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PLUMBING-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BULDER DELCARATION
<br />I hcEby !fiim uidcr Fnahy of Frjury lhsl I m cMpr frod lhc Conra.loN Liftns hw lor lh. follosinS E&$n (Ss.'7031:5
<br />Blsiness and Prcfession Codc): Ary Cny or Counry whi.h Equies r Frmir io mnstrocl, rllr. imprcrt, &mli$ or rrEi. oy
<br />rlrudm, rir lo irs hiur.cc, !l-s EquiEs ih. q,plksr for such Fmil lo frh . siemd shlcft $ar lE o. dE b lic.ncd pummt
<br />b $c lmviions of tlt Co @ror's Lid.sn Llq (Chqncr 9. Comming snh S..lion ,000 of Dilisio. 3 of rtltB!.iic$ and
<br />Pmlcrsions Cod.) o. rhd lE or shc h .r.mpl thcEfrom ond lh. b.sis for lhc lllcErn crsmpfion, An, viohrio. oasdhn 703l .5 by rny
<br />sl,Flicsnl for ! pcmir slbj$rs rhc apnlic. to s civil pcMhy of mrc rtun litc hundrcd dolhrs ($500).
<br />l. as owtrr olrhc popcny. m q.lusivcly co mrinS with liccnsd conrE lor ro .onnrud E poid (Se. ?o44. Busims
<br />dtd Aoftssion Cod.: Thc Conrdrd\ Li..n* Law dc nor amly to e 6wn.r or r,ro,,cny pho builds or ihlmwr rhd6..
<br />and who con@h lor such p'oirls *ilh a Conhcro(r) lietrsd puG@r ro tlE Conr&ro. s Li(.nrc bs).
<br />74 6u*".
<br />DECIdIdIIO!
<br />I hcrchy !firn utrdn !.nrlly of Irsjury otu ofltc,ollowins d(ldolionrl
<br />-lheE
<br />a willnuinrdn o C€ni,trrc of Con\d bsclf l.\trrc fn sorkch .onl|).trs.rbn. as fovidcd f(tr by s&1n,n .l7lx) o, rhc
<br />tjhtr ( odc, aor rhc ,rnnmumc oI lnL w.r[ nn which rhc Ilcnni is nsucd
<br />-l h!!. ond sill mintdn so cn .on{Ersrrio! insmftc. a. nqniEi by Selion l7O0 of llE tjhor tu . for lhc pcrfollrm. of
<br />rlr srk for *hich rhis ,cmir ir iNrn, My wdk6 ompcmdhn inru,@. ortr un l[lty tudt r d:
<br />I ccdi(yrh in thc p.foirnrmc olrhc qork for whict lnis pernril t issucd.I shulln.r cnploy tny pcson in any,unncr
<br />$ N ro b.Bom subrcr ro rhc w(,rtc6 .onlcnsriioo law. 6f Caliromin. rnd 088 lhol i, I should be€om ilbrc.l ro rh.
<br />wortcs' compensario. polni.nr .f Sdrion 3740 of $c rjhor Codc, I sh{]l bnhwilh conuly wilh th.c pbtisions..
<br />WARNINC: F,ilur. rd sln workcB onlFctrs0tion .ovcEgc is unl{etu|. rnd shall sutjccr an mll)loy.t ro .n riflal Irfllltis lnd
<br />cjlil ljnc\ up to onc hlndrcd rhousanl dollus (Slt[.u[), in nddnion ro lh. cosl of cnnr4r*rion. .taro8es !s nrovidcd for lhc
<br />Scd'un 1076ul thc tibtr Celc. nrcrc{ antl anarm\ t rev ,
<br />,",". iltt/zqi ^pp,e,l Lret ' ugEsEP-glNrxag!f,
<br />D0ctntrArrol!
<br />I hctul,y uilrn undcr pcn.lryol Frjury rhar I .tr! li(ned undcr amvision ofChaptcr 9 (ommrcins sirh sccrt o 70oo) orOivhn'n 3
<br />ol lhc Businessind PmfcsionsCodc.lnd nyliccne is in full a cc andcnrr
<br />SANIIBI]qrcIj.INDIIG.AGENCT
<br />t lEEby .lt6 u*r.r Fodly of Fryry thd Ih@ is ! @irtudbn Lidi.8 arlmy for rlE Frfolrffi of tlE srt for which lhb Fmn i!
<br />i$cd (s6. 1097. civ. c.).
<br />ATILICANTDECLAAAIIAN
<br />I lxrcby .trm uMcr ,.nally of p.ljury oic of ltc follo*inB d*ladrions:
<br />D.mujon P.mits-Asbcsros Notiricarion Fcdcrll Rcpul,tions (Titlc.lO. Prn6)
<br />Rcqurcd hrrcroiNotili( i,rr
<br />-l
<br />cslify rhar rl* f€nc l rclxlrrion. Eg.rding.rbcsb! nmv.l m ml.pplicrbh lo this pmj6r
<br />-l
<br />.6rify rh.r t hrw rcad lhic rppli..rio. rsl sl!r. rhd tlE ltrw i.fo,mtion is corer I slre r. 6.Dly wirh {ll Ciry a.d Counly
<br />onlinrmc\rid SrId l rs\nL i'r! r, huildi.F rucrion. n hcEby luthorizc rcFcentdivcs olrhir Cny ed Counry lo cnrs ur'.|lE
<br />.hovc Bnrioncd DrorEny lor insDdi,)"
<br />Appllo or Ase slsMlue /K--,",(n(\ao
<br />UNDER GROUND
<br />Waste & Vent qla,lhy /zrtYtlftD-- lt 'l -/
<br />Water-Under floor
<br />Gas-Underlloor
<br />Building Sewer
<br />AreaiStorm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent alotltt b a,w trt,/
<br />Water Pipino v td r.1r
<br />Gas Piping 2- t"- ")0e-&g
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq 1-tz-t\J),lrh io
<br />Meter Release
<br />FINAL l-7 - /9 J/rt'l-'fr)
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Miscellaneous
<br />Final Gas Test
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