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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNI]R AUILDEA DEI,CAR,\TION
<br />I hfi.hl rrfird ondcr !.nrlry ,,r p.rjury rhd I dn cx.mpr rom rh. Contrck,s Li.en$ Las tu rh! 61k,* idg rc,$i ( ss 70.1J .5
<br />Dusindss d Profcsidr CodcJ Atry Cily o. Coutrly shi.h rcquncs n rcrni n, coi{tu.r, !lr.r, improvc. dcn$lkh or rcpri otry
<br />rlr!.ttrc, priorro ns t\u{nc., rl$ rqluncx rhc rrpli.rni ntr such p.rmir ro lilc a siln.d sdr.rN.t rlmt h.or shc is liatr{d Prsurnr
<br />k' rh. r.visions .frhc C.ntrcl.rs l.ien\c(l L1w {Chaprcr 9. Conrmcncir8 *irh sccrion 7fllo dr Divhn'n :l .frhc Buriflcss ond
<br />Pmlcc\ior\Codc)orth.rtuorrhciscrcmprrh.lclror!dlhcllnsi\forrhcllks.d.x.nfln,n.AnyviohtiotrofSc.ttun?0.rl5hrrny
<br />rpllicDd n, 3 l.nnn \ubjc.h rhc rppli.,nt b a.ivilp.nriryornor nbrc rhdn livc huMrcd dollaB ( $500)
<br />-1.
<br />$ o*ncr of rhc propcny. or ny cnploy.cs wirh wag$ $ rlEn sk @mpcB hn. wiUd.lh. etrk s,n * str*re n rxJ|
<br />im.odd or oficrcd for $le (se.7044. Busirc$ and Pmf$sio.s Cod.: Th. C{nrra.lols LtcnE Ljw &B mr qDl, ro u owmr of
<br />Inc nFrin, who huil& or ihtmrs tn.el\ lql wth &J$ uh wnrt himrclfo, turscllor thsu8h his or hcr own c ployes.
<br />provid.d rhal3uch in'tftwnlsm fl,|hlcndcd notu ror eh.lt k)M.lhc t{ihin3 or IrEDtm ii sld winin oB rtr
<br />ofmriLtior, thc Owftr Buithr wil hlrc rlE hrd.n or pmving lrd tE or slP dil mr hild or iryrcw dE ImFaly aor th. pEpo. or
<br />-1. "s
<br />own.r ol rh. ,,oFny, am.xclusirl,.o racling snh liccnsd.oi!rEr6 lo @nnod rh. IoiNl (Se.7044, Busift$
<br />d,n ProGsbo Codc: thc Conrraclols Lic.ns trw do.r nor ap!I, lo m owncr ol properly qho builds or idlorcs thcron.
<br />rnd who .ontBclr for such pm,ccrs *irh u Conrncto(, ltensd !!Run k' lhc Coohclols Lkcnsc tiw).
<br />-l
<br />ah crcmpl unds Scc
<br />UOBf,EBa..CI}MITNSAIIQN
<br />D[Ct Af,A]lo!
<br />I hcrcby rfi.n uod.. p.mliy or pcriury one of lhc followin8 deLnlions:
<br />I h!!r dtrd NiLltr$ir .ira(cnillcd.or(inr\ctrll.S(llltrrurc.tr+r,kcrscrDp{n.rri{nr,3\ nn)vnbdntrhyscdion3T(xrolrhc
<br />I ahir Codr. f(trrh.llrtunnr.ccolrhc solk,.r$hi.h rhcFnnir ir i!\u.rt
<br />_l hilcrnd willnEnrllin wortcrr coopcisli.n in\lraNc, a\ rcqttcd b,Sdion 1700 or rhc Lib.r Code. for rh. I).rfomm o,
<br />.mt. !d policy nunbor N:W:''H';i\\kd My Norkda conp.nsarn,n i6nranc.
<br />,a /./"
<br />I..niryrhd ir rhclrrr.nnrmcofrnc *ort tor whichrhk p.irni ( ksucd.l \hrll nor cmnloyaiyrce,n in,nymnncr
<br />nr rro trcom $h]cd b thc wo.kcd coiFn{rioi hwi orcllifonia. $d dln hd if I should tE onf, subjd lo ttE
<br />w"rLc,( ompcnslrion pnrviln,ns o, sccin ! :1700 oa rhc Lrh, Gxtr. I dEll. fonhwirh ompl, wth lhrs pmvisionr
<br />WARNING Failur. h s.uc porkcr' corycosrion ovcosc is unla*f!|, and shall \rbjd an cnfloyrr tu aiDnMllcutrics otrd
<br />civil n.cs up ro ooc hundrcd lhousnd dollm ($100,000)
<br />SNlion 1076 of lh. titDr Codc. inlcrc$ and anotuy\ fes.
<br />in oddnion ro rhc co{ orcomp.nsnrion
<br />,",., 1.b.llo
<br />DI:CI,ABA.IIAN
<br />I hcEby ufirnuder pcnllryorpcrjury ihd In'n li.cns.rl xnd.r !n,vi\n ofChrtrcr9lco.rmcncinswilhScclion70m).fDirisdl
<br />oI thc Busincsud ltofc$ionsCodr, alr nrr li.cn\c n in fllllo(t!'d.rd.
<br />c()NSTRUCTt()N I TNDtN(; A(;ENCl
<br />I hcrh! rlllrn utrdf |tnrlryol lcrjury rhrr rhcrc is a con{rcrior tndins rscnc} n)! dt tcrrornm.c orrhc snk lnr thich rhis Nrnril i\
<br />issu.nlsc. :1097 Civ C t
<br />AI]LICANIIICI.AAAIPN
<br />I }rrhy aflinn un'l$ pcndlryorpcrjury otr. olrhc irnhwirg dccltrrurir)ns
<br />llcnnnirh I'cnnih Ashcsros Norific,rion Fcddrtrl RcgnhrnnN ('l'itlcJ0, Pd6)
<br />-Requtcd
<br />l.rrcr or Norificri,,n
<br />_l .cnily rhar rhc fcd.i6l rceuhrioni rE tding asb.tus Emvdl re oor a,l,licablc ro lhis pmin.
<br />t Gniarrhur Ihllc rd rhisrppli..rimo imnccsnnd srarc ltr,ws rclariq ro6xildi
<br />DtEk nroriomd ,n'pcny aor in\pccrionpo
<br />0d shrc rldrhunh)vc idnnuliotr is I rlrcc t' dnntll sirh rll Ciry itrd CouDry
<br />ofrhis Ciryand C,unryro c.rc. uron th.
<br />lppliunr or,\[cnlSiannltr *,", i L. lb
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq 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 />Tub/Shower Test
<br />Rough Water Heater
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 1/r{ /i{,l)ftx
<br />Final Gas Test
<br />Meter Release
<br />FINAL lo/ryk Ebt{
<br />Notes, Remarks, Etc
<br />POOL/SPA
<br />Water Service
<br />T;
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