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PLUMBING-INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS 0lINI]R BUII,DER I'Dt,CARATIoN
<br />I hcrcb! rlllrm undcr |a rlry {'i p(rjuy rhul I anrcrcnDl tion rhc Cohri.r.f l-i.cnsc L1w ror lic lbllo+iog mr\on (S(.70-ll5
<br />Busnrss aod Prolission C c, Aiy cny or Cou ry $hirh i.qutrc( r tcmrir lo m.(n,cr. alrcr. i'npnrt. ilcnmlish or rcpnt ,ny
<br />srruciurc. pritr n, ir\ nsLa.,rln'rcqnncsrhc.tdianrtusuc[,Emrillo6lc!sistd{dc,ftir (hd h..r shc h licctrk'd pu.$anr
<br />ro rhc prori\nnF ol rhe Conrractn \ Lhcn{d llN rchrpr$ 9. Comncncine $ith S<rim 7fix).1Dirhn,n.l ofrhc Ansirc$.nd
<br />ILor.s\iois Co,lc)orrh,r h..rshc is crcDIn rhcrcftorJtrd fich.!is ibr lhc !llcscd cicnUnr. A.yriolrrionofSation'71J31.5l'yan)
<br />rppl'canr ror n !.nnn subjNrrhc qrplic0nr ro ccivilFnihyolnol.mrcrhri livc hundrcddollffs (S5rlo)
<br />( f * ""*, "*" *,*ry. o, tr1y.'nployccs $irh wl8cs as rh.i, v'lc comrEnsari,nl will dr) rh. w..k dkl rr srnr1rc i\ n
<br />dcklLn or ofitrcd for sllc ( Sa 7l!.{- Bu\incs rnd Proicsinr C*L Th. c nkrtx s Liccn$ t-r* d(\ Dor L'mlv k' rn oqmi of
<br />rtr por^-,ry sk, t{ilds ur i'ryn*cr rh.nn ud rv[o (les {.h so hi'nscll.r hcr{ll or rhn llh lri\.r hcr o{ncnlloyccs.
<br />Inlidrd rhrr nkh i'nnmvc rnr\ (c tror itrtcrxldl qoft rcd nn qb It hotrckr 1l'. hiiding.r inll(*r t.r it dd wirhir', tr ,tr
<br />oiconlnldhn. rhc O$nc.Iruiklcr *illhlc rhc tnkkn oflhvi'rc rhlr h. or slr dA n.r huild or ints)lt rnc ImFiy for rh. purPrsoi
<br />-1.
<br />as owneroffic rrn dy. nn.r.lusivcly.onracring *iih liccnscd contndmlo con{ruc hc pmhc! {scc.7044. Busms
<br />lrd PiDtxiob a)dc: The Conlrrcttr s Liccisc lr* docs nol opply to !r own.i or FroFdy who huilds or imrlovc. rhcien,
<br />and Bho .onlEcls for su.h tojcoq wirh . Conrmdorlr) liens.d pusuant lo thc Conl6cktr\ Li.cn* llw).
<br />L +"*
<br />DECI,ABA.IION
<br />I h.ehy .mrm un&r tcnJry ol lqjury om of llE following d(l,rutions:
<br />I trhn (ixlc. ftn rhc tcrtonmi.c ofrhr so* ntr shi(lr rtu |tnnf ( i\{,ci
<br />l hrvc and w ill moinlrin qorkcrs conpcnsarion i.su6mc, .s tquitcd by s.ction lT00 of lhc ljlx, Codc. lor lhe p4fomftc .l
<br />rh. work fo. which thG pcrn is hrucd. My worlc6 .onrcosa'ion insum. .micr ad rolicy nu'nbet e:
<br />Pol icy N! mb.r:-E rpircs:
<br />11frr,..r,'n^ -tn r*,r,n'ui!c rlrr|'trrntrqhtrhrhhltcnnnisFnrd.I\hrttnnrcn,rroyrnrr.^ntrrnnymrtrn.,
<br />'tr,'^t,r'c."nr.ur'1c.rrrtrc{ortc^c.nncnqri"nlissofCllilornh.xndagrorhrrilI\h,uldh.corft\uh].crrorit
<br />snrko\ .. rrcns ionfovrn,nrnfSc.rion.lTlXrolrhclikrA c.l drll, ronh$irh.onflr_ unhrh.c f.ri{ion\
<br />WARNINGT Fritur. ro eurc $.kc$ conEnstion NlcmBc is unhwfol. a'd 1h!ll suhirl D mpl.'yn lo ni'ninal lEmhi6 Md
<br />cilil lin . u! ro oG hundEd lh.usnd doll$ (Sl{D.Oftl. in .dnion lo lhc co.r of conlEnsrion. d!m8!s rs r,rcvtcd for lL
<br />Serion .1076 ofrh. Ilbor Codc. inlcr.$ ond dromy\ tas.F
<br />ul(L!!r!-l!Q!
<br />nl rlr llr\n.$)nLil,'rlisi,r\ (nn., xn,in'v l..n\. \ | llr llnr!.ri.llc.l
<br />Li.casc C lass
<br />-
<br />Liccnsc Nrnhr:
<br />lrnre. ( onlh(lor
<br />rl)N$f,lcruxl.t:NDac-a{iExlI
<br />I hcrcny rf,nar undcr Fnah) ofpcrjurr rhar rhcr. i\ r con(tocri)n lc.ding agcn y ntr thc tr.rli',nnrc ofrhc sork itr $hich rhis Frnrir ir
<br />i\ird (Scc. 1097,Civ. C.)
<br />ATTLUANI.IEELABATD!
<br />I hc^$rxlitrrndcr p.nrlry ofp.rjryotrc olthc rolkiwing tlc.hhriotrs
<br />l)cNniri l,cnnirs Asl'cio\ Noiilirlrion I:cdcn,l Rr!uhri,)ns (Tirlc,l0. Pdn6)
<br />Rcqrnc lr(crolNorifi.dion
<br />l.cnify rhd rhc fcdcrll rc8uhtnnN rcgurdilu a\hrnos rcr.ovrlrr 0orrppli.sbL b rhis nn,l..r
<br />1zLliin yrl l hi' c rc,,l , hn rmlrir i, m ml ndc r hnr rhc rnnc innnmnn,i n comcr l Ils,e b Lunply wirh all cirr Md counry
<br />odimnftsrtr.lsrllcLr$sEldingrohuildins.on(rucrior.lulhcr.h, rlx rcrcprcanuiv.rolrhhCir!andcouaryhcnle,urcnrhe
<br />dtx,vc mnrioncd pmFny fm insFcrion
<br />e-I e*.,.
<br />UNDEB GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />Waste & Vent
<br />Water Pipino
<br />Gas Pipinq
<br />Roof Drain
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line I
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL tz/a /trl .vh-il,1
<br />Notes, Remarks, Etc. I I I F-,'(/
<br />+
<br />TOP OUT
<br />Tub/Shower Test
<br />Pool Heater/Gas Line
<br />Water Service
<br />F'f," <'o\
<br />u4 w
<br />t ndci\ Addrcs'
<br />-
<br />ApDlk!trtor AsolsiBerut: X-€r0uq
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