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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNEII IIUILDER DELCARATION
<br />I hcrby al6rm u id$ pcmhy or prjxry rhd I ar .rcmfl fon rhe Coorrlcio6 Li.cn* ljw ld rh. rollrwins rcisn ( Scc.r0.l l.5
<br />ausircrs nnd Ptufusrn,n C.dc): Any ciry or Cou ry whi.h ruquirs r ltnnir ro (nriru.r. lllci nnprorc. dcmnhh nr rcnrn rn,
<br />slddur. ri)rk) n\ irsunftc. nl$ rcquncs rk+ rt'rli.,trr for (u.h l*rn h filcr ri8trcd s{cmnt lhalhcor shc is li(.n{J Fr\uanr
<br />ro thc F)!isn,n\ of rlf, G,nt,.roas Li.cn{d llw (Ch4rcr 9. C. !nc..in! wirh Sc.rion 7m(}.r Divhiotr :l ofrhc lrusinc$ rnd
<br />Pdtsrio.s Codc) or Ihd lEorshc hcxcmp[hccrio Mdrhc bish rbr ihc.lL8.n crcmllion AnyriollrionofsccrbnT0:ll5byany
<br />artli.tur nrnpcnnir suhjcct\ rhe {'rlicrnr ro I cilil Itfulry of n.r nuc rhln fivc hr.drcddollrl(S50o)
<br />-!.
<br />as owrcr oa rh. polf,ny, or my chployes oirh w,8.s trs rhcir $lc strlp€nerion. vill do ltE so* dd rlE surEr@ G Fr
<br />iillor&d or orced lor slc (56- 7044. B$im$ lrd Ptofcssions Codc: Thc Cont8dur's Littre Lrw d@r nor loDly to e os( of
<br />rhc pqEny who h(iildr or inp,o@\ oEstr ard qlb dG Mh eort hidrll or lEBlf o, rhreu8t hai or tE. own cnplords,
<br />provid.d rhrl .u.h inpEkmnk m mr i cnd.d o olidrd td $le. lt howM. dE tuiui.e o irlorm h sn wirni, om ,sol@r{,Lt4 tr O{n.. Builrer wiu lbw th trrdcn ofFoving rhd lr or shc dil mt bild or i'r{rcr dE l'DFry fr, ui purlo* of
<br />-1.Iovrcrotth.lrtp.ny.amcr.lusiv.lycont.&'irgwnhleoed.o.a.lo6roconstrudltupmjcd(SN.'7044.Blrirc$rnd hohssim Codc: Th. Conrmlols Lkcnsc kw dcs an amly lo .n oqncr oaprorErry who blilds or impolcs rhclcon.
<br />ond wk) bmEcrr for such l6,xl3 eirh , conracrods) ltcnsd puala 16 rrE comra.ktrt LieM tlw).
<br />I am.xcnrfl nndrr sNtio
<br />D.l.: ____ (rrn.i: _ _ ,woRKF[r coMPFi{:siTiiiN
<br />DECI,AIdIIAN
<br />Ihct byrmrnuoderpcn lryolpcrjuryon..lrhcfolLwingdccldariorsl
<br />Ilrvc.idqillnrinraiinCcnfic,.ofCdNciir,Scliln\urcl,nNorkcrr(nnn(Nr .rslloridcdktrbyS(lionl?lx)olrhc
<br />hlxtr Crxlo. nrrhc p.rtun Jtu.ofrhc sork ror wh'rhrl[ ncnnii n is{rcd
<br />_l hNe and will nrinrain *ortcN compcnsrtion inslBicc. trs rcqlircd by Sdion 1700 olrhc kbo. Codc. a.i the pe.t()@kc of
<br />thc wort for which lhiq pcmil n
<br />+i-I -t -2b-1<
<br />I ccnifyihd in rh. Frrorm(. of fi. wort for whichrhirp.ron is issucd. ! sholl not cnploy any !.son i.onynrnncr
<br />h N lo bccom subr..l ro rhc s*m onwtrstion bws of Colifomig. lnd u8E. rh itI sholld hccdm slbist brhc
<br />wo*c6 sm!.nsalion lmvisionsofScdion 1700 ofth.l,bo Codc,I rhall. fonhenhcddtly wnh rho* tmlni,ni.
<br />lute b sm {ork rc mn{x.qrior rov.nec ir unl,{tu|, ,nd shall subrccl !n cmphrr lo siminal r*iBlti6 a.d
<br />ok huddRd rhuu\xtrd dollm ($l(l. in lddiri.r ro rh. con ofcomF.slion, drmgcs I !rcvidcd for lhc
<br />".,.,
<br />t)--
<br />!.[!]-A]:!-11!lll
<br />o, rl( lln{rc\\ n(ll},na\\ior\Co(|.- rn,lf,y li.cn\c N ir hnlturr. rtr!]_rr.r qfqsL\c- 3v/b -\
<br />c()Ns'rRtjc'mlN I UNDIN(; A(;t'NCY
<br />I hcruhy arftnr ntulcr l)cnrlryolFrju.yrhar rhcrc i\ a.on(n,.rion Lnii.s r!.oc! lnr iLc !.rronDrcc ol rhr \ork rit Nhi.h rhis liflnir i\
<br />is\ucd rsc. 1097. ci( c )
<br />AIILICANLDSCI.AAAION
<br />I lmhyanjnnu Jer pcn0lty orI,-ljury on. oflhc lolh{nr8 dLrl.rarior\:
<br />D.nmlirion PcrmirsAsb.ios Norilicdio. FrdcrrlRcAul io.r ( l irlc 40. Pfi6)
<br />-Rcqutcd
<br />L.trcr oi Noin.ation
<br />-l.tnili
<br />rhrr rhc ndcralr.rtlii,ns rsrdira r\bt{o\ rcnrklrrr ior rtrrli.rhr. k, rh'\ ln,jL{r.
<br />l.difyrhar I Mvc rcod thn aptlk,rion ind nntc rhalhc abrc i.formrion is.orer. l.8N ro conll]ly sith.U Ciry and C.lnry
<br />oniin.nc.s Md Sbrc trws Nhling lo bu horiz.rcI,c*ntalivcsoflhisCilylndColnlyrocnr$ug,n t
<br />!h c Drtrrbncd lI)p.nyi, in
<br />,\pplirnnl or /1Acnl Sigtr$lum L ,"" 6 - 16-'16
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder f loor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />I nterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />l\4ain Drain/Pool Pipinq
<br />Pool Heatericas Line
<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 \
<br />FINAL stl't llD \Y4-?{+
<br />Notes , Remarks, Etc.
<br />COMMENTS
<br />Area/Storm Drain
<br />Roof Drain
<br />Fill Line/Back Flow
<br />--'-1-
<br />knd.r'( AJdE3t
<br />-
<br />II
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