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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEi BUILDER DEI,CARATION
<br />I tEEtry rrm u.d.r !.Nlry of FrJury rh5l I a q.npl tDe rhc CoftEclm Lic6* L:w for rlE 6llo*in8 lten (Se.70]1.5_
<br />Buin*r lnd Pmfdion Co{.)r A.y Cir, or Cou,ry ehi.h EquE, o Fhn to 6 rto.i .ltd, iorrev., dcmlirh or rcron ey
<br />,rcn!!t ,rior ro ir! irs@e. lbo Eqund th. $pli6r for $.n pcm ro file . rieftd sliftni lhlr lE o. dE k lic.E d luddlr_
<br />ro rh. Dmvtuio e of tL Co turd r Li.cnr.d Llw (Chlord 9, Commctuins *nh Sddon 7000 of Division I of 0E Buiins! .nd .
<br />Prcf.$iotr Con.) o. lh.t lE o. rhc i! .x.spl rlEEism ..d rh. h.ti-r h. tlE alk8.d qcdrerion. Any viohlion ofs..rion ?01 LI by lny
<br />aDpliq fom p.mil oldlr th. lpplica.t lo a civil p.mlty of oot mE lh6 fiv. hwdod doll&c {!500).
<br />-1,
<br />ar owM olrh. !m!.ny, o. ny .mplor6 wnh w6s.s I rlEir $lc 6npcneliot'. wi[ & {E wlt a,ld itE dndw ic ml
<br />inl.d.d or of.Ed ft. sL (Se.704d AusiB ed PDa6liou Cod.: |1. ConlEcltr r Lic.n.. t w .bR ml qrlly to d owr of
<br />th.,bp.rry who trild! or ir?mB llE6,r, drd vlD &B ch h* hitu.lfor h.klfor tteud hi! or lr om.oplotr.s.
<br />pmvit d lh.t sch homrEEiB E ml id.i.Ld o,E rd &r sL. ll hw.c. ilE boildi4 or in{,lEmrr i, bld within o( rs
<br />of@nDhrio,L ilEoqffi Br d.. willh.E E hdcn ofpmvi4g rhn h.ordEdd d hnld or invDE ih. F.psty 6r dE po.Fxof
<br />_I, arowEr.frh.!mr.ny, dn.rctusiv.lym @cri.g wirh li*ded o ocro6rooNlrud ilEImjdl (S{.7044, BuiE$
<br />ald Pnf.ssion Codc: 'l hc Coor..ctoa ! Li€GnF Law do.e mr aDply ro an ovE of pmD.ny wno b!il& 6r imprcv.r rh.r.on,
<br />rnd who onulcri hr ch rmj.cts virn. Coorndo(3) lic.h$d t)uM to lh. Conrr0crols Li.m% l,v).
<br />_l @ .r.@pr und( Serion- B. & P.C. for thn rc,$n
<br />D.t.: Om.r:
<br />.EA85!8S-CA!!!ENSAIOB
<br />DECI.A8AITO!
<br />I hdby omrm und.. pcmhy ofFjury oft ofth. folheinS delmibm:
<br />_l havc rd will ruior.jn. C.nifsr. otco.mr lo S.lll@E for mrt6' ompd3niotl Frvid€d for bySelion1700 ofth.
<br />Lrbo. cod.. for {ic p6folll@. of lh. wo{ f6r s,tich rh. pmi i. is.d.
<br />-l
<br />hovc and will n.inloi. wo*.n compcns.tion insum^..c, as r..NiRd hy Set ion 3?00 oI rhc Lahor Gdq for th. fdforunc. ol
<br />tht qort for shich thie p.mit is is.d. My worldt coq,.nsrion insuEnce cldcr aid F,licy nunb.r d.:
<br />-l
<br />c.diryrhd in$. Frformm olth. wo* for stich rhis D.rmn t iro.d. l3h!U mr.mpLy!.yp.Nn in.ny MnM
<br />s ar to lEom otr.l b fi. *ort(6' otrlpdrdio. l,w. ofc.lifomir, $d .sr ltal if I stFuld b.c.tu tubjer lo lt!
<br />vortm' smp.Mlion tmvisiotrs ofs.clion l?00 of ln bbor Cod., I slEll, lb'lt*ilh mDply silh rtb* IlmvisioB.
<br />lv^tNlNc: ljailure ro sr!.e wnrh.6' compensrrim srcmse is unlswiul, and rhall r!6jd dn . Dlort ro mmin0l pcmlrK rtrd
<br />.ril fines !p to om hhdrd rhourand dollam (Sl
<br />S<tion 10?6 ofth. tjbor Codc, int.rcir ond ftork,
<br />lddrtrn h rhe co! .lcoup.nr.rio( dimg.s .s ,mrid.rt for rh.
<br />Ihcd,afl_mrnddF",ofpcriuryrhrtIMlieracdu.d.rpoviio.ofch6pldI(otlll'ftingwnhs..rion7000)ofDivtuionl
<br />.f lh. Builm,.d Pof*io,r Cod., dd By licm* ir ir tull for.rn.,E 1.
<br />cox$aucll{lNtllllllc.AcENlr
<br />I hs.hy .mrm und.r pcMhy of I}crjlry rhnt lhs€ E . @rrruction kndins !s.my for th. Derlbrtunc. . t rht s.rk lor whrch rhB pcflnn $
<br />hsud(S{ 1097. Civ C )
<br />AttucAN.fDr,ctASauo!
<br />I hclby a,Um und.r ncnahy oI n.rjlly o.c of rh. following d.cla,ationr:
<br />Dcmlilion Pmils.A!b.$.r Norific.lion Ld.ml R.SUhrhn! (l.nt 40, P0n6)
<br />LR.quEd L.fldorMtrrsrhn(t
<br />aal cdl,ryrhlr rhc t d.tul EsuhrhN Er.rd,ne a.lrno! rcmrrlu. tur q'pl(rblc ro lhB nDFr
<br />4(1..n,5, ,. , *," * ,* .*,{al. Oll $. abovc intumrin 6 coa.o I rlr ro or{,ly wirh all city 0d counr,
<br />orlnr !.\ JDri sr i.I r\\ rr tr ,!co.srrudoi\ dd h.r.hy rurhoriz. Enre$nbriv$ oa'hr Cily0.d Counlylo olB un nlh.
<br />.boe€ m.nriofl.d po!.rly for
<br />Appll..nl or AScntSl*n.luE: -
<br />,,^r*^ ,r"n,yrfgJ
<br />-/4-6
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ptng
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{raplDrain Line
<br />Main Drain/Pool Pipinq
<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 />Rough Plumbing
<br />Final Gas Test
<br />Meter Release I
<br />FINAL bn//ta -4Yr/
<br />Notes, Remarks, Etc.
<br />^/&-/€9
<br />L.ndei3 Addls:
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