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APPROVALS DATE rD/srG.COMMENTS OWNER BUILDER DELCAIATION
<br />I h.rl,y .rm und.r prdhy of l.rrlry rhlt I m .x.npr fmm rh. Co .r.loB Lic.@ L.w for rh. follovins Bsr (Se.?011 .5
<br />Burift3! 5nd Pma6sio. Cod.t Any cny or Counry {nkh r.qlrB ! Fhir lo @nrtrud. !ltd. in{,oc. d.ml(h or ,qBr .ny
<br />ilrude. rs to ils i*um., d$ r.quirB lh. qDlEanl Lr och Fmr '. 6L r ri8n d nd.11d ihd tE or rlr i lic.N.d pulud
<br />to ltu pmvi3i,N of fi. Co Eld t Lian*n bw (Ch!rr6 9. conftrcry wnh s.cr.n 70u) ol DM3iotr I of rh. Bn.o.* rnd
<br />PDfcsions Cod.) or lhd h. or E i .r.r{,1 thdtoD Jd
<br />'h.
<br />tblir lo. rh. ilL8.d.r.npiio. Anyviohrionofsdirn7lll.tbyMy
<br />.rpl@ for . p.mit tubjcri rh. .ptlic$r ro E civil p.Nhy o amr mE th6 ,ir. hundrd doll.B (3500).
<br />-1,
<br />&s o*Edfln ,mFny. or my.ry'loFB wilh w.3d $
<br />'h.n
<br />$k o'mr'.B!to., wrll(h rlE wnt dn dE nrulw ic mt
<br />i.ri.d or.fid.d aor $L (Sd 7044, ausiBr &d PotrsioN Co&r'l h. Co ncloc.Ii*nrl,w.to6mrlpplyt.o0B6.f
<br />rll pnEny rln l[ildi or lqmB ttEml\ ird wtr .kH sn wlt hm!.lf or h.*lf or thmu8h hir or h.r om .ryhFd.
<br />pmvd.d lld sch mlromnl. e ml inrdLd.r6rk fin sL l[ hwc. rL h]iHins 6. o{Fftd h $d e(hm ok r.rofsi$lcrn! th. owM Au'Bd ell hlr rh. h!d.n ofFsvins rlDr lE or slr dd mr hrld or itrp,ow th. Dmpqty 6r rh. plrFE of
<br />l. ai own.r of rh. |,opdy. m .xcl$^?ly codEdins $rrh nc.nsn conrEron nr mndtod rrE FrFd (s( 7M4, BB,ks
<br />ard Pn,Erii@ C.&,-lh. Conttctoft l-ic.nE l-!v d.6 ml lprly lo anosns oaFr.p.nywtn hurlds.r mnmEi rh..mn.
<br />!d who c.nldk aor schrn)l(N wnh r Codndo(.) lrd*d pulsdt, rh. Conr.clsi L'c.n€ kw).
<br />la,nex. rpl und.r S.crnn .a &Pa tirrrhNrri$n
<br />D.t. O'n.r
<br />tlaBaE8$:coM[Edsalla!
<br />DICIJtrAIIA!
<br />I h.chy aflim u s n.E llyolpquryoft ofllE followinr d..lfar6B:
<br />-l
<br />h!rc &n will mintain . C.nifE r of Conrn' ro s*lHn@ br mrl6t ompestioll, .. pmvid.d for by Serion ]7fir oarh.
<br />bbor C.&, for llr pdfolmre .lth. wort aor *tch th. tmh h ,sEd
<br />I h,k .nd wr ll marnrain worl(r' conp..r,( tr,n Dsu,!r.. !s r.quircd hy s(t on 3700 or rh. l.lhor Cod., f.r thc pdfomm. .I
<br />ir ii .d Myworlda conpmsnon mqEm. carE r]Ix,lrynum[.ru.
