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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDEB GBOUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />A
<br />htt-lJUBough Plumbinq 7-27*l{
<br />Final Gas Test
<br />Meter Release
<br />FINAL rol.w IV lll\tu'tfIt],"l6-v
<br />Notes, Remarks, Etc.
<br />OIINET IIUILI,ER DIiI,CARATION
<br />I hcrcby rfirm uktcr rcnnlty ol p.rury rhal I rm cic"U ,tnn rhc (otrrr!(k)F l-i.ci$ I-r* n, rh.loll.qinB rc.son (S(71).115
<br />Busincs\ rnd Pd!$ionC(n l AnyCiryor G,unr, *hi.h toqrnr\ i Fdil nr.otrirucr.0ircr. inrl)rovc. dcfl,ii\h or tuPar My
<br />( .rurc. priMn, ir\ t{usirc,,l$ rcquhs Ihc,!tri.aN lnr \uch tErni ro,ilc r \irned sllrcmnr rhxll*or shc is liccn{d nunnrnr
<br />ro rhc ro\nions ol rhe Conrruciois Ldn\cd Ljs lchiprc, o, Conrdcncins {ith s.dir'n 7un .l Divirion I of rh. Bu\inc$ ttrd
<br />P fcsi(,i\ Cod.) .r rh hrorshc N.xcnu lhcr.lronra rhc hir\i\ L hc ol clcd ctcnrpiion Anyvid n,nofs€lion703l5byrny
<br />anpli.r lorrNrn subjc.tsrnc rpplicsnlhrcivilpcnrlly.itror,x,crhaifi\chutrdrcddollrn($5u))
<br />-1,
<br />s owM of rhc ptuFny. or my .nlploFi wio wagca s iEt $h omp.s.rion. *ill do rlr wk 5n dE luEnr & rcr
<br />hral(kd or oford for Bl. (56.7044, EusiBs and Pmf.$ioN Codc Tn Conrra.ld s Licne Lrw do.r ml .pply ro u owncr of
<br />rlE rimFny *lb hoilts or inFors rlrMi. lrd ano do.s *h lott him*lf or lErslfor thrcu8h hi m lEr own cq)loyca.
<br />,bvidd lhar su.h imrbwnls e mt i ci&d oro,t sl lor slc. Il lbwwr.llE h,ihiry or irytuwrE ir sld wirhi, om )dr
<br />ofoIphrhn, df, Owmr Builkr *nl lEw ln. hr&n of poviis r,ur lE or shc dn ml hiild ot inprow dE pbFry tor tlE Frpae ol
<br />-1.
<br />as owmr of fic pmp€nt. om cxchsilcly.onr,adin8 wirl liccnsd conrados to co.shd llE pmiEl (Se. 7044. Bucim$
<br />ad ftofssionCodc: Thc Co turois Liccn* trw de. nor rpply ro m owncr of!rcperlywho builds or inprov.s ih.rcon.
<br />s qho onhds for such E irls *nh a Conrrro(r) liai{d plmu.r ro rhc Cbnif,dols Lirn* L!w).
<br />-l
<br />amcicnpt !ndc! S.crio
<br />I)rt ()$ rr
<br />!I}BtrE8Ii:II,}!IIEN!AIION
<br />DECLARATTON
<br />I hercby affirn undcr rEnalry ol pc.iury onc orrh. ftrlo*ing d.cl irn\:
<br />Lnhtr (-rnl.. lnr rhc |{rlirwr.. ol rh. \rork l(r $hich rtu pcrnir n ^\u.d
<br />_l haw aod will dainrain vorlcs .onpcnsarion insurance. N rqutun by sdb. 1700 ol rhc L!bo! codc. for lt* lcrfomh ol
<br />rhc sort 16r ehth thic pcdiir is i$u.d. My workc6' conwnsrio, i.sumNc caic, ud rDlky nlmbet el
<br />-l
<br />(nifrrtar in rh. ri.nnrnude.trhc work ror whi.hrhk p.rmi' k issucd.l shollmr cmrloyanyp$@n in,ny@nmr
<br />e as ro h.com cubj.d ro th. workm ompcnsltiotr lo*sofculifomiu. lnd as* rhal ill should trcom subjd lo ttE
<br />wod{cB c.nD.nsarion tmvisions olSslion 37mof lhc titn Codc- I dull. loflhwnh .dhDly *nh lbs povisiotrs..
<br />WARNINC: Faihrc ro ccurc
<br />civi, litrcs !t lo oflc hundrcd
<br />covcinSc is unlustul, and sholl sbr.d M emploFr lo oimjral Fntrllics and
<br />in addnion ro rhc.osl of conncrqlion, dles.s as ptovidcn for thc
<br />2q UA-/
<br />uGNErLrcNr.E t-jLltsu[(.I&u&n
<br />Fonlryoip.rjury lhal I am I hdcr Fovision of Chprc. s (oftmtri.g with Scclion 7$0) of Divirion l
<br />PDfcssbnsCodc. r ny li..n( i\ in tull lrtrr,nd.l'lc.r
<br />t4 b65L(
<br />I herchy aflirm hdcr pcnalry or p..jury r
<br />issucd (Scc.3Ur'7, Civ. C.).
<br />rudion tndinS oBcmy aor rhe I,crfolr@cc ol rh. w6rk for which lhG IEmn ir
<br />AIzuCANLIECIAEAIIQ!
<br />I hci.+y aflim utrdc. ncnotry of p.rjury onc of lhc n,llos ine Jelnr.rions:
<br />Dcmlilion Pcrmik'Asbcstos Norificlrt,n Fcd.rul RcE!larions (tnt.(). Ptrd6)
<br />-Rcquncd
<br />brlcr of Noriliculi,,.
<br />acdcol Eed,lions rc8ardnrg osbcnos rcmval m mr .ldicabb ro thn porii.
<br />rcud this {dic n'n ud $atc dEt lh. otovc inlbduiioo i. cor6l. I agK lo snply wirh lll Ciry dnd Counly
<br />,rc liws rcldins ro buildins conxtrucrion. lDd hcrcbyaurhnnc rcrrc*nr,rircs ofthis C
<br />Lq
<br />L/LC
<br />t$-
<br />TOP OUT
<br />Pool HeateriGas Line
<br />Miscellaneous
<br />/e,
<br />trnCc''\ Nnm.
<br />-
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