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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNI'R BUILDI'R DELCARATION
<br />I h$cby !flnn xn,t.r ,..,hy 0f p.rjury thi! I m cxcrnl lmu rhc CofiacbE Liktrs b* fi, rhc followiig Ern)n rS.(.70.11 5
<br />lrutinc$ alld Pro,cssidr Q)dc) Any Cny or Cuunry whth rcqut* r Fiinn b con ru.r. rlrcr, nnprurc, dcmlhh or rcpin any
<br />dructrrc,n!filoil\ is\urncc. aho rqlnc\lhc nppli.ur i{tr such lrf,nn b fiba signcd {dcirEnr lhdnlorshcilic.n\cd Nre$l
<br />ro rhc rmyisiotrs olrhc Conridor's Liccnsc{ Lr$ (Chrfl* 9. Conrmn.nr8 wirh Sccrn,n 7fin ot Diri*iotr :t oI ih- Ilusine\\ ond
<br />Pmrcsn,ns CGjc ) o, rhrr hcor\hc n crnlPl rhcrctonatrd rhc h!\n forlhcrllcscdcicmrrion AnyliohrionolSdiinT0.ll5hrrny
<br />nprlic,d kr d pcrnrir subjc.Nrhl rppli.lnrro r.ivilFnrlryolnor n6rc rhnn liv. hrndr.ddollrsl3500,
<br />-1,
<br />us owtur of lhs l,mpcriy. or my cmploycs qnfi w08.s N thcn sk orp.nsalion. s'ill do dr *ort sd tlE sEtle b tDl
<br />in'.ndd or ol[crcd fot ek (5€.7014, Busin.s .n.l Pmfcsions Cod.: Thc Coincmr'! Lic€n* L!* dftr nol apply ro rn 6wnd ol
<br />lhc fmpefly wno hrlds or inrpmws lhssn, $d who der Bt sfi hinsclf or h.Nlf or lhmugh hi. or h.r ovn cntloyes,
<br />pmvid.d thd iuch imlm\tfunh e Nl hr.nd.n orofl.Rn for sh. lf. rswE llE b'rildinE G in{mErnl i3 $ld wihin om )€r
<br />oa omrlction. llt ol,tur Buiidcr siu lEw llE brdcn ofFovi.e dd IE or shc dA mr hild or i8pmE d. FDFiy lor tlE lurF$ or
<br />_1, as owftr oarhc pmpcn, am cx.lNivcly .onriacti.s with liansn .ontnciou ro otrsrtur rlr rrrF.r (S.c. 704J. Buri.sr
<br />ard Ptoftssim Codc: Th. Conlmlol s Licns L3* docs mr epply k' m owncr of pmFny *ho build. or iq,rcrcs lhcron.
<br />and who .ooro.ts fo, iuch lrcj€ri wnh a Coirturo(d licensd lurunr ro rhc Co.m.1or'i Lic..* Lis).
<br />I r.rcnpr undosLtrion- B. & PC ttrrhi\u$n
<br />D{te Otner
<br />!ABr!&5:.COMTE!SAION
<br />DES.AAAIION
<br />I hurcby olfirn undcr pcn.lry ot t'djury oN of rhc follorins drl@rhnrl
<br />I hrlr ul {ill nEirnai', I Ccnilicrrr ol Cd,*nr h S.lf lnn& i,tr *or[crr .om!.r\xrioo- as Fvidc'l lor by Sccrn,n ]7{n of rh.
<br />I ulxtr C.dc. tn. tu ncrn,nunc.. ollhc lok nn *hi.h rhc t^..nni is n{r
<br />I hrr.aid *illmrinhin $ ork.r! .onrFn$rion in\!run.c. a\ rcqutcd b! Sccrion.lT(X)oIrhc t-ahorCodc, f(rrh.rlyf(rniturof
<br />rtu work Lr which rhi\ ftirnn is i\sucJ My { orlch k,nDcnsur ion i',{trrft. cdrid nd Fli.y nu mh(r m:
<br />-l
<br />cenify rhlr in rhc performrcc.l rh. work tor *hich rhis Dcrmir h i\sucd. I \holl nor ehDloy My peMn in ary mannc,
<br />s Ilo b.oft rub.ic.l b rhc worlcm omFnrdion laws olcllifdmi.. lod rym thd ifl *suld tEom rubtrl lo tlE
<br />wolks conFnsarbn pmvisions ors.crion S?0ootrh. Lltbr Codc,l dEll. rodiwilh mnply *ilh lno$ Imvkio.s..
<br />I ARNINC: FailuE lo surc *olkcs onpetrelion ov.Bgc is unlavaul. and stlll subjccl an cq)loy€r to dninal Ftuhics and
<br />ciril li.ca u, ro otu hondrcd rhousand dollars ($100.m0). in addition b lhs cosr of corlr.sdion. d!mB.. a.omvidcd for rhc
<br />Sdio. 1076 of rhc L.bor Codc. inrern and anomy's fes.
<br />LICENIEIICIINIBACIIA
<br />DICIJ.f,{TON
<br />I hcNby ltnmundcr p.Mlryofpcrjuryrhar l0m lien*d u.dft pn,!tn,n ofchrprcr 9 (.omnEncinB wilh Sccrion ?m0) olDivision l
<br />of rhc Busircsssnd Pnrtassioni Codc. dri mt lt.Nc h i. fullfoi.c md cifNr
<br />CANSIf,IJSIIONIENDIIG.&GENI.I
<br />I h.ruby !fljnn uhdcr,ctuxy.fpc.jurythut rh.rc i\, co.srocrion lcndin8 dgqky foi rh. ljtrr.,mE olrhc wo.k for uhirhrnis Fnni n
<br />issrc.l lsr-' l()9?. Civ C ).
<br />d.tfut xLDEcl EluoN
<br />Illl!$ynlnmu cr 0(nalry.lNtury ortr olrlE i)lbqnrN d..lrfurion\
<br />D. mlirn P.nnir\ Aslrno\ No.li.nlnlr FcJ!tuIRcsll,nntr lTirlc.l0. PJ16)
<br />R.quircd I-cn.r ol Norii.rri0n
<br />-l
<br />ccnifr rh lnc fedcnl reExrhrn,ns rcsudin8 a\hcsros rcnn'vul @ nor aprlic$k rorhi\ ptr,j.lr
<br />-l
<br />enify rhar I h.!c o.d rhb uppliclrioo &d norc lhlr thc lhw inaornwio. is .oEer I rSre ro @mply wilh .ll Cily rnd Counly
<br />otrlinamcs rnd Sllrc L3ws rchrinB to building consmclion. $d hcrcby aurfiorizc Elr.cntdivca of rhh Ciry 3.d Coury ro cn!c, unon rlr
<br />ohovc mnrioncd pmp.ny lor i,rspcdio. pu.pors.
<br />Atpllcul or Atol SkMlla:
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Undedloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Tesl
<br />Meter Release
<br />FINAL r/s s. -t;'fiLt*>&7
<br />Notes Remark s, Etc
<br />Li.cnscclrs\r l-i.cn{ Ntrn$cr
<br />Water Service
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