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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />UNDEB GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Roof Drain
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<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 />Back Flow Device
<br />Houqh Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL 5-tg-tt-vd
<br />Notes, Bemarks, Etc.
<br />OWNER BUII,DER DEI,CARATION
<br />I hcrclly !finnr und.r pcMlryorp.r y rhnr I amcr.n,fl rflnn rtu Cont,.rom l-i.cnsc Lrw rb! thc followins rcr$o (s.c7(lrl.5
<br />Buiios\ !'al Pi{Jr.*nn cl)dc)r Atry cily or County wnich toqun$ ! pclnril ro con{ruct. alrcr. inDtuvc, {knDlirh or rcpri. any
<br />sflcnm, rrturo ih hsuancc. rko rcquiEs lh! aprlicrnr lorsuch pcnnil ro lilcx \iEicd rar.nEnt rhit hcot shc n licctrsd Pu^uanr
<br />b thc ptuvisnnrs of rhc G,nLr.k 's Liccnscd Lrq (Chillcr 9, Connrcncin8 wilh Sccin T0(lO .l Divisn 3 of ric Busincss rnd
<br />PiintsiotrsCod.)orrhrlh:orslrciscxcnrnrllrrciro'nndlhcha\i\forhcrll.scdcx.nuti.tr.Atryviohln,nolScrion?0.ll5byrny
<br />rmlic!nrrhrrpcnnirsuhjccrirh.,!tlic. loa.ivilFn,lry.rnurnsrcihrtrlivchundEidollaN($5u)).
<br />-l-0sowncr.irhcpmpcny.o.nrycnrplorcc\eirh*asc!rsrtctslccompcn\dn,r,willdo$crolknndficsrulurui\iorinrcndcd or oficrcd lnr { c lS( 7(}4!, Bu\incss and Ptuf.\\ion\ c(do: Thc Confuct(tr s l,iccnsc Lrw doc\ norrpPly tu nn osrcr of
<br />Ihc poo.ny who builds or imDrors rhcNr ul $h. d,Er sEh slnl hi'nscllor hcr\clfor r)trough hk or hcr own cmaloyccs.
<br />nmv i{lcd rhrr such i'npmvur s nrc mr ifrdkld or ofrcd ntr \rlc li. howcvcr. rhe hlilding or iq'rovcEnr i\ sold sirhii ,,n( i{r
<br />ofconDhrion.rhcoencrBtrildcrrvillhlrltEbudcnotpmvinslhalhcorshcdid nboild.riin (^t $c pmncnr rbr rhc puqx'* of
<br />-l.
<br />as owrcr ofrtu prcFny. mcxclusirclyconhcrinB wirh liccn*d conrrrroF ro co.slflcr rh. pbjdl (S.c 1044, BusincB\
<br />and P,trf6.im Codc: Thc Conracror's Liccnse Law des nor apply 16 m ownft of lrop.ny who builds or ifrrov.t thcmn.
<br />d who conrracls ior such prcj(ls with ! Conhcro(, lic€ns€d p.r@.r ro rh. Conirebls LiftM t w).
<br />-l
<br />ancxcnpl uodcr SNlio B. & PC. ftrrhistcason.
<br />UOf,6Ef,S-.COMIEIEAIIIIN
<br />PECI.ASAIIQN
<br />I hcrcby olfim unds pemlry of prjury oft of rhc followhg .lc.lararions:
<br />IhrlcddwillDri,n.(tnilicrlcol(.{,nrnrn)sclfln\u.clinwo'kcr'.ortcisfii.n,isl)lovnlcdlorhySccli,,n-]7()olrhr
<br />LntxtrCodc. nr rhclr.ronnan c ol thc{ork lbr shi.htfu l{irnir i\ is{rctl
<br />_lhavcandwillnrinrainsolkcNconpcisarioninsorancc-&\ftqlncdbyS.crionITOOoflhchhorCodc.forlhc!.rfoM.cof
<br />rhc rork tor whict lhis Ilcrnil is issucd. My worts ooFnxdrioo insur&@ cdicr ad Iblicy Dumber m:
<br />I cdiryrhar i. rhc p.rfoirmncc of lhc work ior whkn lhh Frmit is isslcd. I +!ll n r cnlpLyany pcMn itr.ny mnmr
<br />$ as ro b€om subjd ro rie wo&oa cooFnsdrio. laws orcalifornii. d a8rc ihar ifI stFuld b*om subjecr !orh.
<br />sorker coq,.nrirtun povhionsofs*rkrn lTmofrhc tibor Cod.,I shnll. font*ilh ompl, silhlho$ tmvisions..
<br />WARNING: Failnm lo *.uE worken' .o mncn sol ion covcm8c n unbwf!1. i.d rhtrll subjcct an .'nplorrr io ciminul Ftuhies and
<br />ddirbn ro rhc cos of.omp.ns,rion, damoSls as prolided lor rhc
<br />I herb, airtrr und.r lcnoh, ol !.rjury rhar l,n liccn{d und.r pmvision orchaprcr 9(.omrNncinE wilh Sslion 7mO).rDivhn n.l
<br />ol thc Busbcssand PofcssionsCodc. ud nylicense k in iull forcc and cnccr.
<br />9,.qat-
<br />Y IJ TIJtq,
<br />CQNSIB]JCIPNIENOI Ii.dC.ENII
<br />I hdrcbyrrarnuNl.r Fndhy ol Frtury thot lhcrc isacotr{rucltun lc ingxgcn., rorrhcp.rhnMncc ofrhcwork for Nhich rhis ts.'h i\
<br />i$ucd (Sec. :1097. Cie C ),
<br />ab.rc nEnriomd tmpcny lor ins,dion
<br />Applicn orAaenlSiennru
<br />IEEA
<br />COMMENTS
<br />kn.Lis Addrcas
<br />AITLICANLDECLAEAIION
<br />I krbya]Imunder pcnolry.rt.rrury om of rhc followirS d(leaiions:
<br />Demolirion Pcrmirs AslE(os Notii. io. Fcdc..l R.Sulario,s (Tirlc 40. Pa6)
<br />Rcqut d trtt.i of Norilicalion
<br />- I ! c1,.]E rrE-c
<br />'cJcidl
<br />r cBular trin. mgd 'l'na s 'h.tr.\ r c''r 'vs l .n.r'ofltrrhlcrorhFnmiRl
<br />]r6aflib rhd I hrrc rcdd rhs apphlnno ,nd drrc rha, lhc ubvc irrorndion iscomcr.I rlre tocom yw h,uc,ryrndcounty
<br />minan(c.;nd srorc L!*. rcldini i" rrrr.ring conrmo,on. ma lcdy nurhoi- rcprcsnrari;s orrhsciri dd c6trdib otr ufl;tr rhc
<br />Area,/Storm Drain
<br />TubiShower Test
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