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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Buildinq Sewer
<br />Area./Storm Drain
<br />lnterceplor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pi ping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meler Release I I
<br />FINAL slts lNotes, Remarks, Etc.
<br />OWNER EUILDER DELCANATION
<br />I hmby aftun und6 Fndly of Frrlry rnd I o qrcorr film rlE C4DrracroE Liccnsc Lnw for rhc folbwing rcasn (S...m11,5
<br />Bosiicss !!n Pmfcsrion Cod.): An, Cily or Counly ehth rcquiEs s Fmit lo onsttuL ell6 nqtrcve. &mlish or mpiir my
<br />{rude. rior to ils nsu!rc. dso quirc3 rhc q'plisd for sun pcn r ro ,ik , siS*d sr.tcm thar lE or shc iq liccnsd pursml
<br />lo lhc nDvisions ot rlE ConlEctols Liensn rrw (Chrpir 9, CommEine vilh Selion 7000 of Division 3 of lhc Blsin.is lnd
<br />Prcfcssions Codc) or rlur h. or shc h cr€mlr thcr.tom ad rlE tEsis for tlE al4.n .xctrrprion. Any viotdrio. otscdi'n 70! L5 by !(,
<br />arplicafl fo, a pcmi slbiccri tnc {!t li.aot to a .ivil pc@lty or ,ot mr lhd nve hrndrcd dollei (silo).
<br />-1,
<br />s o*m! of rlE FlFny, or ny cqrloyes wnh wascs s rh.t $lc @mp.nsirion. *ill do rh. wt and lhc sr.rr.lw Lq ml
<br />inr.ndcn o. o$.rcd tor sh (56.7()44. AusiE3! ard Prolcssions Cod. Thc Conh&rn's Ljc.nsc ttw d.er mt q,!ly lo !n o*mr of
<br />lh. pDpcrly vlb hrids or irymws llEs( .ri sno d.$ sh mlk him.€lf or h.tr.,aor thrcl8h his or h6 own crlloyc*.
<br />pmvi.lcd lh:l seh inprewdni! e ml inl.n&d troltu lor eL I nosrwi lh. hliEinB or inpoEm nst{i$in@r@
<br />of otr{,lclbn. dE Owrcr Bui6.r pil hls th hn!.n of prcvin8 tlu ls or 3hc did mr boild or inp,lE $. pmFty ltr dE FrpoE of
<br />l. a1oercr of$. tmFny. ro er.lusivclr.o.rrad ing *irh liencd.onhcb6 ro con{dcr rtE !,mjd (Sc 7044, Bt{rcsr
<br />and PrDfersin Codc: Thc Conrncroas Lkcns. L!* drcs mr aFply ro .r owncr of prcpcn, *ho brildr or inpovci rhcEon.
<br />lnd who omnds ror su.h nsirrs eirh ! Co.ln ro(s) lk n*d pursumr io rh. Conlro.tors Lt r$ L!w).
<br />I am crcmrt un&r S(uon , B. & P.C. for lht rcrmn
<br />IOBf,EXS:COMIENIAIION
<br />PEILASAIITIN
<br />I hcrcby lmm undcr ncnllry ofpgFry orc ofrlE tolldwiig deleario.3:
<br />-l
<br />hlvc md *i11 mrinhin r Cen ificorc o, Conscnr ro Sclt l.sure for sortc^ i,mp(nern o- !s lF)lidcil for by sccrio. 1700 or rl[
<br />tihtr Codc. for rhc pcriominccoitnc woll n)r wnahrhcFmrir is isu.d.
<br />_l have!.d will mainrlin *o.kcr' codlcnsrtion insurancc. r! rcqutcd brSari{,i:1700 ofrhc L*,or Co<lc, ror d. rsnnEns ol
<br />rh. s.rk for whi.h rhic tcmir is isncd. My workdC .ompctr{ari.i inqurr&c sri.r $d plicy numbcr m:
<br />-l
<br />ccnify lnal in lh.IErlornErc of lhe wort for whichrnisp€rmil is issued., shallnol emplor,ny pcEo. in dny @nf
<br />s a'o rE oft subtcr ro rh. wort.B comp.nstion l0ws orc,lilonrid..nd igm lhr' ill.hould bcom subjcd lo llt
<br />worksl onl')cnelion lmlisions of Scdion l?00 of lh. t tnr Codc, I stu!|, fonhwilh comtly wilt l,Ds !,mvisionr ,
<br />WARNING: Fi'ilurc h s.urc soikc^ cotp.D\alnu .okrllgc i\ tnla\rul, rtrd \hnll {hJ..lmtloycr to nimind lEnohics lnd
<br />a.n. danu*$ as providcd for lhccivil fi.es rt lo om hundr.d rhousnd dolla ($100.000). in .ddirio. ro thc cnn of @
<br />S(l ion 1076 of lhc Libor Codc. inlcrcsl and anomy s fes {. tt tt6Dol€: Arpli@l
<br />DECLARATI(IN
<br />I hceby trluh nndcr pcnfllry of Frjui, !ha' I xn li.cn*d und( ln,lisi.n.r Chdl)le I (conftftin8 wilh Sdion 7000r otDivhion 3
<br />.f rhc Busirc$ lnd Pmfcssion\ Codc. arxl my liccnsc t in tull forc ud eifsl.
<br />-(g
<br />caN,5IISilJIrN-Ll;NlttJliJ$INct
<br />Ih.rrhy lfNund.r IrmlryoflErju!yrhrr rhc'c i\ r.onnnr.ri(,n tidi B rBctcy ln. th. rcrloirnrNc olrhceork li,r shi.hthi\ Ifnnir is
<br />is\u.d lscc .109?. Cir,( )
<br />AIELICAII.DECIdIAIION
<br />I hoEby .nim undc. Fcn.lry of psiury orc of rh. follosing d(holione:
<br />DenDlhiof, Pcrnils-Asb.slos Nolifidlion tu Bl Rqublions (Tnb 40. Pon6)
<br />-Rcqund
<br />Lcttcr ol Norifrarbn
<br />-l
<br />ccnifyrhrt th. acdcml rcglhtions rcSdding &6csros remhl arc nor ryrltabk lo rhi. p&j..l
<br />Iccnilyrh8r Ihn\ercadrhisatplicrrionaflln ciharrhxabkintunturnn!
<br />or'liix'...s Md Srarc lr*r elarngb building consrucrion.,.d hcrchy uurlltrizc
<br />I r8re lo condy wnh oll Cnyand Counry
<br />lrivcsofiht Cirylnd Colntyro c.ter uton thc
<br />h,r D*nrioncl F)ncnv ntr
<br />,\pplionl nr Aq(nr SiBn.tum:<- u-
<br />IFIflIMfirt
<br />*-u-**,on"r, -TF,
<br />Gas-Underfloor
<br />Pool Heater/Gas Line
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