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PLUMBING.INSPECTOR RECORD
<br />ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underlloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain 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 />Bough Plumbing ?fu"/-t tbst
<br />Final Gas Test
<br />Meter Release
<br />FINAL iftvlb 5.i Ufit6,t7\r
<br />Notes, Remarks, Etc.
<br />()l\ Ntll Btr .,)I.tR t)M,( ,\R,l flr)N
<br />I lErcby a,Irn lnder lcnrlly of pcdury lhal I m dcmpl tDm lhc C.nu&loR Li.B t w aor thc followhg Ea$n (Ss.703 li5
<br />BtrsiB. .rd Prclcsrion Co<L): Any Cny or Cou y ahth rcauircs , Fnnn ro ondn.r. aitd. ifrpoE. .bmlish or Ep6n uy
<br />srirlu. Fior lo iri issmc. slso rcquircs rlr rpdka ror sch Fmn ro filc a.igicd ar.mt rhn lE or 3lE i! lie.s.{ ,rMnr
<br />lo ltc pmvisions of tlE Conhcloas Liccnsd tiw (Cha,'t r 9. CoMncing wnh Scclhn ?000 oaDivhion 3 ol$B Ausin.$.nd
<br />Potc.shnr Codc) or lhll lt tr shc is cxetrpr rhcElioh.d rh. h$is for rlE alk8.d .r.mplion. Any viohlior of Sdri,n 7031.5 by a.y
<br />applico.l for a pcmi 3ubisr3 tlE .!pli.r lo a cival pcMhy of tur nm rhe alvc hundrcd dollai (t500).
<br />-1,
<br />as ownfi of rh. 0roFny, .r m, .mploycd wilh wales as rhcir slc .onwnsa'io.. will ito rhc wolt &rt th. nn(lw is m!
<br />inrcd4n q ofrcEd lor st (Sa.7044. BBiBs! .nn PmfcsshB Crn r TIE Conrrmrols Lic.rs L{w dos nor sl,ply ro an owmr of
<br />$.lreFny wth huilti oriqmB 0EEi. a,!d eho &rs shft titu.lfor hcMltor rnblsh his or lB o{n.trplo}tcs.
<br />pmvided ltal sucn i,'pmtmnts N ml hLnd.d oroficrd lilr olc. tt h.w.Ei llE hiuin8 d itrprlEmd i! $ld withhom,{r
<br />of complcrion, the Owmr Buildcr w l nlw lhc htrd.o of pruviog thll lE or ihc dil nor btrild or inporc lnc popery for E pqpoc ol
<br />WOI(ERS' COMPENSATION
<br />DECIJBAIIO!
<br />I hcrcby alfim undcr pcnally of pcrjury on. of thc following d.clfiurioNi
<br />-l
<br />hrv. &n will minr.h ! CcnifEt otcoMnr ro sdf-lB@ fo, wt6 coEp.BArt .. B prcvidcd 16r by Setion 3700 of fi€
<br />Lahor Cod.. fr lhc FrfolMc ol0E wdt lor whth rlE Fmn i. i3sucrl.
<br />_l hav. rnd will mainrdin workcrs conpensdion ins!rumc. as Eiuncd by Sccrion :1700 of lh. Gbor Codc, for rhe pdformcc ot
<br />the sort fo, vnich rhi\ peml is hercd. My qorlcB corycNarion irsuoncc cMicr dd plky nlmbcr e:
<br />Mrdw e-st Cq\ tsls
<br />BN\o wr rrt 34 @ 1c)(l- rq
<br />-l
<br />ccnify lh in rh. pcrlormne ol lhc *ork for whi.h rhk !'.rmir is issu.d. I shall rct cnrrloy lny pcreon in ony mmncr
<br />\o Nri tEom s!hj.{r ro rl'c wo*a' coorrcnsarion li,s ofcaliihrtria, !tu1!3N 6ar ifI sholH lE on'c slhjcd ro ihc
<br />work$ orrnsalion pnlnions of Sdion :1700 ot rh. tlhn Cdc. I shall. fonhwirh comlrly sirh ftoe FDvi\ionr..
<br />WARNINCT Failurc lo wurc workcs omp€nialion $vcn8. is unlasful. ad snal subjNI an ery)loFr to sinrinal Fnulrts.nd
<br />.ivil fin* or ro o* hudrcd rhousnd dollaF (SI0O,0O0), in addition ro rhc con ofconDcnsrion. drmgcs 3s pnrvidcd ior rhc
<br />DECIdAAIPX
<br />I hcEby rflirn undcr lEndryofFrrury rrImlli.cn{dund.rrtuviriJnofChdpr$I(connEncnrgwirhSc.rtun70m)olDivisn,nl
<br />of rI[ Busnrs\ nnd Pftncsninl Corlr, Md my li..n\c i\ in tiill fN( arxl cficcr
<br />g
<br />CONSISIJEIII]NITNDIMi3IiENJ:T
<br />I hcrct y rfirnrundcr pcnohyofn€durylhll rhcrc i\ a connrucrion lcndin3 r8ctrcy for t hc ,rcrli,rm0 ncc ol'lhc *ork ritr *hkh rhis Fmir ii
<br />isucd (Scc.3097, Civ. C.)
<br />APPI ICANT DI]CI ARATI(TN
<br />, tmhy 0liian uM.r rcnall, ofFrjury oDc ofrhc lollowine dNludtions:
<br />D.trhlirn,n P.rnrn$41b.(or Norirrcarion Fcdcrrl RcSUhrnnn lTnh 40. Pfi6)
<br />-RcqutcdlxfidolNotili.
<br />$n
<br />-l
<br />ccnifyrhor rhc lcdcrulrcBll0rions EEUdins lshcstosrcrmlsl arc not
<br />P-l c.nify lhIr I turc rcad rhis .pplt.tion ,rn shrc n is.on&.l. 1 a8B
<br />'o
<br />omply wilh all Ciry snd Cou.ry
<br />ordimmcs and Slarc trqs Elorin8 to buildi hmby aullFrirc rcpr€scnlalilcs ofrhis Cilyud Cou.tyx, cnlo !F ! rhc
<br />abovc nEDtion.d ptup.ny for
<br />Appllcml orA[.nl SigutuF:
<br />Oontt-\ /,v'raS
<br />1ar!.'qjrli ) 1
<br />II
<br />I
<br />APPROVALS DATE
<br />-1.
<br />aso*mr ofrhc pmrcny, amcxclusivclyconki.rmB wnh li.ci*d .onrrb^ ro conidc! th. E.F.r (S.c 7U14, Buinc\\
<br />,nd [rr,L\sio6 Cod.: Thc Conrn ba t Liccn\c Ltrw docs .or lpply t, !n owncr of pn,pcrry wno blilds or iDlrrcws rhocor,,nd who ..nrmcrs nn such pmJccrs $irt a C,nlndo(, lirctrsd !'ursu{nr r, lhc Contrucrols Liccnsc L3w).
<br />-l
<br />!'hcxcmfl under Sedfutr-. B. & P.C. f{tr lhis rcnson.
<br />Dolc: O*mr
<br />r;rii{ii$u
<br />r.",,*"r-. lh{4rre
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