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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUII-DI:R I'I'LCARATION
<br />I no.hy dfllrm ufrld lleMlry of perju.y rhd I an cxcnpr irem rh. Conlracros t-i..n€ li{ to. !h. a.lloqhS rc.$n (S( ?rrl l t
<br />Eushcss rnd Pmlcssion Cod.lr Any Cily or Counly qhrch ..qurrcs ! ,mn r. .on{rul1, ih-. ihptok, &nxnish nr nr'.n .ny
<br />srrucrur., piorlo 'ts iiMmc, il$ r.qutr* rh. aFplicmr lor$cnpc.mrro lilr.risn n d.mht rh'l h.orsh. b lic.n€d l)uNant
<br />tr rlic lmvirn.r ol rh. c.nraclor s Liccnsd Law (chaFr.r 9, commcncnrs wirh Sectn,n ?U)0 of Oienidn I ofrh. Bu$n(s 0nd
<br />I'n' Ic$om codc) or rhat h€ or eh. scxrtrr lher.fm and lh.h0sis lor lhc alk-qeri cxcmlrrn Anyvrol^rionoascctsn?(r:)l 5hy.ny
<br />applrcr loraDcmirsijecNthe.Dplicantrorcivilpenrltyol'nolnn,crhanfivehundRldolltis($500)
<br />_1, $ owEr of th. psFny, or my .mploFs wirh MB* N rt t $1. odp.d$rioi, will do tu w.l! and dE nrudr b ml
<br />inr.ixlrd or off.rcd for sL (Sd.?04d BuiK ed Pdfc.lioo. Codc: l'll. Co, r..lor'r Lic.N. Lrw .b6 ml .n ly to an owr of
<br />lh. p6pdy wt!. hitb or i,proc rlEoi\ !d who dc $cn so* hiN.lror hftlf or ihoo8h hii or h.. om cq,lor!4
<br />pmridel rhar BEh inrrslnrm e rcl i.roxLd orotfold &r ak. l[ how,llE t{ildi,{ or lrpm6dr is $ld silhin oR rlt
<br />oforpkrioq dr OwF Buitla *ill hlw tu burdo ofpmliis tlEr lE or slE did ml hlld o iqmw 6. pmFly for tlE ,!qn* of
<br />l. ar own.r ofrh. pmperry, oD ciclnicly contr&rins sirh lic.tr*d conrracr.B to o.srucl rh. !mi.{t (S.c 7044. tsunmsi
<br />and PNesion Cod.: Th. Contrcbls Lic.ne L.w doe. mr .pply ro 0n own r ofpropcny who hu il& or inpovcs lh€.mn,
<br />and who $nhcts aor such ,miBrs with a ContEclo(s) li..nsd N6unl ro th. Conlrrclvt Lic.ns. L5w).
<br />I m.x.mnl udcr S(lion . B. & t.C. fo' rhrr ron.
<br />Dr,
<br />.u&8aE8S:.CAUIIXSATTOB
<br />DECIdSAIIQ!
<br />I h.rcby ltnd !nd.r n.dlry orrrjury oc ofthc followins dftLBraoNl
<br />I hsv(r.duillmainlainsCenificrtrofc.nr.nr ro sel nsu.e n]r sorkcs conDcnsalion,0s Dmv cd forhys(rbn 1700olrlt
<br />l-al,)r cGa.. nn rh. pdlomm..f thc work for whi.h dc n rnril ic issu.{l
<br />-l hov. !d qill minllin eo,l.tr con .Bariod inso6N. ar c{un.d 6y sEiion 1?00 of lh. titnr Codc lor llE no{.l111,m ol
<br />thh ,mir ii rss.d. My worlss onl}.ndio. ir$dme cad.r and Flicy .umb.r sc:
<br />t )
<br />U\o-
<br />-l
<br />ccnify that in rhc perfomrc. of rh. w.* fo. shi.h rhi. lrrnl ii isiu.d, I3h.ll nol.mployrny lcmn in tny m&n..
<br />$ * ro h.sm. iutict b th. mlt6' comr.derion laws olcalifohi4 and ast. rhar it I .tbtrld h.coft sbj.ct to th.
<br />m.t .!' onrrm$tion lovirioN oas.ction l?00 oflh. LntDr Cod., I slsll. fonhsnh onnly whh rlb* ,ovkioni..
<br />wARNlNc: IailtrB to sur. work6' 6m!.nsdion srm!. is unlo*tuI. .nd shall ohi{ an oploy6 ro ciminal FEhi6 otd
<br />.iv!l fin.i !t lo ne hldrcd rhouend dolhn ($100,0{0)in rddrnn ro rh. cosr ol conp.nex6n. dim!.s as 8)rided tnr rh.
<br />Sdion 1076 ofrh. Litfr Cod.. inl.r.s ard rtiorEy!lt-zT) g
<br />r)r;( r.l\ra,\r'(r\
<br />I h.Eby 6firm u.d.r ,,.dlty o r r.rjury that I m licBcd !rd.r rmvilion ol Chapld 9 (comm.in8 wilfi Setion 7000) ol Divirioo 3
<br />ot $. Bu.iN snd PD,i.rioN Co&, &d my lic.M is in tuU aoM.td.fIer.
<br />)
<br />,.,. ,l-27\ l?
<br />AtfucilLD[ct af,aua!
<br />I tstlry ailm utul.r ,.nally or p.aury one olthc folloqins d.cl0rilions
<br />UcnDlirion fcroik &hesr6s Norific.ton lredcml R.CuLrions (l[1.40, P.n()
<br />R@uned L.ll.rof llorifi cdrion
<br />-l
<br />c.niry thar rh. a.dml csuldhN Ge&dine arh.sros Eooql u. ml appliobl. lo lhis pmj(rt.
<br />-l
<br />c.niry rhar I ha!. Md thir rrplicathn lid !lrr. lhar Ih. dtsv. inli'mliotr h conel. I .!rG lo on{,ly wnh .I Cn, lid Colnry
<br />odtutu6 lid shr. Lrw. Ebri,rg ro aurhorn. rcpr.Edarils .frhir ( ry s.d Countylo.nlB uFon tlE
<br />oh,v. mntiokd nmreay lor
<br />Appllrtrnl or,{p.il SlgnNlur.:rn ;., lt'2)-lx
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Meter Release t,l
<br />FINAL ftlbl$\t,vzr,M 'iA /u l, \-'Notes, Remarks, Etc It
<br />9^"
<br />goNilauquoNrDlDllc-acrxcr
<br />I h.r.by arm und.r FMlty of p.rju.y thal ln E h s orstrucli.n Lidins asdcy lo. rh. prlom.c. oith. vork br whkh rhic !.mir ir
<br />istucd (se. 1097. cie c. ).
<br />L.nd.''! N!m.
<br />-
<br />Lc Jci( A,ldr.\t
<br />/o Gru
<br />Gas-Underfloor
<br />Final Gas Test
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