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PLUMBING.INSPECTOR RECOBD
<br />APPROVALS DATE COMMENTS OWNTJR I]UII-DER DELCA RA'I]ON
<br />I hrrrht siln r uidcr t.trilry ol N,jffy rh l.c\cnDllrnnrhcC.nr(r,F't-i.cn{Lrq'ntrth(k,lk'tring'crv,n1S..7{).llt
<br />Ihsifu!\ rRl ltolcssi,r Codc): Art Cirt or Counrt trh'ch reqrnc\ r lrnnir !, .hnnrucr- rlrcr. nnPn r. dcnnnhh or NF r J J
<br />drucrurc. pri{tr b irs i\{hd... rl$ rcqutcs rh. iflilic t I'n nrh Fnnir [,lil.r \i8trcd nrk'tuir rlrrhco. shc is liccn\cd pu^uMr
<br />k, rhc !n,vi\i{,ns oi itu Coiknckn s Li.cn*d l-rs {( hrt)rcr L Connnc cint wirh Sc.(nnr 7(Xn of Divirir :l olrtu Bu\inc(\ rnd
<br />it!liLiDr lnr 0 pcrnrir su$lcch rhc rpplicrnr t, acivilprnJlrrornor Dtrtrc!hM fivc hutulrcd dol!a6($5(x))
<br />-1.
<br />,i owB of rhe FbFny. o, nr.dplorBs wilh *agcs s llrcn $k @mpcngln n. will do ilE q{it.rn tu sturE b el
<br />i s'd.d or ofi.rcd lor rL (Se.7044, Bositus and Phf..sions Codc Th. Conrerol3 Lic.trs Li* &Es ml qtply ro a osM ol
<br />inc rmFny wlst ili,s or iqmB lhdEa a,n vho &B Mh mrk himElaor lEr*lfor ltmuSh his or lEr own.nployc.s,
<br />,mvid.d rhlt tuct imtF\tft s@mri cixLd oroflircd ror {h. ll lxME.lhc hrilding n inu@Emm is $ld within om ,@
<br />ofor{,Lrhn. rne Owmr Buildd *ill hoE rlE hmkn 6f tmving lhd hc o. sh. dil mt boild or iftForc drc |)mPd, fo. 0E PUrFe of
<br />l. $.wn$ olrh. pspcny, mciclusilclycoor,acrins sirh liccn*d.onr&'ou lo conslrucl llE rxojEl (SB 7044, ausmcss
<br />sod t1of6si, Cod.: Th. Contrlor's Lic.nsc tjw dors mr alrly to o*ne. orpnrFnt wno buildsor nnprclci rh.reod.
<br />end $to mnrEcls fo, suchphj..t wnh 0 C.orBcbno lkcMd pursutr! lo thc Conrrr.krk Lkcn* tjw).
<br />-l
<br />adcrchpl undcr Sdrion- a. & P.C. for dt rclson
<br />l)f,le O*n.r
<br />IOBtrIIIS:.CIIMTEIIAIION
<br />DECI.AIAIION
<br />I lErcby !flkn onder lcdhy or pdjury om of th. following dehrolions:
<br />I hah and witl min.in aC.nifEalc ofconE lo SdtlNuE tor workcR onp.nsdion. !s I'oli&d for bySerion 3700oflhc
<br />Llbor Cod.. fq rhc Frfolliec of thc wlt for *hth tlt Pcmn i1 itsu.d
<br />I h.vc ond s ill moinlain wortcr' conpcn$rn,n iosuran.c, ds oqrnld by sccrion l?m ol $c Lrbor Gd.. rb. rhc !.dormre ol
<br />th. Port n whichlhis pc )conrFnrarion i.surffic clEic! dd policy number ec:
<br />I r>[lz1\o
<br />-l
<br />c.nily rhlt in rhc pcrfor@ec of $. worr ror *hichrhisp.rmn is Lssucd.l shall nd cnPtoya.yFrsn ir 0ny tutut
<br />$ .sro lEcorB subj.rl lo lh. wor[6 ompens&tion h*s oacrlilonia a.d a8rcc rh ifI should h€{om \ubjNt ro trr
<br />wolkd( .o'rFnsalion ,mvl,ions of S.dion 1700 ot th. lrho. Codc, I sh,ll. lonh*ith ohlly *nh tho* povhaon*.
<br />WARNIN(:: Eilurc b v.urd so&cr( c.rp.nrdrirr .o is !nla{t!I. lnd $all subj.rl u cmrh}lr lo dimi.rl pcollx and
<br />*:#xqfT#*1
<br />mpcn$rion. damgcs ar pbrid.d for rh.
<br />I hcrbt uffirm undo lcnlhy 6l pcrjxry rh.r I .m lic.$d undcr fChoprg I (coMrnci.S wirh Scdiotr 7OO0) ofDivi\i.n:r
<br />of rhc Busimss &d Pof$sio6 Codr, a.d my lkcoc h in tull lor.. and cfl(l
<br />D.E:-a
<br />I hcrchy rlhm undcr pcnllryol|trjurr lhll lhcrc is r o,sln'crio
<br />hsucd (Scc l0i)7. Civ C I
<br />for lhc pcdormtc orrhc work lor snich lhh pcnni h
<br />ArILITANfDEI! &U&li
<br />I lta+,y ullinn rdcr pcirlr, urt)crjury oN ollM hlhwir8 dccllrdions:
<br />Dcnnlition Per.rih Asbcsror Norific k,n F.derdl R.Suhrio (Titlc 40. Pln6r
<br />-Rcquied
<br />tr(cr ot Norifi .rrbi
<br />-I
<br />.cniry thd rh. r.dcral Eguklions E8ardins asbcslos rcmvll @ @r tp0lk.blc ro lhis Pmj.tl.
<br />l.cnifyrhd I h,v. r.ll(l rhi\
<br />o inrico\ rid Srrt tiwsaldi
<br />in,{,mrbo is conxl. I r8re ro comtly sith !U City and Coutrly
<br />r6.vc nrfli(nr.l I'krlxn, tur
<br />Applic.nt or &ent SIE@lu
<br />\
<br />r!&nia rcprcsctrhtivcs ol
<br />;"4b5j$.
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq ,.
<br />Gas Pipinq WIW 1-27q\{D.l/Jn)
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<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 />Meter Release ,A
<br />FINAL VsL{x)
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Pool Heater/Gas Line
<br />1-21-l
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