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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER IIIII I,DER I)EI"CARATX)N
<br />I h.r.ht nflnd undci p.trrlry (n ltrjrrr" rhrt L .rc rpr ftom rhc Confticnrs l-iccnt Lnq for rhc iollosi'rr t!w,n lsr 70.ll 5
<br />trusitr.s llxl Prolcsion Codc): Any Cily or Counry *hic[ rcqui,cs ! Frnli' b .onqfl.r, rh$. antrorc. Lr.rmlnh or rctrn 0ny
<br />nd.turc, trfib nr i\soanc., nlso rcquircs rhcapflicdnr ft, so.htrmir ro lilc. sismd {atcnrnr lhll hcor shc i\ li(nsd puruxnr
<br />kr rhc pmvnnrns of rhc Ornrrrctn r l-ifun$d lju (Chaprd 9. Connmtuin! wiih sccrion 7(xn of l)ivnion .l oi rhc A.\iic$ rnd
<br />Ptun\si(nr\ C.d.).r rhd hc.rshc iscxcarpt rfurcfnrnrM rhc btr\i\ tthc lllcEcd.rcnDlion Anyliifri{'no,Sc.ri.n70ll.5byrny
<br />omlicnnr ro. n lcnni subjels rhc lDlicanr to r civil llcnrlry o f ml morc rhm r_rvc irndrd dolla6 ( s50o)
<br />-1.
<br />&s ow*r ot rhc loltny, o, ny cmplori.s wirh w08.s .s lhca. soL o,npcnel io.. wiu do dr wolk !d lh. irftr@ is ml
<br />i.rddud o. oll.Ed lor sle (Se.70,44. Busirc$ ond P,lfcssions Codc: Thc Conrricrois l.ien* Lae ihcs nor .pply lo & owBr of
<br />rhc ,,oFny *ho hikls ot irrm6 rlE6'! ad w,n dfts Mh ftrt hihsclt oi lrelf or thrcnO his m h.r o*n cmrloyccs-
<br />provid.d rh.r such ir{nmnls m mr i .nd.d or off.rcd for sL. ll howcE ttE buiding or nqmtmnl is sld whli. ot }t.fcoq)L .n. rlE Ovn* Bu lft win haw d. t flrcn of rmving rtu lE tr shc did d hrild or in{mrc tnc I'lFry for l!. fllpo* of
<br />,&asowkr.rGctmFry. mcxclusivclyconrrncrins wirh liccnsc{ onrB.loN loconnrud rlE IDl.{r (S.c. roa,l. Blsincss
<br />P,oftssion Codc: Thc Co.kNror\ Lic.nsc kw d.cs not $plyro 0n.wn.r ofprol)cny rho builds or impr.vcs lhcrdn,
<br />who .onlmcB ior such pmjcds wirh a Co dcto(s) liccnsed I,u slanr lo rhc C.nra.rors l-i..nk hw).
<br />Y,
<br />I
<br />Xr"'"e
<br />I hcrcby olfirmundcr lcMlryoflcduryoe of Efo
<br />-l
<br />hivc md will nmin,ain 0 Ccnifrarc oa Con{or x' Sclt lnsurc r'or oottdi onD.nsir ion. as pmvidcd fu hy 56.'l ion l70O of rhc
<br />L$.r C-odc. tor rh. p$frmurcc of rhc work for qhich I he ,srnil k isrucd.
<br />_l hlvc rtrd will tuint,in *ork.B cotr{Enedio. inru6ft.. as requitd by Serk,n 37m of thc tihor C!dc. for fic pcrotmncc ol
<br />llE wrk fu whi.h thk rE nil ir is$cd My wortdl @o!*nrd ion insuEnft (ai.r a,t lDlicy numbcr @:
<br />Ll crn'ly rhr in rtu Frform trc frh.(, nrehtrhrhisr.nnirisi$ncd.Ishallnolctrpbyanyncronina.tmdnn.r
<br />s, d\ ro ttcortu suhj.rr ro rhc sorkc.(ro.rFnsorion lnn'sofcalif(ni{- rnd {sE{ r! il I rrt,uld l.'.om b.J.d torhc
<br />*ork.m' .o rtctrsr nrn novisiotrs ol Satnnr :l?00 of rhc L1htr (de. I dlrll. fi,n h*irh .onfly wirh rho* ,rovisions.
<br />w^RNlli(i l:rilurc t, {d( trorkcrr
<br />civil finc\ ry nr onc hr.drtd rtru\rnd
<br />Sdcrnn, .1016 ollhr Lrtxtr Cod.. id.rcn
<br />onDcn$rion $rc.a8c is unl.wful. Md shall subjst an mnbFr ro nnliMl JEmhts 0nd
<br />ition Io rtu corr ofcon cnsarion. damgca N,mvidcd lor thc
<br />)V*,, a'"(8
<br />I hcrcb, llfrn undcr Fmlly ol Frrury lhrl I an lien$d u n8 wirh sdbn 70oo) oiDivisi(,n l
<br />or rhc Bnsincs od P6it*ion\ Codc. dt mylicctrsc is in full lorcc ond cffccr
<br />Lic.nscchss: LiccnscNumtxr
<br />Dil.r Co ctot:
<br />CAIIIB!]CtrONIE DtrIC.ACENCI
<br />I hcrcby.rtrm undcr FnaltyofFrjuryihlr r,rrc is r.on(ocrhn Lidiog r8.my forrhe pcrformNc ollhc sork lo. ehichlhi\ F.mir i!
<br />isxcd (Sc. 1097. Civ C.).
<br />ATTLTIANIDECIJAA.IION
<br />I h.n:by ofnn undcrycnelly of,,crjury orc of llt follosi.E dEhnt io.!:
<br />D.elirbn P$f,ire^ltEslos Notificrlion Fcn.rrl Regublions (Tnb 41), Pun6)
<br />-Rcqui(d
<br />t (.rof Noliff,rlbn
<br />asb.stos Emvll rrc ior lrplkrbh b lht pmjel.
<br />c rhd rh. *.v. inlorurion icotrd. I aste lo comdy wnh aU Cny dnd Counly
<br />n. furl h.Eby ,ulhoriz. rcIre$trraliks of lhi! Ciry dod Counrt ro cnlc upon llt
<br />@*rr* *..o'r,0,
<br />L-5-a
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarrf ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ivlain 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 Tesl
<br />Meter Release
<br />FINAL q-tg-tg J/Jd2 '-w
<br />Notes, Remarks, Etc.
<br />,x
<br />Gas-Underfloor
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