
<br />-l
<br />ccnily lhar rh. fcdcml rcBlkrions rc3,ditrE aitEsros rcmlll rrc not lnpliclbtc ro thh pnj$l
<br />./, *,',,,,,, ^,,",".,,^,. ;"",'.,,,',,. :*.,.".,,,.,,5"',rm Lc.;.rsx c Lo". rcru'inr i" r',irr inr ..^'.o,rhcub.vc trr'ornurhn is c.nc.r I a8re lo codpl, $irh rll Ciry Etui c.unly
<br />&rhoi,c r.t)rc\cnrrrivc\ ol rhh Cii aid Counry h cnr$ rlrnrh.
<br />!h,vc mtrrioncd poFny for im
<br />Z ^',, /'/3 -dd
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{raplDrain 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 />Meter Release
<br />FINAL l-28'2> :H l^,
<br />Notes, Remarks, Etc
<br />PLUMBING-INSPECTOR RECORD
<br />COMMENTS
<br />UNDER GROUND
<br />Fill Line/Back Flow
<br />Final Gas Test
<br />*, '/'A2-Jct
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