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APPROVALS DATE tD/stG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Helease il
<br />#,.J-1,FINAL Y//l//4 )
<br />Notes, Remarks, Etc rt Z: TEz
<br />OWNER BUTLDf,R DELCARA ON
<br />I hercby arrm undcr p.mlly of lErrury lh.l I m ercm lmn lhe Conlreto6 Liccn$ L!* for th€ louowing rcNon (Sc..7011,5
<br />B!.incss lnd t\ofcssio. Codc): An, Ciry or Crunry shi.h rcqui$ a lcmir ro @nrlrud. ahr, iq,mvc d.molhfi or EI,an lny
<br />ntu trc, Fior ro ili hsuocc. al$ Equins rh. irpltonr fo! skh Frmn b lih a siBncd shrcmnr rt r hc or ste ; lis.€d NNrnr
<br />ro rh. Fovirioos o, rlt Conr&lois Li..n*rt ttw (Chrpkr 9. Comrtring wnh S.clion 7m0 ol Divisior 3 of lhc Busires md
<br />Polcasions Con ) or rnnl E d sn k .xempl llmfron .rd the hasis for rhc dkecd crcmdion. Any liolsrio. ot S&1br 7011 5 by a.,
<br />.ppliclnr for ! Frmil suhj€rs thc apllicdnr ro a cieilrcnllryofnol mrc rhln fivc hundEd dolk. ($500).
<br />L r\ oqncrol ih.!i{,ltny. or rycnln lc.s sirhNrsc\ r\ rhcir n,lr ror|Ensari()n, qilld. itEaork n rhc {ur!rc i. ftn
<br />rnrcMcd or ofcrcd nr *rk r S(.r(X-l. 8usirEss and l,l olcrsidn C(lic: l hc (td racttr \ Liccn{ Lru' des nor aprly h m o$ cr of
<br />rhc pRl*ny wh' huikl\ or i'q,ro*\ rhcn{n. u $hod(f,s\uchsorthi'n\cllorhcr{lforrhn,uthhi(orhcroBtrcmflq.c\.
<br />Imvi(lc rhrr luch i'n|]rirN* aru nor inrc ldt or ofiL:rcn ,i,r eL ll h,wcr (, rhc h itlii! or i,ntmlcnx nv,&lqirhr.k)ur
<br />oiconDlction, rh. owns lluildcr willhrvc tlu burdcn ol pr.ving rhu hcor\hc id nor huild or i'npmvc rhc F'If,ny lnr rlE ,'utx){ of
<br />-1,
<br />!sowNorrhcpnl.ny. rn.iclusilclycn rrdnrs *nh li.coscd onln.lo6 ro con\md rlr pNFr (S.. 70t4. BusiB
<br />oJd Ptbisri{ Corlc: Thc Conkrbas Li.cns. Law &Er nor atplyio tr, o*n r olpoFny eho huilds or ihp.orcs lh.rcofl.
<br />snd who co mcti lor sch,mJ.crs wirha ConrEct.(s) lkcnscd,,unurnt ro rhe Conra.t.r'r Licc.sc Li*).
<br />B. & PC for rhis rosn
<br />lloaf,Eal:coMfrNsAllo!
<br />DECLAEAUO!
<br />I h.Eby atfirm undcr pemlry ot periury orc olrhc lou6wi.8 dd@lions:
<br />-l
<br />hrw dd will mi.llh . CdirE ic of Co.*nr io s.lt- l.snE f.r *ort6s omFnslhr, os Fovklcd for b, Sccrkrn 1700 ol fic
<br />tlbor C.dc. for rhc perfo.1113G of fie m* lor which
<br />'h. ldnl n issRd.
<br />_l h.w lnd *ill nlointaitr wortcG cohocnsation insurBncc. $ rcqlidd h, Sed ion l70O of rh. Ljbor Code, for thc paformrc of
<br />lhc wort aor shkh lht Frmil Lr nsled. My,orksl coftpcnstion inslrure cdicr od Polic, ntrmh.r ml
<br />PolicyNumh.r:Jll)nc.:
<br />_I cnify rh ii rhc lxrformft. ofrhc wort ror which ihis pcflni n issucd.l shall not emlloy an, pcnon inany@ner
<br />e aslo tE om suhjcct to thc wo*6 .lnpcnstiofl bws orcsliaomia. and asr rhlr if I should b..oE 3ubFl to lh.
<br />wolt6 comF.salhn prcvisions of S.crion 3'700 ol lhc L8hor Codc, I snal. fonhsirh 6oply sith th.$ l,mvisions..
<br />\yARNIN(,: Finnc ki {curc qork$l co rl.nuri(.ovcrnsc is utrhwiul. rd sh0lr suhj.ci an cmplorcr 1,, simind pcnalric\ and
<br />civil finc\ up b om hun r.d rhou\rtrd (51 :i;codpcnsation, d!tuscs ,s lovid.d lor rhc
<br />r. +<n I
<br />.t
<br />tlI(:L,Ia ll()I
<br />I h.rhy sllirhrndfi p.n|lry or pcrrury rhat I o'n liccns.d undcr povkion ofchaplr 9(co.rmncins {nh Sccrirn 70uo) otDivisio.l
<br />"g^'*'Codc. lid ny liccn{ is in tlll ibN aJrl cfircr.ffiog
<br />zrl rt C-
<br />, herchy lmnn und.r Fndly of p.rjury llEr
<br />hsued (Se. 3097. Cir, C,).
<br />isoconstdclionlcndinSagcncyforrh.pcrfotunccotrhcwor*lorwhichlhispcmitis
<br />dIruc NLI2ICL n iIoN
<br />I rrrhtrnnduid.r |f,nrh, ofp.rjry.nc ofrhc lnllo$n8 d$l iiidrr
<br />II niri{rn t!.flnns A\hr{ \ Noiricrri( Fcd.ol Rc8olari(n\ (l irlc.10. Pnn6l
<br />Rcq0ncd lxxcr of Norifi carrrl
<br />rcmval .rc nol 6l,!ltat lc ro rhh tojel
<br />infortulbn ir coner. lagR lo mmllywirh rll Ciryedl Counr,
<br />rcprc{nralivcs ollhis Ciryud Counl,
<br />ApDli.$l or Aa€nl Si8nalu
<br />L,
<br />L ft
<br />PLUMBING-INSPECTOR RECORD
<br />Lcndcr'r AtldRs
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