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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DEI,CAIIiTloN
<br />I hcrch) rflnn lndcr pcnrlry of Fdjury rhrr I Mr .xcnu norn rhc Cont.clor' Liccnsc lj! i, lhc arllowing rcr*r lS..70ll 5
<br />Bu$tr.(\ kl Pi(na$im Cdc): Any Cily or County which rcquirc\ ! |xnnir b .on{ .i. nhn. nnPmtc. dctrDlhh or EINi y
<br />{octrtrc, I,ntrr. irs is{'Mcc. al\o rcqdirc\ ihclpplicrnr lir suchFnnir h filcd $8ncd sr.lcnrcnt Ihd hcorshc ir litn\cd prr\unr
<br />h rhc Frvi\n,nr or rh. co r..tr's t-i.cnscd L.w (Chrtt.r e. Commcncirs {irh s.crion 7fi)0 or Divisi.n I oi lhc fitrin rs uM
<br />P(,icsionsCod.).rnrrtuorshehcxetrlPrlhcrcfromMdrhehalnfo!rlfsllcscdcrcmprion.AnyvnnrtiotrolSc.riof?0:ll5hyunl
<br />applicnnr for r pcnnir suhjNrsrh. rrpli.anr t, a.ivilr.mhyolnor n!rcrhdtr tnr lundrcd dollos (S5Olr)
<br />_1. a{ ownc, oI rlt ,(rcny. {r n,y cmtl('ycc\ snh wr!.\ rs rhcn y'b co'npcn\nrion. qill do rhc work od rhc ntum is mr
<br />nncidcd .rotLrcJ ntr {lc (Se.7(r14, Busircss otrd Prcfcssions (lodc -l1rc Conrractr\ t-i.dn* Uw {t(r\ nor lp,,ly n, M osNr ol
<br />lhc pnpcny sl$ hrikG or iryro!.s rhc@n- $d $ho docs \uch $orl hi'n\tlrot h&*lfor thmuth hn or hcr.wn cmpk,yc.\,
<br />,mvidcd ihrr \rch impmfmnN d frn intndcd or ofi.rd r.r sk Il h,*c1rr. rh. builli'l8 or iryi.vcnrtrr n v'l] sirhi" .nc )td
<br />oicon{'ttnin, rtr O*ns Buius sillh!( rtr huntnofpfl,rin! rhrrtf,orlhe dil & hoild or r$mrc llrc tmFny lhr rhc purll,{ ol
<br />-1,
<br />asowftr.ldc pbp.ny. omcxclusivclyconrr!.ritrs *irn lianscd conrrloB ro conslrucr ilE pmj(rl (S4.7044. Buiie$
<br />ond Pnftarion Codc: Thc Conrturof r Lic.nsc tlw docs ar rptlyro m ow.n ofFopenywlb blildr or inprcv.s rhcrsn.
<br />..d who .onhcls for 3Nh pfl,i s with ! Conrturo(s) l.Ined p(fu io rh. Conhdols Liccrs taw).
<br />I m cxcnDr uDdcr SNlion ,B &PC lorrhaMsr
<br />ll)8f,E8LCllMPiBtArrAN
<br />DEII.ASAUIJN
<br />I hcrcby affir m u nd.r Fnolry of lojrry oN of t hc following dcc |4.!r,onsl
<br />-l
<br />harc lrd vilt minr@ a C.rlifEarc olconsnl to Scl Nurc for erk6 @n{E.salio.. rs Fovt.d for by Salk. 1700 of dE
<br />kbo! Code. lot rhc ,Efollrec of dE eort lor whtn lh. Fmir i! issucd-
<br />-l h.!e lid will minrain wortcn coEp.trs.rion i6suBnc€, ns rcquncd hy S(tion 3?00 of lhc L6bor Codc. fo. rh. lcrfomure of
<br />rhc wnrllarwhichrhNncrm 11 ^qd My worko. .oryc.qion in\urmc ffis and plicy numh€, m
<br />."",",, Mr&./(Jl fath lyrf
<br />(5N u r^re o I >rl o ?o l. u.rl
<br />-l
<br />ccflifr rhlt in rh. ri.rtor@ec or rh. work lor ehich rhis plrmir is issuc4l \hau nol enrloy , ,.*on in any nEnmr
<br />$ ,sro hc.om subicr to rhc sortcn ompctrsrion hvs orcrliaotuia. !.d agrcc rhd ifI shouh bccom sbi(l t, rrE
<br />wodGl coq'.nsltiotr t'rovisionr or Sccrion 1700 of rh€ Ljhor Cod.. I rhall. fonhwilh .omtly wnh lno* pmvnionq..
<br />WARNING: Fai]lE b ifu wt6 d'nncnerion @vcne. Lr unlawtul, {'rd shlu subFd M dploy.r lo dini@l Fslris r
<br />civil lin.s up ro om hudrcd $oosrd doltm ($IOO.O00). i. addirhn io th. o3r of.otrpcndioi, datug( 4r pr.lacd for th.
<br />sc.rion 1076 of rhc U&)r Cotlc, inrcrcsrand arromy\ lccs
<br />7.L.tO
<br />I hcEbyaIIr un<tcr ,cnally ol dju.y rhrl I m liens.d undcr Fovision of Chapld 9 (dnmn ing with Scclion 70(n) of Divisioi 3
<br />of rhc Busircss and Pofcssion! Codc. ard ny liccn* is in tull lore od crel.
<br />g I Ooqqal+-L.ra +c
<br />(]ONS'TRI(] ION I I'NDINC ACIiNCI
<br />I hcrcby rllirmundcr pcDilly ofltlury rhd rltrc is i.otr{ru.riotr htrdirg.8cr.y for rhc pcllornhn d ofrhc sork ltr which Ihn Pcnnir n
<br />rsucd (Scc.1097. Civ C.).
<br />APTIICANI.DECI.AAAIJON
<br />I lrEby dlm undcr p.nolty otncrrlry onc ofih. followi.! delnmrionr:
<br />Demlnion Pcirtrih-Asbeslos NolificarnJn Fcdcol RcBuhi n,.r {TirL .l0. Pd6)
<br />-Rcqutcd
<br />Lcrrcr of Notifi arbn
<br />-l
<br />ccnify rhrr ftc fcdc.ll Eetrlitions EEtr dinB a$.stos r.mva! m not iplli.abk ro rhh poi*l.
<br />-l
<br />ccnify rhir I hlvc read rht appli.arion ad slalc lhal fic .tovc nrfomErion is .oNr I !!@ lo comrly *ilh !l! City aod Counry
<br />..dirorer ,nd Sr,r€ l,wi Elarine !o buildin8 .onshdiotr .nd h.rchy lurhoriz reFccnkrivcs 6l Oi! Cny ,rd Counly lo cnts upon l,E
<br />fi)vc nEnriorcd proFrry lor i.\Fdn,n puq$cs
<br />Appli.aul or Agcrt SlBrrlurc:
<br />D,.rr -*a-2.16
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain 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
<br />Final Gas Test
<br />FINAL va/h i\ at
<br />Notes, Remarks, Etc.
<br />Gas-Underfloor
<br />Meter Release
<br />P.mil$ nflnP I DrinO:
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