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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS O!TI^{ET AUILDER DELC trATION
<br />I tErcby affim udcr Dcmlly ol pcrjury lhd I m ercn{ tmn the C.ntftlos Ltcn* k{ aor lhc fouoeilg rssn {5(.7011,5
<br />Busir.$ r.d Prcfc*ion Codc): Ary Ciry or Coudy wni.h r€quircs ! pshn ro ointucl alt6. in 6E &mlisn or Epah ey
<br />srructu , prior ro ns Lis!.rc, lls rcallEs rhc,ppltor lor slch rEmn ro fib a.i8rcd sulm rhn lE or 3lE is lie.sd PuMnt
<br />ro the !rcvbions of ir Co.r@blr Li.cn*d tlw (Ch.!r., 9. Comrcing wilh Scclt. 7000 ol Oivliion ! of lh. BusiG$ lrd
<br />Pmf.ssions Cod.) or rhar lE or shc k cr.npt thE roh .rd rhc b.sn for th. alLgcn €rcnpion. Ary viollrion of Sdion 7031 5 by an,
<br />rpplica for a lcmjr subrrls rhc apdicd to . civil p.nshy of mr ma ih.. five nu.drcd doutrs (1500)
<br />-1.
<br />$ owmr olrlE poFlry. or iy cftploJr< wirh *asci ar rlEir elc onv..siio.. will & dE wort.rn dE nrElE is lEl
<br />inr.ndqi o. offcrci fo sk (Se.'t044. Ausiftss and ProLsrions Conc Tn Cor .!.rd\ Li.cn$ trw dca mr .pply ro a owE ol
<br />tlrc FDIE ty vlE hits or in{lla dEtu.. &id who dB sh mrt tiN.lror n Nlf or lhrclgh his or lEr owi c'roloye.s,
<br />provtdcd lh{ srch in9l$m' s e ml it .i&d qor.Ed nr slc. la houdE. [. tuildi.g or iqftwmtl ir 5! wnnin orc tE
<br />ofonpLlio,L UE o|xmr Builds will lEw rh. t!r&n oflmving rhd n m sh. dii hr l[ild or itrproE dE !'DFry fo. ttE pu,po$ ol
<br />-1.
<br />as owm! of thc l,roF lr, an crctusi!.ly conrelinB wirh lie.cd .o.rr&rm to conrrucr th. poid (Se. ?044. Buiinc$
<br />ald hrfGrtm CLierThc Conr@ror's Li.cns. kw docr nol +p,yro owtur ofpmFrrywho |ruilds o, imp,ow.lh6.on.
<br />and who srlEcrs for sucn pdrcds *irt ! Co.mdo(9 liccnscd pu6unr rd rhc C.ntraclols Liccns t *).
<br />I mrxcM und.r S(tion .B &PC fnrrhn@en
<br />TAXf,DXI]g)I4PINSAIION
<br />DECI,ASAIION
<br />I hcreby a,nfln undcr lcnlhy of Frlury onc ot lhc fouowin8 drcldllions:
<br />-l
<br />haw atrt will mirt0in . Ccnifrrlc ol Cons.l lo Scr.lnsuE for mrks3 oq).tulrion. I ,rcviled fo, by Selhn ,7m of thc
<br />La[o Co<le. 60r rhc p.rloM of th. e* lor whth the Fnil is Lsscd.
<br />_l harc und will mainraifl *o,kc6 ooN.r.rio. in$orcc, $ r.qxired hy selion l?m of lhc Lahor Codc, f.r rhc Frforrrwc 6r
<br />*6116 oqrMrion i.s!,m si., !r'd polty nun !, e
<br />qltb{Xt s.zb.ru
<br />-l
<br />ccnifyrhat in Inc I'crfortu@ of rhc Mrt for which rhh p.rfri as iqsucd,I shall nol cmploy anr rcson in any Mncr
<br />$ ar ro bcmm slbjccl ro lhc m.k6c oopensslion lass oi Caliaomis. alld aEEc lhrl il t sholld t ccom .ubjer h tlE
<br />wort* comtcnsdrion pb{isionr of S.clio. lTm of $. Lnbor Cod.,l sholl.fonh*ithcomply *ilh lhos pm{irioN..
<br />WARNING: Failurc lo s!,c workcis cohDcntlin .ov.,!sc is xdawrul, ,nd shall \uhjd .n cmrlott. lo diminal FnDlris @d
<br />civil fincs up lo onc hundrcd lhou$fld dollss (Sll)o.lXD). in addilioo to rhc cosl comncnsoliotr. dam3cs as prolid.{t foi rhc
<br />Scrion llr?6olrtul,rkn(i .. i c'c! iJxrS.zq'l(
<br />D}:g.AAAII9!
<br />I hcEh, aflirm lods pcndry of Frjur, lhar I m lie sd xnd.r tovtion ofchdprq 9 (con'mmins $irh scdhn 7mo) or oivi\ion l
<br />of thc Busircsr ond h'li\sio.s C{d., d
<br />'ny
<br />li..n{ i\ in tull n*e iJxi cflccr.
<br />13 (o tt q lb<.x\ft k6c
<br />caxtmltcur.NLDNDllc-acENcr
<br />, hcEby riirn undcr pcnahyolF,juryrhar rh.E ii r $n{o.ri,n lc.din8 agcncy fn lhc pcdonune oarh. *.rk ror ehi.h
<br />'hh lEmil is
<br />issucd 1s*. -1097.Civ. C ).
<br />I"PzuCANIIII;I.ABAIIII!
<br />I h.rty nrm und.r Fnally ol,Erjry om olrtE Iollositrs dcclarorn,ns:
<br />D.nxtnbn P.rnirs Arb.(or Noriric0rbn F_cdcml Rc8uhrnns (Tillc 40- Pun6)
<br />_Rcqxt d lrrrsrof Norii.ar$n
<br />/ lccn'l) tlr. rhc lcdc'rrrcculortr.n\ rcFrd'nF r.hciu\,cntr^rlrr n'{ rfnlhrhl. n, rh^ nF,ccr
<br />Lj*nr, *, ,n ." *,0,n,\ rFptr. tr,n Jrl (d( rhJ rhc.tnvc irtonMrion i{ cotrccr I ssrR k,co nly wirh lll cir, rtrd county
<br />o.dinanccs and Srar. liws eh in! b bxildinF coorlfl.tion,rcprcs liilcs of rhh Ciry .nd Counry lo cntr ulrn lh.
<br />{l,ow m.rioEt oDrcn, lo. i.sF.r t(Appli(anl or Aa€ni Slputue:
<br />rl
<br />S-29
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptori Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<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 />Miscellaneous
<br />Gas Servrce
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq Llul (,q -.eu,4 7d
<br />-l
<br />Meter Release
<br />FINAL roflahr 1t\1fr
<br />Notes, Remarks, Etc.
<br />kn'lc' . NJn'c
<br />tr,,L,-'. J.lr..
<br />Tub/Shower Test
<br />Final Gas Test
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