|
PLUMBING.INSPECTOR RECORD ?
<br />APPROVALS DATE ID/SIG.OWNIT BI] t I,DER Df,I,CARA]ION
<br />I hcrchy aSirnr under lenihy ol perJury rh,r I dn.x.nfr Goh rlE (onlr0cloi t-iccnse bw rar lhe lolbwms rca$n (scc?0]15
<br />Bu$n.$ nnl llotssDn Cl\lt) Any (
<br />'ry
<br />or Counry [hrh rquE( . ,'snnr r. conntu.r, rhd, inl|Bvc. &oxnFh nr q',r auy
<br />srrucrure, IrlMnr is issu.'r., iho r.qutr.s rhc amlicrnr lor suchp.rm b fi|.. $3ndd n.remd rhd hcorqhe r l'.ensed Nrsn
<br />ro rhe lr)vkioDs olrhe Conr,.rois Liccns.d I rq (Ch,nr.r e, Q)nnncnc na silh secrbn 7ft)0 oiDivhio ll olrhe llsrness 8nd
<br />flrtss'ons cod.) dr th,r rRoraht isercnfl thcElnnn ind rhe h.qs r(trrlrcillcscdcxcnrpri.n AnyvFlationorst.rsnToll5bytny
<br />,,rn[mnr lorapcnDr subjE.^t lhe rpplic.nr b acir'lFn.hyolmr nmr. rhnn l-rrt hunlrcd dollar(S100)
<br />-l,r\oqn.rol'rlEpmpcny.(rny.mnloFes{ithwa!e!.srh.'r*n.compcns.rNn.Lvilldolhe$drkdndrhtsflduEh'FIinro dl orofcred lorsl.ISa 7044. Busin.s..il Pft' sbnsCde Ih.(inlra.(trs,.'..n.cLNdo.rmt{'plyroanownerof
<br />rlf rnptny sl$ hoil&or n{'mve rhcrdr( s.d wtl).lixs $ch $1* hff.lfor lt.r*li.r rhroueh hr or h.r o{i em!l.)t.s,
<br />novidcd rhar such 'nlp(r ! k rs .rc mr nlcn&ri or oficred nn sk I I h,e(.r, rh. htrrklmg .r iqmrrlmi 'r
<br />$k] $(hm om tqr
<br />olc.mplerion, fte o{ncr Blildcr willtsv. rhe burden oi nmvirs rlsl he or she did 'd bu'ld or in.)m\c llr lmFly fitr rh. nurl1oe of
<br />l. rs.*ncr.frh. pml).ny, an exclusr!.ly.onkicuns wirh liccn*l .r,nra.roN ro conslrud rlE preiNr lsd 71);14, Auiinc$
<br />and l,oAsion c.d.: l hc Conrradois License l,!s does nor rnply ro inowner olron rrrc'ho tuild. or nnproEs lhcreoi,
<br />rnd tr,tn ohcG lo. surh pnrds s'rh , co rmcto{n nc.n*n pusurnr ro rhe contr c'olsLiceDsktr)
<br />I on.xcmpt u.dcr Ssl (
<br />l!48tr[8l:C0llf!!lAllQ!
<br />DECI ARATION
<br />I h.rcby.,Irdundo !.oltyof p.juryo..of ltu folloqins dcclahtionr
<br />-l
<br />hN. .rd will Einrain ! C.nifiorc ofcoNor b S.laJmuE for w*6 @op..stion, ar lmvi(H for by Sdlion l?00 of llE
<br />Lrbor cod.. for rhc p.rt)mft. of th. elt for which th. pdnn k is.d
<br />-l hlr d.d eitl nai.|'in workd comDeNalion insEmo ar r.quircd by s.clion 3?00 oflh€ kb.rCode,lor ltE n.rfomfte ol
<br />rh. *o,t fo. which this p.mir ie is.d My srtds smr.nt|ion iBnlaN oEis ond ,blky tuhhir e:
<br />lblry Numh.r-txPtr.q:
<br />-l.difyrnot
<br />in rh. r.raormrcc offt. wo.t for wni.h tlis p.mi i ks.d, I shlll ml .q)loy any t.mn in lny tunn.r
<br />s as ro b.ae sbjd ro ih. wo.IN'oDp.r*rion laws of Colilomii, and 486 thot if I sfiould hccodc .uhJccr ro th.
<br />wo*crc dmr..srion rmvi.ioN of sdion 1700 oflt LatBr cod.. I .rel!, nlnhsith comnly *ilh lhos pFviioB..
<br />WARNINC: lailuR l. KuE srk.F @mpcnslrion m!.h!. s unl,wlirl, .trd shdl iuh].cr dn dnlloyt. to crimi.tl loElri\ snd
<br />clvrt lin.s up t. on. hundrcd rhoucand doll&s ($100.000). in addnn'f, lo lhe €o3l otconP.nsrion, dams.s as lovid.d lor rne
<br />S(rion 3076otrh. rjt rCod.,i .r.st ond anorn6je tes.
<br />Drre: t npptt"orr, *
<br />T,ICIXSELCOtrIXACIOBrlfcrJf,Arlo!
<br />I h.Eby amnn udd Fmlry of pcriury rhd I ah lic.trEn unl.t pmvhion ofchiprd 9 (sm,rcrcins , h SNri,. ?000) of Division 3
<br />ol rh. Busine$ ond Pofc*ioN Codc. and ny !i..nrc is in tull f.R ond cfi.cr
<br />Lienk Ch$:-Lic.tri. Nuob.r:
<br />D.t.: Co r..lor:
<br />colslSJ]cuoll'.LENDrN itilcl
<br />t hesby.fiirnr und.r Fmhyotp.rjury dar thde r. onsrudb. l.ndins lsen.y nn thc rcrfomnnc. oflh. Bork f.r which thh D.mrit is
<br />iss.d(s.c 1097. civ. C ).
<br />I ..niry lh,t th. Ld.ral fsulatiod{ ES.rdine aqb.{G lttrval 6r. mt 4tlicabk to rhk lmj€l
<br />-l
<br />cdiry rh.l I h.k @d lhi! dl,plidion ed 3tat. l,$ lh. .h.E inf.!tudion is 6trt 1. LSN lo @Dply wnh ![ Cnv..d Colr{v
<br />odimffi aid Slar. rau chling to b{ildins con*uclh( !,t lmby.uthoriz r.pE€n&riwi offii! Cilyud Colnlv lo.!td upon tlE
<br />5bov. m.nriotud porcny for inaeti.n purFEs.
<br />*, *<x
<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 Pipinq
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />lr/ain Drain/Pool Pipinq
<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 FIow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL 5-D-t1 lr'h/A\
<br />Notes, Remarks, Etc.
<br />)
<br />COMMENTS
<br />L.nd.i! Add.$
<br />-
<br />Allllcalt-llrlcl,asarlod
<br />I hortiy.trm undcr pd,hy ofpsjury orc oflhc lollowin8 ddlmhns:
<br />Dcmolirion I'(nirs-Asbcfos Nolificalion ljcd.ral R.sulations (Inb40, PM6)
<br />-RequiEd
<br />L.tt.r otNorii6lion
<br />Gas-Underfloor
<br />Roof Drain
|