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PLUMBING-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS oNNER $Ull,t)ER Lnt,( RlTt(]N
<br />{ .run. lriff n, ir\ i\\urNc. rl$ rcquR\ rhc rpplicrnr i{n \uch linnirt,lilcJ \i!trcd nrr.nrnr rhirh:or nr i\ h.riscd N^rxnr
<br />Prni$r)n\ (itrtr)or rhrrh or\h. i\ ctsmpr rhcr.liotr in(l lhctu\i\ lnrrh. rllcgcd .r.a,pri(n, Aty\irnrri,roiSc.rnnTl).rl 5h!rn)
<br />npfli..fr l i!rnnt strhic.r\ rlr lttli(rtrrh civll|t ilrtulior h'r rhm livc hundrcrl tlollrr\ (15(Xrl
<br />l.r\ o$ncrrfrhclnrlrc v,or rt.idorcN siihsnu.\ r\r[rn \n. .on,ltNrr i(trr. willdo rhc \dk rtrlrhr {tu1urc is.ol
<br />id.Ddc{l o,ollurcd ln. q,hlsa 7lll.l. Bulie.\s rn,l,,rol.si,nN Cql. rh.(inrrkx s I iccns.lrq doc\ rci rlflr" n, rn o{mr ol
<br />thc Dn)p rl tr l&) hikl\ .r ir{,rn$ rhcE'n. ud who d({\ {trh tr.rl hinr ll or h.r *ll o' rh' oueh hn or hcr o{n cnrpk)ycc\.
<br />tnli,lcdrh r$(h nnpn,v$rn( m R i'n. doroffcrd f{n sk Ir, hoqr\cr,rh( hhkh turirymit rnriiird $ithironc rBr
<br />-1.
<br />asowmrolrtu l,.Fiy, am.rclusiv.lyco r.dinBwnh lccns.d.onrodor lo onsE.|'nc pmJe.r {Ss.7014. Busmsr
<br />,nd P&rsqbn Codc: Thc ContBctoa. Li..ni. La* d@s nor apply ro d opnc. of lrcncrry eho builds or ispov.s li.rsn.
<br />lnd who oitmrs ror such preiEls wiri ! Co.reto(s) lt.n*d puuunr ro E Contra.roas Lt.ns. t!N).
<br />l.mcr.mll xndcr sdrion ,B & PC. rnrrhis @ron
<br />lQ8f,E&rcltMfjNtAlots
<br />DECI,ASAIII'N
<br />I hcrcny 0fltmund.r p.n.lry of Frjury orc oirhc followin! d6la0rions:
<br />-lhrvotr,xlwillnrinoriCcnnicdcofConscnrn)s.lllnntrcnrw.rkcrJcouJf,tr\dtn.nsDovnb(lforhlSccrio!.17(xrofrhctjhtr C.dc. tu rh. Frturrnm.c.frhc sort l(tr slri(hrhc It nrir \ n\id
<br />/qrr,-"-a"ir nun,Jtr,qi{rcn'.nnrncns,n,,trFurrm..nsEqurcdhysccrnn.r7(xrorih.r-JborLidc.kxrh.rrft,nm.c.,
<br />',r (r'l l, {l'tr1rIi.IT'r,'.\.sri]V)s.rt{rnrrt\.n.,rh'ni,trJ',trr.rrrrtrnlpnL.)r1tr,h1.'-
<br />A'Ip.
<br />(R -)- 2\
<br />-l
<br />dnifyrhar in th. rErinrtutre or rhc wort for *hichrhhDcrmn h hxucd,I sh,U nor cmrl.yanypcmn in rnymanBr
<br />m slo tE{otr rubtrl lo thc m*.8 omtEnslion l.ss otc{lifornih, aftt r8m rhll ifl sk'uld bc..m subicr lo rlt
<br />woirBl .omFnsorion !rcvhions of Scclion lro0 of the tjtnr Codc. I sholl. ronhqilh omply wnh tho$ Imvhions ,
<br />WARNINC: Fruilurc ro *curc wo,kcA comtcnsarion c.rcdsc is unlNtu!. and shall suhjNr !n cmplo,tr
<br />'o
<br />drinal Frilhs und
<br />cilil fitrc\ up ro ot hundrcJ llDUslnd dollur llx).llx)r. in xddilion !' rhc co\r oi cnn'n.na n4 dansBtr r\ l)(,!'dcd ror rh.
<br />DrgJa -!]1)!
<br />I h.rchy rfinrundcr pctr{,ty of rcrjury lh.r I an liccncJ undcr pmvkio..iChllrcr 9{comnEncin8 silt Sation 7O(x}) ofDi!ki...1
<br />ol rhc auiircs\ md Prof.ssi.ns Codc, md nry lic.6sc is infullf.nc andcfic.r.
<br />(
<br />IONEIAIS&N.LENDINfu{iDNCI
<br />I hcEby omrmundcr Fnrlty of 0c4ur! th.t lhnc is a.omlrudion Lndin8 N8cmy for lh. psaornrmc ofthc w.rk for Bhich lhh lErmil h
<br />i!qu.d (sf. 3097.civ,c.)
<br />ATPIIIANI.DECI.AAA.IION
<br />I lre+,y !trdn undcr ncnolry ol perjury onc of rhc follosinE dslaElions:
<br />Dcnnliriotr Pcrn ls-Asbesloi Nolilicalion ftdcml Rc8uhlionr Onk 40. P!n6,
<br />_Req!ircd l.ner olNorifrarhn
<br />-l
<br />r(iilt thot rh. rcd.mt rceuht nns Es0 lrnr !O.{or rcm\ al JE nor rmlErhlc ro thh pmj<
<br />-,,..-Zlrcnirr rhsr I Mvc rcsd rhn amlics"on 'nd
<br /><sre rhar rhc 0b.vc inl'orrorion is c.dcr,I rsre bdnqilywirh allCfiyand connty
<br />ordi'rnccs trdd srnrc I-rs\ rcl ii,,g r)cdBrru.rio.. otld hcEby aurlt)rie enr.e arivcs olrhis Cny df,d Coun'y to cm6 upon ih.
<br />nhrr nf,nri,nBl |n,n nyli,r i'l
<br />,\p0lir nl or.\x.nl Sitnsl ^n2
<br />nt),/-
<br />.Z\
<br />Waste & Vent
<br />Water-Under floor Zy'zt/zs ,(-e z-,)
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<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 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 />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL -//r</. n t- (,1,-/" 1A< 7t
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />n'(k4'-"',", z-?'<o
<br />od{ tt{
<br />o"a, \.t2y-t r>
<br />kRhf3 Addrer\
<br />UNDER GROUND
<br />Back Flow Device
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