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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Water Pipino <br />Gas Piping <br />Rool Drain <br />Tub/Shower Tesl <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <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 <br />Final Gas Test <br />Meter Release <br />FINAL t--'{-tb,1),Sulc (\q) <br />Notes, Remarks, Etc <br />()tvNER BUI-DUR O!:l,CALll l()N <br />au!tu\r ! lPiolr\{uD (,)dc) AnyCiryor Connr) *h(hrrquts r |tnni n)..rtrlflcl. rlrcr. inrro\c. dcnolnh or rcprn rny <br />.pfli.ntrr ftrn Nrn suhjc.rs rhc |lppli.rtrrb a.iviLprnxlry.lnor mrtu rhr ll\c hudl.d d.lm {S5oO) <br />-1. <br />ar owrcr of rhc potEny, or ny cmployees wirh qrScs as lhcir sL conlEn.alion, will do tlE wort rnd rhc sln$E ir rct <br />inrcndcd or oficr€d for slc lS&,7044. Busies od P,bfcsioN Cod.i Th. Conl'!.rols Litrs Lio dra. nor tpply io tn .wmt of <br />tu pmFny who hilds or itrprlEs llEm.. aDd who dG uh tu* tidrclf or h.@lf or r}! rSlt his tr lEr oM crployccs. <br />prcvidcd thct .!ch iqrrcvcm, s m mr i e*t d or offald ror sL. l( h)kE. lhc buiuDs or itpmhftd h $u wilhm .m ,w <br />ofmnplctbr llE Oercr Buildd will h,E rrE hrfllm orlr.ving ihx r. or dr dn ml tuild or ntl'mE fic Ftldty fotllE rE r$ol <br />-1, <br />a. oB*, ofrhc pn,Fdy. mcrclusiv.lyconlr0.lin8 wnn fi(.sn.onl@loB ro.od(ftirhc F.IE (S(. ?044. BNirc$ <br />0rd Pmfssbn Codc: Thc Conrrlclols Liccnse Low dcs nor aprlyro uown6.lp.olEriy who huilds or inrprovcs lher.or, <br />lnd who o racr. for su.h FnjBi3 warh . co.rBcio(o lkfos.d r0 rh. C.nrra.rr's 1"i...{ Lau) <br />io! .8. & P.C <br />I h.rchy afilro undcr p.ndly of rsj!ry otu of rhc follo*i.s dehdionrl <br />Ih.vc i*illnuinrainoCcnificarcotcon*nrroS.lalnrualorhrksconpcnsdion.!sEovidcdtorbySccriodlT([ollhr <br />tjbr c.dc, ror rh. ,.rfonruNc .f lnc soi( for *hi.h ltc Fimil ir isso.d <br />-l <br />halc and {ill nai.rai. workcs' co,np.n$lion insuraNc, as Equtcd b, Scclion :l7m of rhc r2txn Codr. lor Inc I'dfomncc of <br />tl* vo,k tor which tnt prrnir is h$El. My wdtcx comn nsdion insurarc cmid and Plicy nur$.r N: <br />-l <br />*nifr rhd in lhc lcrformmc of lhc wort tbr which lhis pcflnil is isslcd, I ihau oor cnPloy,ny F6on in lny Mtu, <br />s &s io b.roB subicl lo ltrc worts omFnslion bws ol Cnlirdmia, !.d agEc ltur if I slnlld bc.om luhid lo trt <br />worh6 omp.osarion pmrlsio.s of Srclion l T00 or the Llhor Cod.. l slull. ldhwth ohply snn lfios Pmvirionr. <br />WARNINC Faillrc ro *{m $orlcs conpc.srion covcasc is rnhttll shall rxbF.r nn cnulors rn siminll Folrh\ dnd <br />cilil rin.s up ro onc hutulrcd thousMd dollus ($100.01,]). ir ol cotrrrr.Narion. drnrqc\ ,\ povidcd lnr th. <br />Fi,,iiffir UITLIBAI]QN <br />I hcrcby af,tm udcr F.ahy of lcrrury rhd I m lis.$n un.h. novision of ClEPtd 9 (@ftftming eirh S.clion 7000) or Diision l <br />l,mlcssions Codc, ,i liccnsc i\ in liilllai$ dftl clLci <br />tuE <br />CANSI!]]SION.LENDING.AAIIgI <br />I hcrchy orrilnundcr p(n,hyorp.rjuryrhst rh.rc n r consrrurriotr hndirs aacncy tor rhc p..lnnnsi.. olrhc wotk ior *hich rhh Fmir is <br />trsucd (Scc. 3097. Civ C.r. <br />ATTLICANIIECI.ABAIION <br />I hs!ry ,trnn und.. ,.nrl'y of t'crjury orc of lhc followin8 delanrioor: <br />Dctul ion Pcrnn*Artt{os Norificolion r'.n ral RcBulllions (Title.l0. Pan6) <br />-RcquiruJ <br />lxud of Noriltarinr <br />I ucnifr rhol rhc fcncrll rcsudions rllrding Nb.{.s r.orv0l e m' lrpl'Eablc ro lhis pmjel <br />-l <br />ccniiyrhrr I h!!c read rhir,rplicat abovc itrfoturion h .o ccr. I sE N r. .onr <br />ndinlE-'cs dd Slarc Laws 4Lling lo <br />ohovc mntioncd pmpcn/ lor insr.rt <br />nnd hcrch, aulhri^ rcprcscnrdircs df this C <br />Dpt"mr <br />d Asm' <br />/y *nh oll Cilrdd C.unry'til;:ffi*'* <br />Waste & Vent <br />Water Service <br />I <br />Lcndcr'. \,,1'(*