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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor 7 a--. <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <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 />Main Drain/Pool Pipinq <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 />Rough Plumbing 6/Y//A-vfi)ru v/^4) <br />Final Gas Test t --' <br />Meter Release rl <br />{ytrcila-FINAL l0ltiltk llrt , <br />Notes, Remarks, Etc. <br />OWNElI BUILDER D!iLCATI TlON <br />I hc.chy atfinn rndcr !.nahy {,f rrjrry rhnr I m crcnrfl lrom rhc C.itx.t,N Li..trn Uw f(tr rhc lollowirB r$hn (Scc.?lrll.s <br />iu\nrc{s nlld Pn'i.sFtr c( ) Atry City or Counry *hi.h rcituirc\ r Ennil r) con{ruc1. rllcr- nnpovc. dcmolirh or Epd M, <br />{tucru.c. prnx ro ns hsuancc. rls rcqrtcsrhc applicrnr aq \!chpcnnir r. filca\igncd (r.mnr rhar hcorshc ir liccnscd ,ursudrr <br />r, rhc ptuvi(nrns urrh. conkr.lr\ Li.cnscd Lrw (Chr|,$ 9. Gnnncncnrg qilh Scdion TtxX) ol Divnt,n :l olrh. Bu\int$ Dnd <br />l']nlts\n,nsCodcrorrhrr ltorsh! is.rcnu lturclrorrtrd th. hisi\ for lhc!llcsed.rcmplion Any!i{'hrtrolsc.ri,nTI}.1l.5hynny <br />nnplicrnr lor a ptnnir suhtech lhc rpplicul ro uuivilrLnrlryolNl m,clh!tr livc hund,cd dollu6($5Olr) <br />-1. <br />I osnc. .f rhc p@Fdr. or my .q,lor!e *ilt wr8.s !s rhcn Fh sdp.nsdion. will do dE m* !d llr srtunr k ml <br />itrrcndcd or oficed for sle (56.?044. Blsin.s ond PDfcssions Cod.: Tk Co .urofs Liens Llw docs nor {ply io s ow..r ol <br />rh. pmp.rty who boilds o. ir{,@rs OEm.. .rxt who dc sh s* hios.f or h.alf or rlmugh his tr lEr own cnployccs. <br />providd lhll such im,"owrnls e nol inlcndcd oroM lor sh. l[ tD$va. ttE 6uildi.g d itrpmkm is sld wihinonc ]td <br />of€,r?Lliotr llr olxnr alids eiu hlE 0rc budd orrmti.g rlar h. or shc da mr hitt or irlmE ,E P,spsly 6r llf IlrFs of <br />_1. at nwtur of rh. Fopdy, md.hriElyonr.dins wirh licc.scn conrndoF rooBmcl E @.i(l {sd.'rol4. Busiics <br />dd h!6sih Codc: Tne CinrMror\ Lic.n$ Law docs nor.rplyro &owncr orprcpc y who builds or inprots lhcron. <br />lnd who ontra.rs for sEh pror.{rs {irh . Co 6clo(r) liccnscd Du*unt to rhc Conractols Li.rns Lre), <br />I adcicmor undc S(rFn .B &PC furrhilFen <br />uoaf,EBs:(:oMtrNsAn0! <br />DECLAAAUO! <br />I h.rcby amrn lodcr Fnalry or,,oj!ry onc ollnc aolhwi"S d6lmiio.s: <br />I hnvc adeillnui liorCcniliurcorConsunrt,S.lflNurcn,sorkrs.onpctr\ nnr.r\ povnlcd tur$J_Sccltu lT0Oolrhc <br />ljhr C{xlc- lnr rhc lditr nmNc oI rhc sork rhr {hich lnc pqn l is h\ucn <br />_l hltc and will maan'ain wortcm compcnra'ion insurdBc. N rcqdEd by Sd ion 3700 or lhc L.hor Codc. for lh. pc,lolfuc. of <br />rh. sort fo, shich rhir lemir ts bsu.d. My w6rkcB 6nFNrio! inlranft cMir &d polt, ounbcr @: <br />-l <br />c.nify rhat in thc llc formncc oflhc work for *tich lhis n rnrn is isucd. I \h!ll nor.nployriy pc^on in any nsnncr <br />$ a\h bccofu \!b]cd b rhc xbrk6 orptnsdion lnsr otcrlitodia otul.!n. thol ifl should t*onE subirl ro lhc <br />w.rkss con[.osarion lolist,ns otSerion ]7006rrhc L.hn (-odc,I shall. fonhwith comtly wilhlho* !m!isions.. <br />WARNINC: Fiilurc lo wurc worksl otrl,ENtn,n 6rcBs€ h unhwfll. and shau rubhd u cnploter ro siminel IEmllis ad <br />ro om hudrcd rhousnd dollrs (5100.(x ), io addirion ro rh. co{ or c.qrn$rion. damScs m proridcd lor lhc <br />Sccri(r.llr?6ulrl[ l]}in a'{nlc. nncrci rnJ <br />I hcEbyalitrmundcr pcMltyolp.rjury thol I I ol ChaDrcr s (omm.ci.s enh Se.li.,n 7{xn) oi Division 3 <br />ol lhc auiin \{ dd Prol.$io.s Cod., 0nd my ltc.e h <br />t h.rcby ,fli.m undcr F.iLy of psjury lhrl <br />kucd (se, 1097. civ, c,), <br />ruthn lc.din8 tr8crcy {or lhc F.fomrce olrhc trrk for wnich lhis pcrmil is <br />APPI !(:ANT Di'CI ARATIoN <br />I lrfthydfimuidcr l.ndlry orJ)cr.juiy onc olrhc foll,)$in8 dc.lsartunr <br />lI'nolirniPcnnir\ A\h({o\ Ndrifi.dnrn l:cd.ful R.!xbrn \(I'irlc4l), Pnd6J <br />Rcqun d hrrcr ofNorili.dDn <br />-l <br />ccn iiy r hot rhc fcdcrrl Esulolions rc8a.dinB astEsros rcnhlll dc nor appliclblc b rhir ptujcd <br />i! cord.I &Erc tocomllywilh {llCiryond Counry <br />.eF.*nraliwsollhir Cilyand Counlylo entd upon lhc <br />-. L'? O(x <br />DIETD\Afiilhl <br />Waste & Vent <br />Fill Line/Back Flow <br />tr.irs: <br />Drt.: <br />lclt t6t <br />D€ <br />I