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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG,COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />AreaiStorm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />,A o dzl <br />Water Piping a)-'- \)"'g <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />P{rap/Drain Line <br />Main Draini 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 Plumbinq <br />Final Gas Test <br />Meter Release A <br />FINAL ia-l -/Y V^L,l$) <br />Notes, Remarks, Etc <br />{''N-. t0 l^nk 4,-?ac, j logxffi4t <br />OWNER BU!LDI* DDLCAR.\TION <br />I hcruhy oiftm undcr ncnllly 0f Frjury rhlr I !m cxcmnr riom rhc Ornlrlcl,,r l-i..n\c tiw tor rh. fi,lk,*in! (rts,h lscc 70ll 5 <br />Buli'iN\ snd Pruf.*tnr Cdl.) Any Ciry or Colnry shiclr r.qutc\ d Fiinir !o .on(flct. rlto, inrrrovc. d.mli\h nr rcpon Jny <br />nru.iua. riMI. irs issu,tra. lho rcqutc\ rhc.tJli.Mr ro! su.h pcnnir!) ilc. si8md n.remnr th fcor snc i\ lico\cJ puruanr <br />kr rnc ,roririon\ .t rhc ConrEctn\ l-i.cised tjw tcilnrcr o. Commcncins sirh sc.rion 7fln .r Divindn I oi rhc Busirirs n d <br />Pturr\\n,n\Codc)orrhr hcor\hr i\.rrmpr rhrcftufrmd rhc hrsi\ for rhL lllc8cd cxctrptn'n Anyvioldi()nofScdi,n7lr.ll5l,yany <br />rptlicrtrr lor rNnr subjccB rhc npplicdn' ro!.ivilpcnDllydlnor nucrh$ firc hund.cd dollus lssr](rr <br />-1, <br />6 o*ftr of thc rhF.ry. or Ey .nll)loyEs whh *dgcs !r rhen $b conpcB0lion. sil do tlt sort !n llE sr.Etb h hl <br />inlc .d orofcrcd 6r *L (Se.?044. Busincss &d ftDfssions Cod.: TIE C.nka.rols Liens L€* docs nor arplyL !oowN, of <br />rh. pFt ri, uho builds d i.proh thetr.id who &*s sEt w.t hituclror h.mlf or lhmugh his c hd own cnployccs. <br />l)ovid.rl thlr such ih9brcmnls.rc ml intcldcd orolIcrcd f.r$b.ll ho,cwr.llt tioiBins o, in{,olccor i.sU whhinon. rld <br />ofmn{,hlk ! rh. Ow.cr Build.r u harc lrE tord.n ofpsvine lh, hc or sh. dn ml hild or inpmvc lhc pmpsry for Oc puqbs of <br />-r. <br />as owmr olrhc pmpcnr. !m cxclusivclr ronrrucrirg vith liccnsd €onrracron ro coasrtoct rl^. n8)j(l (ss.7()4":l. Bu$nesl <br />dtul Pnrf(\i,nCodcrThcCont,cror'.Li..nscL.wdMsnorstnlyhunowncroftmpc y pho builds or im[ovcs rhcrcon. <br />and who conracts for such roirrs wirh a Conhcxtr(, liccnrcd puFu rorhd CoorE.ior's Lkcnse L,w). <br />-l <br />!mcxcnrrt undcr Ssl B. & P.C. turhis rulion. <br />lllBf,E8S:C!)!|lldSArr0N <br />DEITASAIIITN <br />I h.dby !fiirn !nd.r t nrlry of Fjlry one of rhc fotlowinS dc.hdrioB: <br />_lhivc ald w ill roinhin n Cenifi. cotConenrroSclrlnsurcro.*o'kcrrconF.sarion,aspbvid.dforbtSLrli{,nl70Ooirh. <br />L'hrr Cqlc, for rh. ldloirnNce ol Ihc work fitr which rhc Frnril rs hcucd <br />_l h&vc lnd wiu torintain eo1*6 corpens.lion i6snhe., di rcquiicd b, Sdion l?00 of rh. llbor Codc. for th€ pcrfomtc of <br />rhc w6.k for shi.h rhh pcmir is Lssu.d. My wor*.N .oop..sr io. insurdcc cekr a policy Nmber m: <br />-l <br />ccnily rhd h rhc p.raormna olthc work aor *ni.h rhis ,)crmn is isilcd. I sh3ll.or erploy any |lcnon in dny 'flnncr$ ds ro bco'ft sltftr to rhc M*6 con{*.sdrio. hws 6ic!lil'or.i,. and !8r& lhtrl if I should bcco,r subjscl lo tL <br />wdrlcB conFnsrrio. pbviiilmofS*rion l7m.frh. t txtrCdlc.I $rll. fonhwirh <br />WARNINC: FailuE to surc workc6'comDcnpl <br />civil fims up to orc hundr.d thousnd dolles ($ <br />!n cq,lo}tr ro dimjo.l Ffltics and <br />Slrri.n 1016 of rhc I ilnr C.d. inrscd <br />I hcrcbyrlftnundur |xmlryol t{rjlryrhll I !n liccnsn wilh Sslhtr 7000) of Division :l <br />oa rhc Busims md Pbf.sio,s Codc. ind my liccns is in ni <br />I h.rhyrfiirIuf .r r!trrryol p.r]uryrhJr rh.rnrcotr lcndinr agcicy ror rh. t rfom0cc olfic qork for *hicn rhis Fnril i! <br />AIIIICAITDEO.IIXAIION <br />I holt'y afrnu undcr Dcnalt y of rrjury om of rhc follosins dcL,6l ions <br />ocmliriotr PcnnirrA*b.sosNorificalion Fcdcrll Rc8uhliotrs(Tnb40. Pd6) <br />Rcquircd t ilnofNorifica on <br />dtx,lc irirnBrnr i{coft.cr La8reroconrplrwilh!llCilvandCou r, <br />s oflhis Cny oad Cou.ry b c d xF)n rt <br />Waste & Vent <br />POOL/SPA <br />05oL<plb- <br />I <br />fT <br />= <br />=