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PLUMBING.INSPECTOR HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Under{loor
<br />Buildino Sewer
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />It/ain Draini 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 />Back Flow Device
<br />a)FntslRouqh Plumbinq {/t't/tt 9ir
<br />Final Gas Test
<br />Meter Release
<br />FINAL 4-/?-/6 ..//r
<br />Notes, Remarks, Etc.
<br />OWNER IIUILDER DELCARATION
<br />I h.,chy rl6nn und.r Fnalr! .l prrjury rhlr I m cxctrr!,r from rh€ ContrrhE Li...s ti$ liY rhc nnl'sin8 r{$n ISLU 70.11 5
<br />Bu\nrs !n l Prolcs\n)n c{'dc): Any Cir, or corir, *hi.h r.qurc\ r |irnrit ki $nslrucr. lllcr- inpr'!c. dcrmlhh or rcNn lny
<br />rtucr&, prtur{, n\ i\sodkc, also rcquncsthc +plic,trr l'or su.h tr lnirto,ilc a sisncd { ent i rhar hcor shc is liccnscd nuruant
<br />lo rhc nmvisions oflh. Conl!!.lor\ l-icctr\cd hs ((hll)lcrr). (',nn'En. nE wirh Scdioo 7t{)O of Divnioo I of rhc Brsincs rnd
<br />Polc$nnrs Codo or rh0r h. or \h. i\ .tunvr rhcr.rr.o d Ik h\ir ror rh. rlLSed crcmnl ion Anyliollrio!orstcri,nT0ll5byrny
<br />rlplna i loraNrmn suhjer rhc npflicanl lo !.ivilncmllyofmr nntrclhr nvc hLnd'.d dolle\(1500).
<br />-1.
<br />s o*Br oaihe prcFny. or my.nq,loyss wiln wl8cs.s lhcn sb mnwn$lio.. Mll do dE wk tid tlE srrEtr k ml
<br />inl.ftlcd or or.rcd for slc (SN.lOl4, BrsiBs lnd Prof.sioN Codc: The Cod.eto* LiNn* t w do.s iol BPI'D tn .i owE ot
<br />rhc nmrEny vlro hoilds or inpros dEmo. o.d who &B $ch wrt tiNclf or hcMlf or llhugh ht o ho oan ctrplottcs,
<br />Pmviddihal such inllmwmnlle ml hl.nd.d oro,Lrd tr sb,li hoEE( E hildin8or inp,ltmnl is$U eirhinorc lar
<br />of€spLrbtr ltr OvEr Buil,.r wil hlw dr hu&n or lroliig tlEl ,t tr slt dii 6l tdiU or i.pmB t E FoFty for lh. Furros ol
<br />-1.
<br />I osEr of tlr pmtEly. !m cxclusircl, @ @tins wnh lkctr*d.o.[rct.R io.oniMt rh. porel (SN. ?044. BaiB
<br />o'd hDf*ion Codc: The Conr6toas Licc.s Law d&s .ol al,ply lo an owncr of prctEny eho buildr or iq'rcws lh.rcon.
<br />lnd wh6 6fl6ch tor Nch proj.ck *nh . C.nrmcro(s) lienEd ,uB@r ro rhc Cort r.tn r L@n* ks)
<br />I andc.'ll und$ Sc.o.B. & PC f.rrhi\ rc on
<br />wot(nr6, coMpi.ltsaTt()N
<br />D&CIIIIAIO!
<br />I h.rby afiirm ud., l).nutry of !.rFry 6nc of lh. folloainS dNlmlions:
<br />-l
<br />Mw dd will @inls t Cenilirst of Consr to Sdllslr for *dt6 @dp.r!dbn. s ploviLd for by S*lion 3700 of lnc
<br />t$or Cod.. fd $e F.folrt!@ of $c port for which rh. Fmi is L!s!.d.
<br />-l
<br />haw snd will maiflluii wortcts c6Fpcn* ion insuruncc. $ (qun.d hy SBt ion l?00 of rlE kbot Cod.. toi th. pdfornw. of
<br />ir iinai. My workda smp.nsrhn insua c aEtr !d poli.y nuntx. d.:
<br />rlhr C+>t ,rl .
<br />EN,./uJ Cet 5c7 dlo 4
<br />-l
<br />ccnilirh in rhc Frro.m..c oflhc wort for *hich rhis p.rmn h hsucd.I shdu nol cnploy onyp.rson io any mnncr
<br />$ asro tr6m subj.rl lo lh. workcr' oryf,trsrion l,es orcaliaomiu. and !8r. rh0l ifl snould beom subr€l ro l,t
<br />workdc .oBl*nsthn tmvkio,s of Scclion 1700 ot rhc Lat r Codc. I th.ll. ronhwith comply wnn lhoc pmvisionr..
<br />WARNING: Foilurc ro wrc *o .tr coryrcnqlion covcE-lc is !nla$tu|. ud shdu {bj.{i M .mphrr to siminal Felii* lnd
<br />civil nneq up r. on. hundFd lh.usnd dolla (3100.000).i. addnion lo rhc co{ or n. drtrurcs as ,,n)vnicd inr r[.
<br />IECI.ABAIION
<br />I hcrh, rliirn undcr Icnrllyofl]crjuryrhrr I [n liccn$i mdcr toririDn ofChlptcr 9 ((xnnsncins wnh Sccri,. Tux]) oiDivnion.l
<br />ol thc Busiftss ani Pmlcssi.ns Codc. un nry liccn$ n in full turc sJxl .r..r.
<br />o4qotQ
<br />t6ler..r, a t ,}n'!i conlra.lornHrrr
<br />CON!iISI]cII1}XItrNDIN AILCI
<br />Ihdr.tyrfttnrrdrrFMlrtorltrjuyrhntthcrci!con\iflrclionbn,lin8r!.nc,r rhc pmrormn.c ofthc work rir ehich rhis Fnnir h
<br />is{ucd rs€.3rn?. civ. c )
<br />A.EELICANLDECLIBAIIQN
<br />I hfr1'y {,tim under p.nrlry ofpcrjury o.e otih. t,U.si'rs decbDrions:
<br />D.mliri.n P.rong Asb.nos Norindion Fcdrnl Rquldions (Tirlc.l0, P,nO
<br />-Rcquncd
<br />krtcr olNoriftrtrrion
<br />-l
<br />drily rhir rh. fcdorl ESubtiom E8&din8 &rbcslos rcmvd m mr .llli.nbL t rhi! pruicr
<br />Za,*,itithd llu\c r. rhi\trIpll.rnn, d {rrcrh rhc rh)vc r I asN roooply wirh rll cityund counr,
<br />ordinomes and Sr.lc L.*s rchring ro -'t|fiY,f"?,'ioTs-
<br />ab.vc mmio..n ,opcny for
<br />tU
<br />Area/Storm Drain
<br />Roof Drain
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