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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE to/stG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under Iloor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />Waste & Vent <br />Water Pipino <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />It/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 />Rough Plumbing <br />Final Gas Test <br />FINAL 5-1-lV 7.W.il) <br />Notes Remarks Etc. <br />OTVNER BUILDII' DI'LCARATloN <br />I hcrchy illtn xndcr pcorlry ol pcrjury rlur I am cicn{r lnnn rhc Gn{r}.hN'Licnsc L.$ for rhc l'ollowi.3 Er$n (scclo.ll5 <br />Businrss rtul ltolisi{r C.d.)r Any Ciry or Gunry shich r.qtrn.r r r^..iinil Io on(ruct. ihs. irpnra, {Lnkni\h 'tr rqrr Jny <br />{ru.ruru.ri(rhirs,rru,tr.c.rl\orLatutcsthco,rpli.ndrir\u.hBirnnn'filcr\i8mdnrrc'tu 'hr h.nr sh. is li.ctr{d Pursu.nr <br />n) rlr F,!i\it)ns ol rhr Coirrurtr's t-i.cn{d tip (Chllrcr 9. ComnrRing vlrh Sc.rion 7U$ ol l)ivhn'n .1 otrhc Au\inc* rnd <br />Prolis\iorsCorlc)orrhirh.orshcis.xcm0rrhcrclioD drh.bJsnntrrhcallc8cd.rc'nprion Ant!i,'hri tofsr.rirl0:rl.5by!iy <br />!p!licrtrr li)rr p.nnir rul,Jlcrs rhc arpli.,nr io n.n il lcnrlr, of n.r niRrhntr livc hutrdrcddoll{r\ (S5U)) <br />-1. <br />as oqrcr of rhc p'Dtrry. or ny .trOloycs *nh urscs &1 rhcn sb @npcB.tion. wil do IIE *dt !n $. nrkr@ is ml <br />inrcddr or off.rcd ror $h 1Sd.7044. Busimrs snd Prbfcsiom tuc Th. Conlreror's Ltlde tre &B lor +ply lo u owrcr of <br />rh.lo,rcny wtF ttuildr or inprors tnde rn<t Bt dG sh mlt hirelror herclf or lhmuSh,rk tr hd own cnrloye3. <br />novidcd rhir skh inrovtmnts @ mt inr. hd orofi.Ed for sb. If.lbftE rn€ l,ilding or inlx*E k sld v'lnh @ rru <br />ofhtrplcrhn. rhc Owmr BuiHd wi! hor r|t b&hn ot Fovin8 rhar lr or rhc dll ml t{ild o. irpmE dE pDFly for dE I,TIFE ot <br />L asowtrcr ofrhc ImFcnr, ,rn c xc lusi vcly conrroct ing $irh li.cn{d conkxcn'nn' condni.r ihr pr$id (S.c. 704!. Busims <br />und hnasbn Codc:1hc Conra.ktr \ Liccnsc t r$ docs tror I who builds or imrrcts rn..con. <br />&d wlE .onrrn ts ror su.h pojers with. conrracro(9 <br />6? <br />tlljlLlllillr.u! <br />I hc(by aflinn und.r !.flkyol ptrjury onc ofrhc followinS dc.laralions <br />lJxtr(,xl..lnrrh.Jrno xnrcotrh! sork ntr{hL.h rh. |tnn i\ ^{'rd <br />-, <br />nav. snd eillmtrinl"invo cr' co'npcn sar ion in\lmncc. !s rcquncd tySccrnrn:1700 ofrhc kbot Codc, for lhc lcrfo,marcc of <br />lhc mrk for whih lhis rEm is isnd. My *ortcn mmr..solion insorancc ceicr dd Flicy ntrnbcr m: <br />Poli.y N!trttrJ4ircs: <br />-l <br />ccdily lhd in th. r€rormmc olthc wo* ror uhich lhh Frmit is irsocd. I rhill nor cmploy tny !.Mn in lny morcr <br />s !sro lx.od $tii*r ro rhc Mltrs conqEnsrio. lNs of Cllilomi.. Md r8m rnd if I should bc{om sbjd lo rh. <br />sortcF c.'nNn\!rion pdli\nlni orsernrn l7(xr orrh. ttrhr Codc.l sh.ll. Pnhwiri ompl, * <br />WArlNlNGr Flitue ro NU,. mrk ^ .otrp.nsdion o ,ri ro rimiml FMhics md <br />cPil fii.r up ro om hundrrd rhoussnd <br />s"--" !n76 .r,h. r /h' d.d. i"F-{ <br />"",", "rry/o <br />damgca as pnvidcd for rh. <br />I hcrcby a,lrh undcr pcn.lyoftcrrury thd I am li.cn*n nmvish.aChaprcr 9(conmncing wilh Scctiotr TOOO) olDivisn n l <br />or rh. ausincs rd Pmrcsions Codc. lnd mylicctr* h inlull forcc 0,n cilccr <br />CANiIAIIEIIONIf,NDIIiIiJICII!:I <br />I hcrchyrfiirmumlcr rnrltyolpcrltryrhrr lhcrc isa(nrln'dion tnningrgcn.y n rhcIf, nnrrn.cofihc$orllotshihtiispcrmiris <br />i{\u.d rsc. 1097. Civ (.). <br />A.ITLICANLDECLAXtrIIAN <br />I hc[$y ainm uM.r pnr]ry ot lcrjury onc of rhc followins dcclr{rio.sl <br />Dcrnolnio. P$nir\ Asb.{o\ Norin.nlnr rrdchl Rc8ulrrions Il-nh40. PlnO) <br />Rcquirdd Lc(cr of Nor ii.ndrl <br />-l <br />cerafy rh l h!rc ,c!d rhis rppl corcd. I a8re to co rlly *irh rll Cily md coutrly <br />orlinanc$ rnd Srtrr. uwsrclxrin8 snlnlivcs of this Ciry$d <br />rkrvc mnrbncd pmtcny lor ? <br />I <br />TOP OUT <br />Back Flow Device <br />Meter Release /n\ <br />lr!d.r'r Addrs! <br />- <br />_l ccnilyrhol rne acdcol rcsulsrions r.B,rdina r\bcdorrcmovdnr. n.r utdicablc ro thn prcj.d <br />-------T------ <br />-------T------