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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTVNDR Bt]II,DER DEI,CARATION
<br />I icrchyrin uidcr p. xlry of pcrjtrry rhnr I Mr.xc rpr lio'n rhc C.ntrfon l-trtr\c ljw tur rhc lollowing rcrv'n (Sr70.11.5
<br />Brsincs rkl Pr)fcsrion (dci Any (-iry or County shich rc.luirc\ r ncnnir k' con{rucr, allcr, i'rpi{rrc, dcmolhh or totxri M,
<br />rrru.xrc. prin ro its t rncc. aho rcquircs rhc lPllicinr lor such r.mir t, filcd\igncd {ar.ftnr rhm h:or{E il liccnscd luru t
<br />b rhc ,tuvi\nrN uI rh. C trra.rols Li.cnscd Li$ (Choprcr 9, ConnncncinS silh Sccrnrn 700lr ol l)ivi\idn .l of rh. Busincs ttrd
<br />Prci.$tuns Codc ) or rh h.orshc ncx.mpl lhcrcrionrrnd lhc hasis tir lhc rlhscdcxcnfrio Atryviohrn,norScclionT(r.ll.5hyoy
<br />apllicanrtrrFnnir\uhrlchrhcllrlicrdt,r.irilr.nalryofnor !tr rhrn fivc hundrcd doll.r (t5OO)
<br />-1.
<br />!s osncrol thcrmllcny. olnycmnloyccs $nhsrs.s rs rhct solconllEn\rrion- silldoItsrrkDnd Ihc idtuE i! our
<br />inr.idcrl or oiltrcd lor elc tSN 70.!1, Bu\in \r rd Pi.Lrsions CGlr: rhr Cbnrrtr'\ Li.cn{ Lrw dms nor Bpdy k' r orn$ of
<br />rlr pn'r{y *lr huil.h or iq,ro\c\ rh.unr, aid qho do.s n,.h work hi'nsclfor hcrslfor rhreu8h hi\ or hcr own.mpl.y.cs.
<br />provdcd rh.r {r.h iDnnrcnEnt @ mr inrendcd or oftrn li,r slc lt lx,*6s, rhc buiunrS or nrV$ur nstlnnhin,ncrd
<br />of.onlpkrt,n, rhc Osn r Buildcr willhtrw th. hdcnorlnrvtr8 Our lf, or snc dil mt buildo! inlpmw lhc Impdy n, df, l!rF$ of
<br />L N owmr olrhc prcFdy. am .xclusivcly conlracti.8 wilh liccns.n conlractoB lo .onsrtucl lhc ltrojc.l {Se.. 7044. Busilcs
<br />atrd PDLsion Codc: Tfic Conrturols Li.cnsc L,s do6 nor apDlyro dosrcr 6rr,6r,cny who buiids or inprovcF lhcrcon,
<br />md wl'o con"ac( for such ,micds pith . ConrBcto(s) licns.n puisunr ro tlE Conrdrols LieM l,lw),
<br />-I
<br />rm cxe mtt u.da Seiio.- a. & P C for lhis Essn
<br />Dot.
<br />woR(r'R(' C0MPENSATION
<br />DECLIAAIION
<br />I h.rcb, aitum undr FMlly ot prjury orc of llE louoain8 d(Lhlions:
<br />lhr\cn lqillnui ninrCcrrin.rrcoiConrnrt('S.ltltrsurctur*orke^'$nlncnnii,,i.r\ ptuvnldd Lr hyScclion llrlDofrhc
<br />tihtr G)d.. fd rhc llcrronMkc.llhc work for qhi.h th. ltnnir is isrucd
<br />_l hlk !trd *ill mior0i. Bo,kc6 .o.!rr3,rio. in$Bmq &s rquircd by Scriotr l7g) of llE l-.hor Codc. for llE pcrfo@ncc ot
<br />rhc w6rk for *hkh rhh pcrnir is ksu.n. My workdC .o'nFNslion insu.Me cmid en polty numbd ee:
<br />P.li.yNu $..-ltrttcs
<br />-l
<br />ccnify lfid in lte pcrformancc olrh. work for *nich lhis p.mir is ksucd.I shall not.q)loy any Pcson in any m!.ncr
<br />s a{ b lrftm snn kt h rh. mdrcn' .or{Ensarion laws of Crliromin. 0nd rgrc lhal if I stnuld hcroft slbrc| ro rh.
<br />mr*.r{ cory)cngrion povhions of Sdion 37m of fic lihtr C!de. I shall. aonhwilh smply wilt lhoE F)viiioos..
<br />to surc worken ompcns0tiotr coEroSc h un sfinll \ubjccr sn .mtlo,tr ro diniM! pcnallies lnd
<br />hundrcd rhousrnd dolla lslfi).tx)(r, in lddnion cosr of conqcN ion. drm8.s {3 provid.d ao, lhc
<br />Codc. inrcrc$ lnd dltormy'
<br />I hcruby{ilnn tridcr pctrJlry orFrury rld Ltrr und$ Fovi\ion of Chapler 9 (commminS wnh Sccrioo 7000) Dl Division l
<br />of ltc Busimss lnd PDfcsions Conc, and ny liccn$ h in tull {orcc ltid cr.cr.
<br />I tcml,y nfiin undcr pcnalry of p.,jur, rhir rh6c h a
<br />isru.d (Se.3097, Civ. C.).
<br />n bnding lgency tor$c pslornue oflhc wo for Bhich lnis Fmil ii
<br />AffulANLDEclrLBAlIO!
<br />I lrr+,y,ftrn undcr rnrlry oll,crjury orc ol rhc nnh$in8 dcclrlliors:
<br />Dcnnlirdr Pcnnirl^\h.{o\ Norincdmn Iicdcrnl Rceu[rDn\ (tirlc 1O. Ian6)
<br />Rcqunrd L1(cr of Norfi .dioi
<br />-l
<br />ccnililhor lhc fcdcml rcBuhrn,ns rgddins astrslos rcnnlal!rc nor aprlicnblc t,lhis pmid
<br />-lccnity
<br />Ihll I hlrc r.ad ihi\ lplrlicrrion rtul dar.rhnr ahl,E i.rffro'hn is colNl I agre ro snrtywitt lllCnyand Counry
<br />ordiilnccs lnd Srorc h*s rchtins ro buiHing and hrrcby urhdri2c rrtrc\cm ircsolrhisCityrtrd Counryk'c rcr trtirrhc
<br />abovc mnliomd pm!.ny lor
<br />,\ppli.ahl 0r AAenl Si*nnl
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh 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 />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/06p t-5-k v.t4l[)
<br />Back Flow Devi5e
<br />'
<br />Rough Plumbing
<br />Final Gas Test
<br />Meler Release A
<br />FINAL a
<br />f "9- tk ft.,\4tD)
<br />Notes, Remarks, Etc.sv
<br />L€ndcis N!mc:
<br />-
<br />ktn 13 Addas
<br />Pem[@Em(p.tnr:_
<br />^,., tfqftg
<br />Waste & Vent
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