<br />I(s6 a
<br />-l
<br />c.,rirylhal in rlE pcrfolmEr otlhc *orl for vhich thi! p.mn h L!{.d. I $!ll not.q'hy.nyp.Mn in lny runEr
<br />m aeto tEom hler rorh.m*6 66D.mrbn l.*rdfc.lit,mlq and.Bc rtEl if I.lslrd hc.m ol!..r t. tE
<br />wd(m'onp.nelionpmvlchnsofS.clionlT00ofth.lltirc.d..lrhJlfonhqirn6hplyB'rhrlsrpmBsbni
<br />WARN|NC ljaitur. lo Eur. work.c' on{Ensln. slrh8. i! unLwtul. 6nd rhall NbFd dn mplo,lr ro qimiMl Faii6 and
<br />.'v'l fin.r up io oft hurdEd lhusnd dollm (t100,0ru), in iddition lo rh. con of coEFMtio( drruB.! ai prolid.d fir thr
<br />sNlion 1076 oflh.Lll[rCod., inr.r.r ed lnomy r lRs
<br />ol
<br />DICIAAAITAI
<br />Ih.r.hy:tlirm uBlcr n€mlly.lFrJUry lhal I am lic.nsl u Lr nmvsion o l( n1pl( I (comrmmins s ilh sarxm ?m0 ) .l D'rFion .l
<br />of rhc llunn$s.nd Pml4sonc Code. lrrl.ryl'cenk B rn nnl 1,"c.i lcfli:.r
<br />b
<br />{1ln
<br />ratsraitcl]QNt l:Ntutci( rrI
<br />I h.rchy.llir,nunl.r no.h,ofll.rNryrtsr rhr. rrconnfl(nn End gr8.my litrih.perli'mrnc.ofrh.\uL lirrh'.hrln(n m n
<br />fsudl(s.. r0rl7, cr c)
<br />ATIj,IC^IILDT(IijaAUOX
<br />I lirryr .lllnn unlc. pam[ y ol n rju, r. rnc ol rht lnll1r*
<br />'ng
<br />&.]ffrr k)n\
<br />D.nrrlrtrtn Pernrs shrdos N.r'n.rtnn'.(l.ral ReSuhr(ff ( I [|c.10. lin6)
<br />R{utrcd I rlcrolNor'ficxrnn
<br />-l
<br />cdrfy th,l lh. f.&61 R8uht,.ns qardin! arh.nor mrv.l ar. mr .ppl$bl. ro rh$ pml.d
<br />[!i cEr' ly ,har I h5!r (!d rh,! .nrlrlrnn sd cr.r. rhd rh. db.v. mr.mrinnr;6,Nrc$.nd sk,. L.rEhtmsro hu,ld,ns cod rucr htr dn h.Eb.u,tFru
<br />ir corer I ase tommplyvirh Dlt Ciryand Counly
<br />ahorc m.nlon.d pmpcny for insndio. nury$sB
<br />Appll.rnt or At.nl Skn.tur.
<br />{W,L *q4 lq
<br />UNDER GROUND
<br />Waste & Vent 2-d1
<br />Water-Under floor 1.,-Za-l"j
<br />Gas-Underfloor 2-7'{.1 c
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifrer
<br />Ftil'U"b. AtYQIY 2*?1 YJtl
<br />TOP OUT 1
<br />Waste & Vent z-2i,41 l.u[tr,It
<br />Water Piping
<br />Gas Piping lt
<br />Roof Drain 1\
<br />Tub/Shower Test 2-2AAo)
<br />RouglqW-ater Heater,€,r,
<br />GV *rur WW_@'22641
<br />P{rap/Drain Line
<br />lvlai n Drain/Pool Piping
<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 \\
<br />FINAL ;-?-\\YNJ L\N \
<br />\-Notes, Remarks V
<br />PLUMBING-INSPECTOR RECORD
<br />\41h1b
<br />V"UJ tbt
<br />POOL/SPA
<br />Pool Heater/Gas Line
<br />Etc.
<br />l"l **n o Lt
<br />rlidiAd&6:
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<br />I
<br />I
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