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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNFJR BUTLDDR t'EI-CAfu\TION <br />I hcrcby rllnD undcr lcnrlry ,,f pcrrury rhar I dn dx.otr finn rrE cd n.rmr l,i.cnsc lju (n lhc db*in8 rrlv,n ls.c 70ll 5 <br />Bu\incs atrd &orcsnnr C(ilc) Atry cny or CouNy which r.qtrrc\ I Ernrit ro co.nocr. rlrcr. inlrov.. tLrmlish or rcNir rn, <br />rrudlrc. priorb ns nsuatrc.. al\o rcquncsrhc al]Pliclnl r'or such pcrnir t, illc r siE cd iddfttrr rl tror shc n licen\cd pt(trnl <br />rr rh. pi,)vi*ions ofrtr Conrmctr'r Lietrscd taw (Ch{Uq 9. Qnnnrcnciis sirh Sc.riD 7fl1) of Divnxr I oi rhc gusinc\s ud <br />Prolc$ions Codc)orrhll hcor\h. i\.rc.,rr rhrrdi.oatui rhc hrri\ lff rhcnllcScdcrcDlrrion AnyviohrionoiSccrbiT0.ll5hyxny <br />rflli.rni lor r pcn ir subjdr\ r l[ .mlu ro r.ivilp.n.hy.l mt nmrcrlu,ne huBjrcd dollus (S5m) <br />-1. <br />!s owrn of rhc lmtEny. or dy .n$lorrs wirh tugcs ai 6cn sb comFnsiotr. vil do tlE wdt .rn lllc slittr it ml <br />ine.d.! or oficrd for $1. (S€.r044. ansincs Md PrDlcsioni Codcr Thc C..lrclols Lienc t q d@t nol tpply ro o owE of <br />tlE pmpcny who buiLrs or inpro6lt*en. &n who dtrs sh klt nihsclror hcMllor rhmnd his or n roMcn loy€.s. <br />povltcd lhar *!ch itrVDwftnB e Dr hrcd.<l o! ofrcrcd for st l( tbEB, *E buinine or intrcrmnl is sld whhh .ft t@ <br />ofotrplcrior th. Owrcr Buih6 will lErc rlE hd.n oalroving rhll h. or shc dil nor bliu o. impreE llE lopory fo. lh. <br />'[rpor <br />ol <br />-1. <br />&r o$ftr of rhc Folcny. an €&lu\iv€ly conrelinS wih li..nscd connadoB lo coNtrucl lhe pmicct (S( 7044. Brm.s <br />0d Prot*si.. Codc: Thc Conlrelols Liccn$ Law dms mr amly lo sn o$no ol pol).rry rho builds or i'nprovcs ihcrcon. <br />lnd who @ ruclr tor ruch pbjd6 wirh. c!nl&do(,li.c.ed nunumr b ln contutols Liccns t *) <br />-la <br />cxcripr lndo Sccri.n ,a &PC forlhhrca$n. <br />]!,8TEf,S.:COMSBTAI!AN <br />DECI.Af,AIION <br />I hcrcSy .rn.m lndcr pcnally oa p.rjuy onc or ln. rollo*in8 dcloolions: <br />_I hivc ad will minrlii o C.nifrdc of Conpnr ro S€lal.sw for wr6 drp.Bqlhi. a Fovidrd fo. by Sction l?m of th€ <br />Litff Co<lc. for rhc pcrforMe of fic mrt lo vhi.h rlE p..ml i{ ia.ed. <br />_l h.vc and will nuinain sortcr' cory.nsrlion insramc. ss Equircd by Sdlirn 3700 ofthe t b.t Codc. for lrE pdfomm of <br />thc vorl( fo, which rhi! 0mjl i! ias.d. My eo*6s mmpcn$tion in$Etu. dir dd lolty runbc, @: <br />I.cniiy rh{ h thc p.rforromc ofrhc work tor *hich rhn !'crmil n hrocd. I ihlll nor.FploFny p.ison in nny murcr <br />e as ro bcrom subjcr ro rh. qokc6 @dwndiJn lawi ofcllironh. md oqe lhal i,I shoold ttcotu subj.d b rh. <br />$o.t6 conpcNrrio.rftvhkn\ ofSdlion -1700 orrh. tihir Cod..I stull. forlhwiln comp,, with rhos rrcvisio.r.. <br />I,VARNING: FlillE ro surc rtrlcB' comFnsdion svcm8c is unhwtuL and shrll .ubiir e drl,lortt lo anDiEl pcBhics ttrd <br />civil fiie. un lo orc hurdr.d ln Nand doll s ($1m.000), in ddnior to $.co$ ol codranurio., d.@8s as povij.d for tlE <br />serbn 1076 of rlE Labor Cnl., inr.Esr and anorEy s fccs. <br />UIIIIIT.CONINI(IAB <br />DICI4RATION <br />I hcrcbyarftnr undcr,'cnahlolFrr!.y rhd I ao lic.awl lnder pn,vision.iChtrprcr 9 (.onnmncins *irh SccriD T(xx)) olDrvhbn l <br />or rhc Busincs md PrelisionsCodc. md nryliccnsc h ir tl'll lorcc anlcfircr <br />Dorr ( ontdcro.. <br />(ANEIXJJIII9NIEADIMiTIiINCI <br />I hcrcby allirm undcr lcnrlryoll]crJ ryrhar rhnr i\a co idcrion Lidns.Bcncy turthclcnbrnEaccofrhcsorr f.r whthrhhIsnril is <br />n\ucd (Sr. 1097, Cir C r <br />ATILICIILIIECIIIEAIII}N <br />I hcn:$y afrm undc! t nalty ol ncrjury oft of llE fd&,$in8 dNllr nns; <br />D.elirion Pdmn+A3bcstos Norific.tion Fcdcra, RcSulotions (Tirlc 40, Pin6) <br />Rrquircd txtlcr or Nolificolion <br />UNDER GROUND \ <br />Waste & Vent G-rt* ly ]*tv/at1 ) <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />lnterceptor/ Clarilier <br />TOP OUT <br />Waste & Vent a-ll"tk T.0a/rra#-Water Piping <br />Gas Pipino ll <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/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 />\ <br />Rough Plumbing e-lFtk Yldr>01 ,fl <br />Final Gas Test 6-lt-ty \ Du.ld !4) <br />Meter Release \ <br />7-l4.lt q${.}e\ <br />Notes, Remarks, Etc L <br />Area,i Storm Drain <br />Rool Drain <br />FINAL <br />I ciilcr'. AdiIcs <br />-l.cnilyrhar <br />rhc fid.ral ruErlrrioo\ ft!*din8 (h.{.\ rcnxrvrlrrc no' rrrlicnhlc n' rhi\,,n,j..r <br />-1..n'frrhd <br />I h*c icad rhk n,rdk iondd strlc rhd lhcrhorc irlonroli{,n t.orc.r L!r* ro oryl, wirh rll Cil, lrd Couniy <br />ordinriccs dd srrrr lle\ ehrinS ro buildin8 con{ clion,dtlgchyaul[,i.!rcprc\.nrarivcsorrhisCity.ndCounryrocnlc,uFnrhc <br />{hovc nEnriomd prop.n, fuin\Fc(in Nrl[*\ <br />Appldr G Ag6r siBDroE: <br />P.nnllR ri.lprhr): <br />-------T------ <br />----= <br />I <br />=