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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS o1.l NllL Strtl,DllR I)tiLcaRl\ fl()N
<br />I hcrcbt xlh lnJcr p.nnlrr-,ir pfljry rhl I c\cmDI nonrlrConr !tri Li.ctsr LrLr lnr Ih. b]l(t\ins rcasot (SLr.7oll.s
<br />n) th. tu\isioi\ ol rhc Co tr.rr'! Li.c \.d LrN (Chrpr.r ,. (oDncring rvirh Sccrlon 7(xX).f Divi\ion :l ofihc Busnr$ rnd
<br />rfdi.rrr,nr|fnnilsrhj&rrrhcrnrliratrrbr(ivil,,.rihy.lnor"rrclh r l'n. hundrcd (lolhs($5m)
<br />l.NosNrofrh.ProNnt,ortrry.n'Pl.y.$wirhwxscs$lhcirn,lcconrpcfsrrbn.*illdolh.Borka lhcndclurci\nor
<br />icndL.d or oflLrcd f.r $lc isc.7{X4. Busnrs lnd ttofcst)n!Cdc IhcCo rrcntr\ l,i(cn$ I:rs docs nor trPIly l. $.*ncr of
<br />rhc n'.ocnt *ho huil& or inw,rs ih.ron.3nd s,F d.cs {rch soi* hN$lf or lDr*lfor rhrotrlh his or hcr own crplo)rc\,
<br />F)vnl.d ihJr such i'nlrxrDEnh ar! frn inrc ndcd or .flardl tur!'lc ll, howc\$,!tu huiklin8 or nryn)rcnrnr h sld sirhiior. ycrtr
<br />ot conDlclior. thc Owmr Suilds willh.vc lhchurdctr.lpnni+rhnr hcorshcd tror huil,l or imtmr c rh. I,mFiy r(r rhc t,ur 1r\. of
<br />-1.
<br />asowmrolltc pmpcrly- , m c xclus ivcly .onl racl irg wilh li.ctrs.d .onlfuloa l. mnsr cl rL pmirl (S.c.7o4!, ausircs
<br />md Bsfs.iro C.d.: Thc Conrr&roac Liccnsc Llw docs rer ltrly ro an owner ofprepcny qho truilds or im[ovcs rhoeon.
<br />and wt'o cotrL€cts lor $ch pmjcch wnh r Co.ri.ro(s) liIn$d plBumr b rhc Co.rrlofs Lkcnsc tiw).
<br />I mc\cmn' undcr Sdion .8.&P,C.torrhnM.oo.
<br />lqatrE8E.coMPiNtArlaN
<br />DECLARATTON
<br />I hcreby .ffirm u 0dcr peMlly of!€rjury om oflhc following delaErions:
<br />-l
<br />hlvc dwillm.ifiritri(tnilicarcoicoflicnrroscl n\ub liy work.n .onDcNnrn,n. as pmrd.d for by scclion lTul ol rhc
<br />Lrhor Codc. tbr rhc p.rfonumc olrhc work ld sfiich rhc lcr.it i\ issucd
<br />_l havc and will moiniain wortcs' comlcns,lion insurdrcc. $ rcquircd by Setion 3700 of lh. tlbor Codc, for lfic pelornucc of
<br />thc work for wnich lhis pcmil is issucd, My work B compcNrlion insum.e caicr rd policy numbcr m:
<br />l.caiiy rtu ii rnc Fcrloroancc orrhc wdrk for rhich rhn pcrmir is issucd. I shall nor cry,loy inyDeNon in !n, maii(
<br />so isr. h..Dnr subicd b lnc workdx onpcnernri h{$ dlcaliaohiu, rnd iBrc rha' ill slDuld beonc sxbjcd lo rhc
<br />trorkcr(.ofpcnsmionptulisionsofsccrio.l?fl)olrhcLrhrGrlc.lshnll.tonhsirhconrplywirh
<br />lurc to wue Norkca' coryrcnsario. covcraec is unlaNtul, md shal,0n cnrplo)er ro cnmin.l Ilcnrltics !nd
<br />om hundEd lhousand dollm (Sl00.tD0l. in addnio. io thc cosl n. dam8cs !s providcd tor Ihe
<br />l- .r Codc. intcr€sl .nd oltomy s
<br />D[CldEdJraN
<br />I hcrcby arfirnunddr pcndlry.fFrjurr rhd t an licci*d ln.lcr pmlnion ofChlprd 9 (co'norcncing wirh sucri.n 7000) ofDivirn,n l
<br />nf llrc BusnEs lnd Proltssions Codc. ud myliccnse h in lull fncc o clltct.-r-
<br />,,,**'*,ffi *r ^,**,tI hcrby dinmund.r pcnnlrt.rlf,rjurt lh,l rhcrc ie r.on{rucri{)n lcnding,g.n.y r.r rhc pcrihnun c oflhc work lor which rhh Frmt k
<br />t.ucd {sE -1097.Civ. C )
<br />ATILICINIDECI,ABI.IION
<br />I hnby.flim undf Fndry ol p(j!r, on. otrhe lollowiis dcclaErions:
<br />Dcmolirion P€rnits-Asbc(os Norificarion Fcdcrul ReSuhtn,ns (Tillc 40. Pn 6)
<br />-Rcquircd
<br />L.ller of Noliticnlion
<br />-l
<br />ccnily ltd rhc lcdcral .c3!lul ions rcsadin8 ashcslos rcnDval arc
<br />-l
<br />ccnify rh.t I hrh rcnd rhis oppli.arion dd srdc rhar in.mrion h corcd.l,ercro comply wirhallCilyand Counry
<br />ordinnnc.s itrd Sratc liws ohlin8 ro buitnrg.onsrdcr sxrhorir rcprcscnrativcs of lhis Cny,nd
<br />ahovc mnt.ne,i.r6*nv ftr insxcuon
<br />App[cdl m Ag.nt Slgrllun: N ,"'"S\t
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Gas-Underfloor
<br />Buildin g Sewer
<br />Area./Storm Drain
<br />I nterceptor/ Clarifier
<br />TOP OUT
<br />Water Piping
<br />Gas Pi ptng
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Itrlain Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool HeateriGas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL b/d//B \JCsT
<br />Note s, Remarks, Etc.
<br />Waste & Vent
<br />Roof Drain
<br />Miscellaneous
<br />9q?
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