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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNIiR BUtI.Dt.]R DELCARATION
<br />t h€rchy r ifln undc! t^..nalry ,,r p(rjuy rhd I d .x.n ln,6 rhc CtnrracnN l-icc \c llw lnr rhc ftrlo$ins @en (Se., 7l,.lr 5
<br />Bu{i'r.s\ rfrl anrc$i{nr Codcl ny City or Croumy uhi.h r.quncs a ttm k' conirucr, ,lrcr, inwovc. d.rmlish oi to|ur ,
<br />iruchtrc. ttrro ir\ ilsuai.., rho r.qrnci rhc orplicsnt rbr u.h pcnnir l,' filc ! silncd nrtcmrnt rhll hcor she is licc!{d pncuent
<br />ro thc Ptuli\n,ns or rh. Co.rB.lor\ t,iccn$d ljw (Chnfrcr 9. conmc,Eins Nnh Sccrinn ?O(r) ol Division I of llE Bu{nc$ ntrd'
<br />Itirt\\ions Codc) or ilDr lI or !h. ir cknpr rh.rciom lnd rhc hssir aa, $c rllcgcd crc.,flnrn AlyliolarionolSccrbnT0-ll5 by tr!,
<br />amli.rnr for ! pcnnir suhjcchrhc il]pli.anl ro u.ivilpcnilryornor iktrcrhM filc hundrL{ doll!6 (!5(D)
<br />l. r. ov*, of $e poJrny. or my.q)lolEs ,irh *agls Ds d.n $h onpenetion. wil do ihc mlk.rn dE s,ufu b mr
<br />inlcJicd or or.rcd for sh (Se.7o44, BBies. and Profcsions C.de: Th. Co.rrclo. . l,irB Lrw d@r rcr qjply io e owB ot
<br />lhc p6Fny *ho builds or irpbE! t E@r od aho dcs uh tu* himscll or tcrclf or ttmush hir or tcr o$i crqloyces.
<br />pbvacd ft.l such imloEmnts E mr inLd.d orofGl f( elc. la, tbBE ltE bu,ldare q inpmEeDl i. sU whtf, oB J@r
<br />of6.rpk{hn. dE OwN, Btrildd wul tEE tlE hrdcn of !revin8 $ar h. s slE dil mr hild or impow th. Fopsry for dr Frpo$ of
<br />-1.
<br />!s o*rr ot rh. fmFny. !flr c(clusiv.ly conrad in8 wnh [..ns.d ..ntd.r n, snshd ih. pn'rftr {Sdc 7044, Buvms
<br />lnd PiuhssionC.rl.: Th.Cd.rrd{r\ l-iccnsc Lae.locs not rrplrlo !n o,ncr of [o!.ny who buiklsor im,rrovcs thcrcoo,
<br />qnd who contncts for such lml.ch ,iln a co .rc'o(s) licc.$d puruor ro rh. Conrrd.ror's Ltc.se lj*)
<br />-l
<br />!,n cxcmpi under Sa'o/,t&qloIar -l
<br />DES.AAAIIIIU
<br />I hcnhy aaliro undcr pcnahy ot tojlr, otu of th. lbllo*ing d6l&srions:
<br />I h.vc..d will mainlain a Ccnificarc ofconsnr ro Sclf'ltr$E for mrkcs .oml'cosrion, $ prcvidcd lor by Ssrion l'700 offic
<br />Litor Codc. for lhc lErfommc ot th. Bork for wlfth lh. Fmlil is issucd.
<br />-l h&w a.d will mainldan porlm compcniaraor iniuhme, as rc{!n d br Sccrion 3700 of rh. Llbor Cod., for rhc pct6.l1@c or
<br />lhE sor* for {hich $n l'omi ar bnEd. My snl6 @m0.nsdion iNuMc 6icr ald policy .uhber e:
<br />l.cdili rhar n' rhc rqrorroift orr& *olk aor snkh rhh Frnril h tsu.n. I shtrll nol cmplo, anypc,en in any mlrns s to h.crm subid b rhc *odcrs conD.n\0rion laws orcdlir.rnid. rnd 08m rhs! irI $duld b..om aubjd n' ih.
<br />worlc*.o'np.ns,rionp&vi\bnsofSNriotrlT00.frhclrtxtrCodc.lsh,ll,fonh$irhcortlysirhrho*fbvisn,ns..
<br />WARNINC: FriluE to suR rortcB' mnD€mdion svcEgc ir lnlawtul. sd rhnu slblri o .rplo)er ro oioi.rl FruliR dd
<br />civil fircs up lo orc hubdEd rhous..d dolla lsloo.ooo). an addation ro th. .o{ of..rp.nsrri6r dlmgcs ns prolidcd for
<br />'hcSdrion 1076 of lhc tihor Codc. inlmq &d
<br />-,, { llolll
<br />^tu -J Ll*'h n-
<br />I,IE1;IAf,A.IIAN
<br />I hcrehy om n uMcr t nrlry oi I'crjMy rhal I rnr lic.{d u.df rn,vnion ol Ch,Ir$ 9 (conmrm inC wnh S..l iotr r00o) ol l)iri\ion I
<br />of (hc Busirr\\ind l,rofc\sn,ns Cod., rl nrt lkc.sc is ih lii ll 6..r aid cflirr.
<br />qONEIAITCIONIENI)INI CT'!!IIhcrhtnllnno.'rumhyoftrruryrhrrrlrcisacon(rudt,nl. i,rgqcn.y ftrhcncrlonNncc.l rhc*or! nt whi.h rhn ,fnnit 'si\\uc.l(S.c .l(r97. ( i\ C )
<br />ATTLICAtsI.IEII.AE{IION
<br />I hcr*,y ofiim ! ndcr lcn0lly ot !'.rjury onc olrhc lbllowin8 ddldrarion(:
<br />Dcnnlilioo Pfnnh-Ashc{or Norifi.otion Fcdc..l R.Sulrrio.s (Tirlc 40. Pan6)
<br />R.qut d lltrcr of Ndifrdion
<br />-l
<br />enif, lh8l lhe fcdsal r.Bulrlions ESardin8 .sb.slos rcmrul ac nol |Fplkrbh to lhis prercrr
<br />-lccnifyrharIhnveEtrdlhislpplicrrion0dnlrclhdrhc
<br />rw nrforminr nconccr luBrL{ros'rplrwirhlllCiryondCouory
<br />ordinanccs nod Srsrc liwr El,ring ro buildiry con{rudn,n, lnd hcrby aurhoric r!rc\cnrdilcs ofrhis Cn, rd Cou.(yro cnrn ulx)n tlf,
<br />ohor mnri0*d pmncny ror in 4,^il k, *,",{,!ppli$nl o. Al:.nl sitnoluft n IC
<br />auLilAd Tl+t l<i'
<br />UNDER GROUND
<br />Waste & Vent drale &)57-
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildin g Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Bou gh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />It/ain Drain/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 />Hough Plumbing &,alP'7a 'z\,/
<br />Final Gas Test lt u/
<br />Meter Release I
<br />FINAL t0l6hK fhtr*'t 04
<br />Notes, Remarks EtC.I
<br />Liccn* Clars:-Li.cnsc Nlmbcr:
<br />D.t.: cortmtor
<br />Tub/Shower Test
<br />Miscellaneous
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