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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS orvNtiR Irut!-DIR Irtit,( AR,lrroN
<br />I ln.lt rlfr rt,lcr rn lr) ()f N'jny rhrr I n crrDln ioD rlr. arnnra(nts l-'ccnr l-rq ld rhc lillowin! !.rv,n lsr.70:11 5
<br />lluslnc\\ rrd ltoLs\ion Codc): Any(ir,o Cortrry $hich rcqtrtr\ r F-nni! tri con{tu.r. xli$. nntnnt. d.trFli\h or r,'rn uy
<br />n) rhc nn'riii* of r)f, Cotrk..rr'\ Licctql trw lChJ|r.r 9. ComnreNir! Rlrh Sdcri( 701)t) ol Divislor .l of rhc llu\incs rn{l
<br />Itolc\n.r( C.dd o, lhrr tE , t \lN i\.x.t,Ilrh.r.froDrnd rh. t\i! i,n rhcrll.!.d.xcn|,n'n Aryvi.ltliotoiS.crionTo.rl56vrny
<br />rltrlicr r lor r pcnrir \uhjc.r\ rhc Uplicrnt [, i.rLrll)ch]rtol ru rtrcrh lrvc huMrcrldoll \l15lX))
<br />-l-
<br />s oqB olfic lrclfn,6. my.n{,loye3 wih wages s lh.n $b 6r'Fnelion, *iI do llr work dn dE cnlrn is ml
<br />i cd.d or oficred fo! slc (Se.rO44. Busims and PrDfcsion! cod.: TIE c. reloat Lkc.s Llq dGs Dol q,!ly lo m okt of
<br />tlE p'DFny sho huilds or irpro$ rtEtun. !d ,no dc sch m* himclf or h.&ll6r lhmtrgh his or hd own.mployces.
<br />pmvac.l rhlt such inp,!rcmrts d Nr inrndcd oroltu for elc.If. iowffi. rlE hrildin8 o, irpreEmni k $E *nhinoG )aa
<br />of.orplxior tlE Owflcr Builld wiu h.r 0E hldq of lmvinB rlEr hc .r slE dA mr bild tr ilrcoe dr por8ry for rlE lurDos or
<br />-1.
<br />$ owrcr of th. pmFny. !m €r.llsivcly contnctinS *irh liccnsd conttuios rc onxdcl llE prsj.rt (S.c. 7044. Buiimri
<br />rnd Pr.f6sin Codcr ahc Coorrerofs Lic.nsc trw docs nor ,tily ro on owncr of tmpcn, *ho huilds or imDoh3 themn.
<br />lnd who snrmrs for slch lFicds *i'h ! Coirturo(, liccnsd !!6ufl ro rhc Coorerolt Len* bw).
<br />I !n.r.nnl un&r S(Don .B.&P.C aor lhirrce.
<br />$l)8rc&iraMfBsauo!
<br />DECI.AMIION
<br />I b.rc5y ldirn unds pcn lly ol pGjury one of lhc followitrg &cl8alions:
<br />I hr$ r'il *ill ninnri'r r Ccdilidc of(nn$trr tu SclllNUr. tor \.rkcrr co pcnqrion.rr pDrid.d larbyScdtun:l?(l(rolrhe
<br />l-rlxr(i .. ktrrhullriornxnkcof nrtrorl f(tr*hi.hrhcpcrn,ir i\i\\Nd
<br />I havc and will mainrain workcr omp€nsalion insuancc. as rcquitd b, Sc.rioo l70O .l rhc tjbor C.dc. lot ltu l,erfonmrcc ol
<br />lhc wort ror which fih Fm l is issd M) vorlcc' .onpcnsrion inslmmc .uier !d p.li.y nunttr ac
<br />_l.cnify rh{t in the p.rrormE. oflh. wort for whth fib Frmn is i$E(l I shollnor.tlpld, ey !c^on io my nMncr
<br />$ asro bc{om subjd ro rh. e 6 @n'peistion hqs ololifomh. a.d ,e@ ltul if I shuld tf,com subj$l lolhcpo*w coq,cnetion,mvisions of k i(,n 1700 of thc Lskt Cod., I ah"U. fonhwith.omply with tlDs l,Dririoni..
<br />WA|rNIN{L Frih'm b htrr warllTl n ovchSc h utrhstul. Md shau $bjd e cmplorr. ro diminal ldElris and
<br />civil 6nca up ro oft hundrcd rhousnd dollm ($l ). nr lddition ro rhc cod orcomlcn{rn,n, dnmgcs as providcd fo,lhc
<br />Sc.ri.n il{r6 ofrh. titrtr Qtc, inrcrcn axl
<br />,"...=,*9.!!.1-L
<br />I]I;(IIA-IUQN
<br />I hcrchyoffiinr undc. lcnlhyofrrhrylhal I rm liewi lodcr polisn,i ofch8fl.r9 (co,nnErcin8 $irh Scclion 70(x)l ofDiviiidn:l
<br />of rhc Busnrss and Pbfcssions Codc, ond my liccnsc is in tull ntre ud cycr
<br />t)i6nqlb
<br />,0. K
<br />COISIf,IJCIIOIi.LENIINCIIiENCI
<br />I hcreby rfiim !ftdcr pcnalr, of Frj!ry lhd rhce is a .o.(mri6, b.ding {gcrcy ru ths l.rforroae of rhc work for *hhh rhk tmn t
<br />issucn (Scc. 109?, Civ. C.)
<br />IIELICAII.IECLAAAIO!
<br />I hd!6y lnim und$ p.nlhy of psiury oft ot thc tolloein3 &.brationsl
<br />Dcmolilio. Pcrmils-Ast slos NolificoliDn tuc6l Rcsllalions CThlc,l0, Pfi6)
<br />-Rcqtrncd
<br />Lcncr of NnifEalhtr
<br />-l
<br />ccnilyrhnrrhc acdcral rcsularion\ ec,rdins !\lrdo\ r.m,!aldc nor!mli.$lc I.lhh,)r+cl
<br />ll.cn'rrrhJrlhJlcrc,Jrh^0nplErr^n d{orcrhnrrhcnh)rci nnuri.n n eorccr Iaareroconpl,wirhallCiry{trdCounry
<br />onlinnn.cs nnd Si,rc ta*. rcl,rins ro buirdirs.lnslrucrnn'. lnd hcrc$ylurhori/! (tr.scnrdlivcs orrhis ciiy,trd Counlyro cnlcr qnn rhc
<br />nl$v. nrfn rd ptupcny for
<br />,\!t,lacsnl or.\rrt l Si!tut t rot
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back FIow Device
<br />Rough Plumbinq 1 luh4 E\>tq,
<br />Final Gas Tesl
<br />Meter Release
<br />FINAL /u+ t4 ,\c*
<br />Notes, Remarks, Etc.
<br />Area,/Storm Drain
<br />Rool Drain
<br />Fill Line/Back Flow
<br />*cc t4c.
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