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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE
<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 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 />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 Itl>pltur,'vu)r r l-I:Notes, Remarks, Etc
<br />OWNER AUILI'SR I'ELCARA'IION
<br />t h..cby rmm uodo a.olty .f rrjury rhrt , D .x.nt i tsm lhc Conlr.cloE Lic.ns. L., aor lh. follo*i.s Edtn (5$.?011.5
<br />8Bii6r rod PrcfBlion Cod.)r Any City or adnry whi.h EguiH 6 lcfril lo 6 d cr, !116, ihpmw, dmlbh o. E,8nriny
<br />5uuclG. Ftu ro tu isu.E, olr r.sriH rh. appltdr for rch p.@jr ro lil. ! risxrd $lrcft dal lE or ih. i! lic.n*d pudE r
<br />to th. rovilioB ofd. conm.to.s Li@i!.d hw (ch!fl( 9. com.ncing wilh s.clion ?000 ofDivirion 3 ofth. B$inBt and
<br />Pot $ioi! Codc) o, th lE or rh. is .x.ltfl lh6.li, ,m rnd th. hdeii Rlr llE .lk8.d .x.ftrrtion- An, vioLrio. ofsctbn 701 t .5 t, ey
<br />sppli.s! fo. d p.@il $bj..lr lh. lppliqnl lo . civil p.Elty of ml mE thm liv. hundEd <tolha (5500).
<br />-1,
<br />as owr of thc ,turEny, or my ctrDlorrc. * h wass &r rh.t sl. @np.Nriol! uill .b dr w.rt ad lh. rnxlE i, ml
<br />intad.d o.oficrcd fo. el.{Se.704,1, Buinds ond Prcldsiom Cod.:1.n Conldclor'! Li(lM La*.!td mi amlylo tnowE.ol
<br />rh. t6pdy {16 tuildr or impmE tlE6( rnd wlh (hs Mn slt nimr.lf o. h.mlf or dh!8h hb or hd own .mploy(6,
<br />pmvid.d rlEt s.ch impm@'ns e mr i'rnd.d oroftu &,r sh lt hN6s,llE ttrildiry o. i,{'mmnl is $ld *ilhin or Jtd
<br />ofsrqLlior\ th. O*Tn Bu d.r wil hlw rlE hld.n ofprovi.g thd h. or st. did mt t{ild or inpdG ft. poncry for rlE Orpoe ol
<br />l, &i owmr ollh. I'mpdx am exclusiv.ly conlEcrinr *ith licensed conlrrl.fi Io @ntrud
<br />'h. ,,Nld (S.c 7044, Ausffs
<br />o.d Poisin cod. I hc conlricioas Lic.n* tiw d..r mr onply t. rn oqn.r o t nnp.nr sho buildr or ihnor.. lh.rdh,
<br />6fld who mnlnds for sch ,mjds wirh a Cofll6cto(r) licc sd nlnlanr lo $. ContDflols Liccr€ Lrw).
<br />lam eicmnr unde! s.cr
<br />! ni[Bs:eou&ll ra!
<br />DECLAXAII(B
<br />I h.r.hy 0mnn under p$rhyof neUuryoneof th. folk'rins d.clamti('ns
<br />_l have rrl {illnBinr.inacedi,lcarcofconre n,s.lalnrurcrorwork.B'onrp.nsrion.rsrmrdcdlorbyS.crionlTo0ofrh.
<br />L.bor Cod.,lin thc pdlomnce otthc uort forwhichth. Dmil is issucd.
<br />-lhavcand
<br />*iU minllin trukeis' compcNarirn rFurance. as requn.d byS€crionlT(r0ollhc LohorCode lor lh. pdlormrk o I
<br />Ro.d MvedGr @mdsr<-t?(b )ion iriuhncc mEer aad rolicy nusbs s.:
<br />7
<br />_l c.niay(har nrh. r.rl:@ft. of rh. wod{ fo. which rhh !.r. h iesucd,l shall mr cmtloy any p.Mn in .ny m0nmr
<br />so N ro h.conE Nbr. o rh. @d(6 on dsrion laqs ofcalifoo'd. ,nd r8E. rhar rl I stbrld h.$m shj4t lo rlE
<br />wo*m' ompcNalion rlDvtioN ofsd ion 170{ ol rh. L,lnr cod.. I {sll. fodhsnn snDly wilh ltDs ,mvisions
<br />$ARNINC: l,.ilu.. ro wure work s'comrEnEarion svcms. is unlsstui .nbjer M mplorrr to rininal p.mhi6 rnd
<br />rcd thousnd dolla* (Sl00.mo). in addilion ro
<br />cod., i.r...st ond oturmy s fcs
<br />lyolncrjury that l0m liccnrd un<|.. nNvhio.9 (c6mh.m inB wnh ssrion ?0001 of Divirion l
<br />.l rhe Busincrs.nd Phf.$ions codc, ,rl ny licms. ir infull aorc. rnd cf.cl
<br />I hcEb! xmrd nndcr pcully.r r.rury rh rl'.f i n con{tucr i,'n lMdmg i8.ncr, tu th. pello.m.nce .I dr. }uk lin s h'ch rhil Snnir r
<br />Nsucd (Ss l(,9?, Civ C).
<br />AttllcaNl-lllicldtr l.IoN
<br />I hFd', aliim nnd.r rnalryolpcrlury o* of'h. f.l[,sin! drliaro6s
<br />Dennlirionl,.nnrlsAsb.srosNotilic.tionl:(lc.rlR.cuktions('litl.4(,,Pan6)
<br />Rquircd L.rtd oaNorincolion
<br />_l c.nify rhat rh. fcdc6! E!!l,L.n. n8trding drh.nor r.msl or. ml alplrcrhL to thh ,,mj(rl
<br />I ccniayrhar I h.!r.eod rhhapD licirion Md slatcrhar rh. ahovc informron hcotrd. I
<br />ordiMncs end s'are Ljwr Ehtin! to huildinSconnru.r
<br />rhnc Denrioncd pn,pcny ior $I{ri{rn n
<br />,\ppli.rnr or .\s.ni sisnxtu,r:
<br />5
<br />IrD/stG.COMMENTS
<br />Lend.r, Ad&$ _
<br />Gas Service
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