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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ONNT.R AI'II.DLR ULL( AI T I T'N
<br />I h$chy rmrm un,lcr netui! oincrrxr, ,hr I m.\cmnr lmm rhc (ontidots l-i.efli€ La* lir rhr i,llowing r.0v'n (s(.7011 5
<br />llurirrqc Jnd Pmic$n Codc) Any C{y or C udv whrch requncq , p.mir h ..Nru.r, ,lr.r, r'nftM, d.imlkh or r.n tr ..y
<br />ntuduft. nriitrn, s hsurnc. asn rrqdr.s rhc rmli(rm lirr such F.nur h filci stncd slatcmnr rh.rheorsh. h lic.ncd ,urqanr
<br />ro rhe nmrjqionq.lrh€ C.trtrrcloir l.icensd Lrw lchrrrs 9, ( oDDeRinE wfi Sccron 70011 ofDrvision ] nfrh. llusin.( rnd
<br />PmlasinnsC.d.r.rrhir h.orql'e i eten'rr rhercfmrnind the h.sis inrtheille8.d.remprion Any !iol,lio, of Ssrioi 701l s hrnn,
<br />0pnlont nr r p.ron srbj.a rh. appli.rnr ro , ciril p.ulry o t mr nnE rlan ti!. hrodr.d d.ll,F (S50o)
<br />f,'l4(1*,,"".,.rrr'.p",p.d).o,mr.nfr,,xe!wrhvr!.insrhcnRnccompensirmn.ulrrrrortEwo,k d rt,.nmru'c!sn'r
<br />nn.el&l .ronercdfitrel.(s(T044,Ausinss.ndltfessionsCod.'lh€(nntacnr'sl,rcenrljwdo€sndrapflybinonn.rol
<br />rhcpmpcny sls hoilds.r tlpmre ttron,0 l who dos flch $1J* ins.li or hcRll or rlmush h,r or h.r.sn cnrdoltcs.
<br />nrovided rtd such i.rl1lov.nEnts rc mr i.ratcd or of.Rl hr slc ll trrud'.r, rh. t\rld]u or nnnmlrmd h $ld tr irhin oE ]m.
<br />.lconuldi.c lh€{)*rcr AurU.r $rll lrve rlE I'urd.n ofFrunS rttrr hc or shc dtrl (i bl'ld or iryr.\t lne pmtdy ftr rlk nu{nic.r
<br />_1. aso*Nrofrh.rmn ny, ad.xclusivclycontmctins wirh liccMd co mcloF lo @nsoct th. pmj(tr (Sft.7044. Bu!.d3
<br />a l tmLsbn Cod.: rh. Conl6clol3 Licrn* trw (n).. mr 3!ply ro o .*nd ofrmp.ny wh. buildr or iElov* rh.r6G
<br />and sh. @.tncls for Mh pbjcl, tnh o Contmcto(o li..trEd puBunl b rh. Conrrcbls Lic.ns. L.s).
<br />_l M .x.opr u!d.r S.c]i.i_.
<br />DTCIAEAIIO!
<br />I hdcby amm uftlcr I.Mlty oltojury onc ot rhc followins d6l.ratio*:
<br />lhaveudvillmnimalnaCcnific.r.olcookntros.lf-lnflr.lorqorLcGconrpcnsllion,asptuvidcdforbyScdmnl?00oiihc
<br />l,obor CodE for rlr n.raonMnc. ofrh. wor[ iorq[rh rh. r.nDn F 'sru.d
<br />_l t v. d.d willmiol.in aort.n coor.nsario. in{aftc. as r.qlncd $y s<rid l70o ofih. ljb6r cod.. lor ih. pdtom.nc..f
<br />rn mrt lor whkh rhk p.mt i3 i$.n. My workd 6hp6srnln insu6.c. 6m.r rnd lolicy nnnb.r m:
<br />f fi4^kaity that h th. paro,mm. or rh. worl ror whrch rhF p..mn i (s.d. t shatl mr cnploy .ny p.m. m a.y mnr,
<br />; ri ro b.@tu rul'J*r tn fi. wnrtd'@mpcnsd,on L* ofcllifomi!. .nd asc thd if I rlbuld b..om $bjcd ro lh.
<br />m*6' emp.Mrion ,mvirion! of S..lion 3700 ofllE Lalnr Codc I ilsll, fonhwith mmply *irh llbs nDvisio6..
<br />WARNINC: l:.ilurc lo Kr. ur*.rC omp€nslion coE6g. ie u.liwtul, rnd sholl $l'jNl 0n emplo].r to siminal Frltis and
<br />civil lincF !p to orc hund..d lhouend dolhR ($100,000), in.dd ion ro
<br />'hc
<br />mst ofo mr.tri.lion. d.rox.s o$ nmvidcd tor lh.
<br />Sdrion 10?6 oarh. hbor Codq inrd.n dd lnorn y s f€d
<br />ou,, - //'b'-Nt? .*etr-*.
<br />ulljt-EDLuNllt ll_-L()a
<br />lECLdBAltON
<br />I hcEhy aflirm undcr p.mlty n aD.lury that I am tienEd und.r pmvkion ofch.nrd 9(commftins wrlh S.dion 7000) or_')irrion l
<br />ol the Duircss and Pmf.ssio.3 Cod., di my licchse il in full lorc ad .fiRt.
<br />Liccnsecla$ L'ccnsc Nutrrli.r
<br />CQIiIBUCIIAII,I'TDIIIi
<br />I hcrohyafiim undcr F.mlry.il.ruryrhd rhcr. N,.ondtudion lsd'ry r8cnry lir rht l.rli,mBncc oarhc s.d{ ntr wh'.h rhis p.rnrii ir
<br />i*u&l(scc 11097. cr! C )
<br />AIIITCANfDI'CI,ASAIIA!
<br />I hoJ, aBifln lnds pcnal y of perjury onc olth.lo!lowins declararions
<br />Demlnio0 PcnnrrsAsbcsoF Notific.rion l:.dcril Rctuldions (lirlc40, Prd6)
<br />R.quEd t.u..of Nolifierion
<br />ltdrli rlrN (fu ,in.ml nlulnr(,N rr8xi(lid! Nh.$os rcnn,ql rr. n.1.'rnl'c.hlt n, rh { |m,].cr
<br />TLfZ.nru,nn ,,.* *.u,n\ irnLcrron xnd ni,.,h*rr 3o,r. urLm,i,k,n tr.nrdcr r 38re,..omnLy \1r arL ( () antr ( otrnrr
<br />W ir^#,;,",,' /t'i.)Ot
<br />*,^,*--,r*u, * iilu,c '{lpir.fq,Z
<br />oc
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rou gh Water Heater
<br />POOUSPA
<br />P {rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<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 ?)6ltq'f,4&rci1 '2/utRemarks, Etc.
<br />-rr(
<br />Gas Service
<br />Notes,
<br />n;*,.o^,.- I /- b-90t I ",.",,
<br />Ldde r ad.lr6s _
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