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PLUMBING-INSPECTOR RECORD
<br />COMMENTSAPPROVALSID/SIG,
<br />UNDEH GROUND
<br />Waste & Vent
<br />WaterUnder Iloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main DrainiPool 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 />IRouqh Plumbing
<br />,frY1|Final Gas Test /?/oq lttr, '1,/,-,\Meter Release
<br />FINAL il-$,-lK x,v/'10)
<br />Notes Remarks, Etc
<br />I
<br />oIINF:R B T]II,DER DI]I,CA R -I-ION
<br />I h.rchy rllirnr undcr pcmlry ot p..jury rhlr I !m .r.frPr liorn rhc Contrk,ft Licctr* tiw for rh. n hsira rclsn (su' 7oll 5
<br />Eurinc$ 0d ltoi.$ion Codc) Ary Cir, or OruNy rhich rcquircs i lfmir k, .on(rucr. atrd nnntovc. &mrli\h or rcFrn v
<br />{tucror.. lritr b irs isu!nl{, dlq, equncslh- lmliclnr rix \u.h Fnnit lo tiLr rismd {arcmnr rhd tuor rh( i( lien\cd rurs'nr
<br />ro rhc nreviri.i\ or t Co.lrlclois Lic.nscd ttrw (Chrrcr 9, c(nnnrrr.s Birh Secrio' 7000 of Divhi{']n ll ofrhc rlulincs rnd
<br />l'r'nsi{,trCodc)orlhaltEor\hciscr.n/lhcrctomandrhchrislorrhc0llcscncr.ilpri.n.Anvvnnurnrii.rSsrion?$l5bv'nv
<br />upnli.l lnr (lcirnil slbjftt rh. lFrlicrnlx) a(ivillxmlryornor.mrcrhfli llvc hutultcd dollar iS5U)).
<br />-1.
<br />us own$ ot rh. lotcny. ,tr ry.n{brccs wilh waBcs r\ rhcn Yrh dnnt(ns i(t will do lh. work drhcsncturcknn
<br />inr.frlM nr oflircd l[ slc rSN.7t)44. Duier\ und Pioissions Cqlc: -t h o)ntmhls Liccn* Ltrw docs nor an y h m owncr ot
<br />rhcpmFt, who bunds or impm\ts rhtsl { $ho d(B such Mlk hirnscll or h.t\clf.r rhou8h his or h.r osn cmplov'.\'
<br />providcd rhtrr uch i.rro$rnh e mr inrctolcd d offcitd for sh ll. fu)*$tr. rhc tuildir8 or idpmerEnr ir skl sirhi'r onc }!!'
<br />;fc.nrnlcrir. rrr own; Build( *ill h,vr rhc hudL{ ofProliis rhd hc or shc.tid m hiBor irymle ln. pmFn, nnthcPq$tof
<br />L rsowncrotrhc pmpcny. r cxclusircly contriinB wirh ltc.scd cont!.ft,N r, .tn(rucr rtE Pn,F't (Scc. ?a!t Bn'ik*
<br />rnd ,\,lssir! Codc: The ConrrKroas Li.ctrsc Lav d@s nor aPfl, t, nn .wnd oa PrcFdy uho huilds o. imP.otcs rhcrcof,
<br />!.d wno comtuh rDr su.h pntcch sirh 0 C..hcror(s) liccnscd nutsua hrhcan ra.rofs Liccnsc tiw)
<br />-l
<br />om cicmpl umlcr Sc.t ts. & P.C. forrIis rcovnr.
<br />OM..
<br />woRKEis' c{lllrPENsA'lloN
<br />PESLABAI TN
<br />I hcrct y atfirm ud.r Fnahy o{ pcrinry nm ofrhc rolhwins d(l.rlrions:
<br />-l
<br />hlre and {ill miniain ! Ccnilrurc .r c.nsnr ro Scli lnslc ft,r wod(n{ ohPcnerion. as Providcd for bv s(tion 1700 Dr rh'
<br />khor Cdc. ior ,e p.rfdrnEmc of rfic s.,k tor whhh rh. ,)cmn is hsucd.
<br />-l hnvc lnd w ill mri.rain w.rk.( co,rycns0rt,n in{!Etc. as rcquncd ty S.rr ion .1700 of thc L,tx, Cdd. for rhc p'rrofmtr' 'r
<br />rhc *oik for which rhh pcmir is issucd My worlcn .onl.6sarion insurDncc .micr ud policv nunb.t arc:
<br />-l.cnily
<br />lhlr io rh. p.normtc nlllE work ftr whict lhis p.rmr ^ s$cd. I shsll no'.nplov anv I'cR'n in tnv ronft'
<br />v, trs n' hc<om su$F! !o !h. eorks{ Nmncn\ar '.. hwq ol C.lifomie ud agR thd rf I 'hould b..om suhi{ u rh.
<br />mrtc^ ortrpctrsrrio. povirhns of S6rion 1700 of ihc rjhor Codc. I {DIl. fonhwiln comdv wirh lhos PDvis,on*..
<br />WARNING: Fditurc ro w!* wo,k 6 .onuEnsal
<br />civil rincs !t h oN hundrcd lnoutund dolhru ($
<br />ovcdgc is unhwtul. and ihrll suhirt an dplortt lo ainiul FEhis md
<br />I in ,l{liri h rhc con ol nsatio.. d,mgcs .s trovid.d Lr lhc
<br />Sccrn,n :1076 or ihc l$or Codc. inr.ftsr trd
<br />I tcrc$y lmrn uBlfi p.n.lry of Frjury rlut fChlprcr 9 (tummrcin8 wirh SLtrio. Tmo) ofDivisn,n l
<br />ol rhc Busircss ud Pmfesrbns Codc. ald ny Iic.N is in n ll lod ,,*l .r.tl
<br />t4+
<br />I hcrny aflirm lndF Fmlty of r.riury rhd i
<br />isr$d (Src. 309?. Cav, C. ).
<br />hMinS.Bcdy f.rrhcpc.fo'mmE orlhcwotkforshichrhislErmir (
<br />Lcnd.is AddAr:
<br />APPI ICANT T'FCI IIAI'ION
<br />I lErcl'y altm lndcr pcn.hy ot lrriuy onc olrhc lollowins dcclararbns:
<br />Dennnnion Pcrmirr Aslf,sros Notinc bn Fcd$rlRcsulations(Iirlc '10. Prn6)
<br />-Rcquncd
<br />kriu orNolifi culion
<br />fcdcral rgal,rions rcBardin-! lstailol rmv0lorc nor aprltahh ro lhn pDj.ir
<br />hdc md fiis alpltdnnr dd {.rc rhd rhc !tn!c inr{rtrtrrbn h comr. I .Crc lo snll)ly enh .ll Cily and Co! ,
<br />ppe*nuivcs of rhh City rnd Counly lo cnter uFo rtE.onsrE.t0n. and hc,cby onrhorir
<br />P€mi'6q
<br />DATE
<br />%/^
<br />L!nd.r'r Nlm:
<br />Gtner;e,
<br />-,, ?/zs-/r,q
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