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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIVNER IiUII,DNR DELCARATtoN
<br />I hcrcby.finn un,lcr nc,rdlrt of Erjrry rhtr' I 0n crc ll rrorn rhc conro.da l-iccnsc lrw lnr rhc iollo*in8 rcusn lscc.7r.rll5
<br />Busn'cs rftl PmlNri0n Codc): Any Cir, or Courry whicn rcquircs tr |Eirnir l(, (onnrud. ohr. imFovc- dcmlish , r rcrrJn dry
<br />srtucfur.- plntr ro ih i\sulnce. aho rcqlncsrh. apnlicinr tu such,,crnrirro filci sisncd srrremnr rhar tEor \lr t li..oscd prBlrnr 'b thc pn'v^ions ofrlr Co.kr.rof\ Li.cnscd trs (Chrprcr 9. Comiftncin8 *nh Sc.rnr 7fi$ of Divki.n I ol rhc Busir.s ind
<br />lhfc$nnNCodcrorlhrrtLorshcircrcnrl,lIhcrclionnJIhcbi!isinrrh(nllcpcdcrcmDri(in An, violilioroiS.clion Trr.ll.5 hy rry
<br />arplicrnr rhrr Nnnir suhjcch llrc lppliranrlo r.ivilpenullyolml nnNllrn nrc hu !.d nollxrs (S50o)
<br />_1. N o*tur ol rhc ,mlErr, or h, cd{,loyas qirt *!gcs as rhcn sh .omrnsrion. will do tL work aid r,E si*t@ ir et
<br />inlcndcd or otr.ed rd sh (5€.70421. Axlin6s r.d Profcrlioa Codq Thc Conrerors Lic..* tj* d.cs nor lpply b an owRr of
<br />rh. poFcny who h!il& or itrpmG llf,sn, un who dGs ech wlk hiN.lf or h€mlf or lhmush his or hcr oq cnphyc6.
<br />Imvilcd lhar ruch iqroEmnB @ mr int.nd.n o.6tu fo, qle lt tnEE, rlE hilding or inpreEanl h sU *ithD om ,*
<br />of6r?b1aotr rlE Owm Buidq eill hlw tlE txld.n ol troljns thar lE or shc dil er buiu or ioproe lhc pEFny for ln. purpo$ ot
<br />-1.
<br />ac os.cr of lhc ImFny, am cx.lusivcly ontreling ailh li.cncd .onlturors lo onsdcl ltE pmj€l (Scc. 7014. BusiN$
<br />a.d Pbtsqio.Codc:Thc Conrdcror'r t,iccnsc Las dms mt slplyto an ownd oft,lopcny shd builds or iotorcs th.rs..
<br />and *ho .o.rflck for such pmFts wirh. C.nhcio(s) lacncd luRMr ro|n Co.rncrols Lk nsbw).
<br />-l
<br />omcrcn$r uMcr Sccrio
<br />!AKE8g.CO!II!NIAII9N
<br />DFCLA RATI(TN
<br />I h.rcb, .fltrm undc. ,corxy 6r Frjury onc of lhc following dcchori.nsl
<br />lhrvr nl*,llnrnrxDrCcdifrnrcolConsctrrt)Scltln\u..tu'sorkrf.onr!cn\nri.n,x\ lni\id.dnnhtSc.rt lT{xrolllr
<br />Irtxn ('d1.. n]rrhcp.ni,nuncc ol rh. *ork r'or*hi.h rhc p.nnir i\ i\nrJ
<br />_l hrvc 0nd pill mintai. wo*6 .ohFnsalhn insuBft., a N|UiFd by Sdion l?00 of lh. L.bor Codc. for lh. Mo,fue of
<br />pcmil is knrd. My sortss' comrEnsaiio. insurorc caEicr dd lolicy nlmbcr rc:
<br />\\.14
<br />I c.niry rhsr ir thc rErlo,Nne dtrhc wmk lo. whi.h rht Irrnir ii i.s!cd.I \hrll n r cmpk,yany lcr$n in 0ny mamcr
<br />$ $ to bcconE suhj$l h rh. wolk$ conr0.nsorion l.wsofc irorni( 0nd o8E rnal ilI should hccom subicr torhc
<br />krlcs'compcnslionpDvisionsofsctiotr3700oflt Litnr Cod.. I stull. fonhwnh smlily *ilh ilns pmvisio.s .
<br />WARNINC: l_ailurc ro s-uo work.rl onucn$rion orcrlsc n unh*lu. lnn rhill suhjccr d cfrtloycr ro ..imir0l pcMhics 0nd
<br />.ival fincs !F kr otu h!ftlred rhousnd dollds (5100.000), in lddnion to rh..osr ofc.ftFnrarioo. da
<br />idtffitifi$l'l;;::
<br />DftcldltrIlQNIhctubynf u d lt.rlry of fcrlury rh r I r r ltu\.d utd.r p(,viri,rt of Chdl)l.. 9 (..nrr..io8 s irh SL{rion ?oul) oi Oivnion .]
<br />nf thc Bu\inc\srnd ttolcsions Codc,.nd mvli.cn\c is in tulllorcc r c,lLcr
<br />w?,|.tE-l .
<br />D+!${+201101 k=aa*^nrr-
<br />IONSIB]JCIIOIULDINGI(iI]N(I
<br />nid lsc. l(r7, Cn. ( )
<br />ATPIICANLDEEI,ABATIO!
<br />I hsr$, anim under pcnnhyofprrjury onc oarhc aollowing dccl0rurions:
<br />Drtrrliiion P.rn t!Ash.ros Norificrlion r,cdcral RcSuhrn,ns (Tirlc40, Prn6)
<br />-Rcqun€d
<br />Lcncr of Notifi$rion
<br />ordiMmcs od shr. ties EldinS b buildinB.onsrruclnrtr anl rErcht 0urhonrrcpesntlrircsofrhis Cnymd Colnryr
<br />)L;iftow mnri6ftd pror.nr lor in$eiion puqxNcs.
<br />,,P,", N tr
<br />ADDli.al or Atenl Sitnrlurc:
<br />€no*l *"'
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Undedloor
<br />Buildinq Sewer
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />TubiShower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir,4ain Drain/Pool Pipinq
<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 />Rough Plumbing blqrls',Ft ffi
<br />Meter Release
<br />FINAL 1/cr/ /2, ,.B tol
<br />Notes, Remarks, Etc
<br />Area/Storm Drain
<br />Rool Drain
<br />Final Gas Test
<br />"r'.r^,.n* tllU$\rlcol&tDo,,",,',".
<br />-l.enifyrh,r
<br />rhc fcdcra I rqular io.s rus'.diq ashcsro\ rcnnval arc nor arplicahle ro rhis,'hj.{r
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