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PLUMBING-INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarilier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line 8/zaftc -/<./4fu4 <br />TtarrBfMain Drain/Pool Piplno f7 q'/s\Itr <br />Fill Line/Back Flow l <br />LlEI?f-<Pool Heater/Gas Line €l.z /nr S.\t K_I <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL \\tA6 zt ttl(tq) <br />Notes Rema rks, Etc TT <br />OTVNER AUII,DER DUI,CAlrA'T!oN <br />I hcrchy rlltD utrd$ pcnrlry ol t'crjury lhd I rn.xcnrpr rru'n rhr CdiLncttrs. Li.. { bw rd rh. (,ll.wing.:cry,r {Sc..7o.rl5' <br />Bu\i',c$ x llolussi{in Codc) Any Cily or Cotrtrly whi.h rrqur.\ r trrtrlir k) con{ru.l. rhcr, nn|Rvc, dcDnnnh',tr rrtrr ) <br />sru.rurc, tlrffk, ir\ i\surtu-c. ah. rc+nc\ rh.lprlicur n, suchJrflnirn) c a \igncd srlrcaEnr lh.lhcorshc is li.rn\cJ rnr\urd <br />k'rh.ptr,vi\n'tr\olrhcConlrrcr.rsl,iccns(l1.trw(Chrrrcr9.comnr.ncinssithScdionTtxx)ofDnnio..loirhc0u\i0csnnd' <br />l.ofc*ir[! Codc) or drr ltr Dr\]E ir crc lI, (hrrrrio$rtd ihc h,\i\ it rhr Jl.Ecd.rrmprion Anyvi(,lari{ ofScrrhiT0.ll5hyanr, <br />lpplicrrr tu! pcrmit nrhjcch rhc rmlicn lo..ivrlp.trah, ormr nrmrhiD 6vc hundr.dd.ll !lJ500r <br />l. N owrcr of rhc Im!.nr. or my cn loles {nh srscs a rtEir 51. .onp.n*rion. {ill do thc wdk &d rlr $retu i! mr <br />itrlcndcd or oficrcd lm slc (Sa.7044. Busimss sd Prbfcsions C.<tc: Th. C.nlretol s Lie.€ tiw dG nol dpply lo !n owmr of <br />iIE lioFny wh6 hildt or irpreB tlEffia .nd wth .h6 nrn hlt hi@lf or heEltor rhmugh hb tr he. oen .nploy..s. <br />pmlnbdrtur st in{mvmnrs E ror i.roied or oficrcd for $k. lf. hov*r. tlE hoildinS or irpftmir is sld *ilhin oft F{ <br />oaonphlion. llE OwE. Auilc sill hrw ItE h(hn of p,oving thd IE o, slE did ml hild or bptuw [r l,ot dr, for tlE piitb* of <br />-1, <br />{s owmr ol fic pdpeny. .n.rclurivcly coorrding wirh lien*i .oturoB <br />'o <br />r$.sdd ih. Imjer (Se -r{x4, Busuc$ <br />rrd PtDliarbn Co<!c: Th. ConI&bas Li.cnse tiq dB mr !!Ily to m owncr of pFpcnt wlD builds or aopl*s fi..con. <br />and who contuts lor sh p,oids rith s C.nMo(3) lien*d pursMr io th. C.ntrclor's Lkcns tjw). <br />I mcr.m undr Sdrbn .B a PC. for'hlq E@n. <br />rc8trE8s:grMlEtAlqN <br />DECI.AAAION <br />I hetry llfirm !nd.r pcMlty of ldiury oft of rlE aollo*ir8 d.rlmrk m: <br />-l <br />hak &d *ill tuinroin r Ccnificlrc of Consnt lo Sclalmurc tor qort6 ompcn$rion. a\ Frvihd lor by Serirn :lIlO of rhc <br />ofthc wort lor which rhc pdmil is issucd <br />ond will m0i.loin wortc6' comllcnsnlion insur.rcc. as Rguircn bySdion l7lr0otlic t bor Codc. for the P€rlomtc of <br />thc *olk for whkh lhir pcmit is tscd. My *ortcis comtrnelion i.suEmc tricr 0d policy numh.r ac <br />?tr^ finr€- fu-) <br />8Ln+-4 /s/,s <br />-l <br />ccniay lh{ in ltE pdlomre of thc worl fd which ihh F nj( is ilsucd. I shlll ml c,ploy my Fmn in uy M*r <br />s .r to b.@m slbF.r ro rhc wort6 @mr.Ndion bws of Caliloniq aid agE lhd it I should b.roE subjet lo tlE <br />rcrkss onwnsarioipDvirions ofserion l?0Ooarh. khor Cid..l shdl. fonhB h@mplyaithtlF.prcvhioro.. <br />WAnNIN(;] Failurc '. su. workcs .oqrcosdioo ovcogc is unhwtul, ,nd sholl subiEt e cnploru lo aini.Dl ,,ce!lix ud <br />civil fin s up ro om hundr.d <br />'hou!a.d <br />doll0tr (!100.000)of uomncns{ion, danaBcs as pro! cd for thc <br />o,n, 5l'0 I r <br />I h.rcby alttrm rd.r r,.nalrt of Fliury rhrt I m lien*d lndcr pmvision of Ch$r€ 9 (onftftin8 wirh SNrion 7000) of Division l <br />of $. Busimss and Pmfcssions Cod.. ard ny li.cns is in tult foEe .,n qff!.I. <br />a ?',>)cz?r <br />a <br />I hmby {lfrn uder F@lry of p..Fry rlEl lhN ! . coBln ltrn hnding l8cEy lor lh. Frfolrll.R oI lhc turk for whbh lhis ltdn is <br />hsu.t {se. 1097. civ. c.). <br />AlILlcANfD[clnlBAIIllN <br />I tmry amm undcr lr.!hyofpcrjlryonc otthc f{'llo$in8 dcchralions: <br />Dcmlinrn Pcnnn$AstEsos NotifEarlr Fcdcral Rcgut i.ns (Tnh40. P,n6r <br />-Rcquircd <br />t rl$ of Nolific{lioa <br />-l <br />ccnifythar thc [cdcml rc8llariotrs Egarding $tcsros rcmov0ldc.or npFlicabL ro lhh,norcct <br />I mnifv rhrr I h,v. r&! this is cotrB-l I oera ro coryly *ilh all Cny ,nrl clounly <br />rcrcscnrorives ofrnh Ciry und Couoryto.nlo ulorrlrordinrnccs ond Slorc liwsEhliu lo <br />$o$ mnriuncd pmFny for <br />Appli.snl or Atcnl SiAEluR c(,5 c <br />I <br />1 <br />DATE <br />Gas-Underlloor <br />r <br />=