|
PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDEH GROUND ,r)Waste & Vent Loltolg T,
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />I I /t)Waste & Vent 7Water Pipinq lv ttvl., I 'hY\
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{raplDrain Line
<br />Main Drain/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 />Bouqh Plumbinq
<br />Final Gas Test
<br />Meter Release ,/,zl)tD-alu i\'tNu"t<FINAL
<br />Notes, Remarks, Etc.urf1
<br />OWNIiR BUILDI]R DI]L('ARATION
<br />I hcrch, rmr xndcr !.n6lly {,t pcrjory rlrd I nm cxcnu r'mnr rhc G,nt,ctus Li.cnsc llw nr ihc liillowios rNrn (sN.?oll 5
<br />Busnr(\ rd Pm{cssi Codc) ny Cny or Counry $hicn t qutc! I ,rrn,ii n) un(fl.r. ilrc,. imprNt. ilcnFlnh oi rcPan dtrv "
<br />srucrurc, pritrro irs icsuoicc. !ls. rcqutes lnc lmli.nnr ld suchrilnil t,lilcr siBncd nllcmnr lhd rLor shc n li.cr{d pursmni
<br />k, rhc pnvhnnN olrhc Conklrktr r Li.ctrscd Lnw (Chllll( 9. GnnEmi.E \ith Scdnn 7flx) oI L]ivhn'n I or rlf t'u'in's and
<br />Pnni$ionsCodcrorthar lrorshr ilcxcnrfl lhcrctomand Ihc hNs rorlhcailcscdcid'nprio. Anyviololion.rSc.rionT0ll.5bvrnv
<br />alpli.lnl r'or ! pennit \trhj re lhc nmlicanl lo s civil pcmlryur tror 'mrdhan,lvc hnndrcd dollars (S5(x))
<br />L d osncr olrhc lrotcny. or nry cnDlorccs sirh srsc{ 6 rtci. $h.om,).nslrirn. silldo rtr vork aDd
<br />'hc
<br />iturur is nor
<br />i .Rldl n'ollrcd ntr {rc {sN.roa4. Blinc\s ud [rrofcssn,nr Cdr: rtu Conbtn, s I iccn* ti* docs rFr lpdv ro o oIN' oi
<br />rhc nR,trdy sho ttrilds.r irq,r.!c\ rh.Nr arl wlx, tles such *n* himscuor h.rsclfo. rhmulh his or hq owncfrPlotc's
<br />lr)lidcd rhar uch i'npbvcnrnls a( rn inrort d orltEt tu srlc I I lt,wcRr. rrE huiktins or iril].\tmnl h stl airhi' I {'c )t.u
<br />or.oopLiiJn. rh( Owncr Bui!$ will hirc fic hunLn ol'oovin! rhlr h .! shc dil mr hlil oi ifill)orc fic Irepciv for th. PurF]t of
<br />-1.
<br />s owncr ofrhc,.6p.rry, lm.r.lositlyconoacling wnh ficcnEd connnroElo oln d r prciel (Sd 70at, BunN$
<br />lnd hotu.hn Codc: Th. contdlort Liccns hw d*. nnl aDplv ro .n osn6 of lrcFav vho builds or imPrcvcs theNn,
<br />,nd who onrdds for su.h prejea *nh d Co nclo(s) li.c.scd ,'uB@t lo lhc Contr.clc\ Lt.nse l.tv).
<br />I nn.xcr.Dr undcr S.ti
<br />"",.
<br />q/
<br />DECLAXAIXIN
<br />I hcrcby ufirm und( r.uxy of rcrj!ry om 6f rh. tirllo*ine dchrations
<br />Ihav.mdwillnuinhinaCcnilj.drcofCon{cnrioSclilnsurclorwotkc$ conncn$n,n.3s I'mvid.d tor bvSsrion 1700 or$c
<br />tlhor Cdlc, lor thc r.rfom.d oftnc Rork fttr which rhc pcrmir ic issu.d.
<br />-lhalcaoduilloainrainportcs
<br />d'dpcnsarnrn insuro.cc. !s rcquircd by selion l?00 oflh! Ltbor Codc. for rhc F.fr,ruEc oI
<br />rhc *ort id which ihk !.rnrit is isslcd Myuork s conrFf,slion insrEtcdnicr udpoltynuohcrdc
<br />-l
<br />.cnify lhal i. th. pcrformmc ofrh. work aor whicn this I'.rnir h issu.d. I snall iol cnplov.nv P.rsn in anr oanRr
<br />$ !c ro b.sB slbjd lo lhc wo*6c conrFnsalion h*s ofcalifomi4 and oEtu $ar irl si$uld t com subjccr lo lnc
<br />qortoa cory.ns.l ion prclisions ol Selion 3?00 of lhc tr,or Code. I ndL foflnwnh @rply wilh lho* ,hvi!io.s..
<br />WARNINC: Frilur t, k...tric sorlcri .o rFnnrion is lnlrwrtrl. Md sholl sltirr on dPlortr lo dioinil FNhics lnd
<br />addna.n !o lhc o\l of conp.6sarion. damSls as povid€d for lh..i l fincs !p t, oft hundEd lholend dol
<br />SNrn,n 1076utGc lab.r Cod!- mrcrr{ anJ,.*'?/zs/g^
<br />L']ILA!.!TAN
<br />.f rl[ Buin.ssmd ltolir\i,)n\ Codc, rtrd trryli.cn* i\ in tull i,tr.c kl cltccr'
<br />caN$f,ucu9.N.LElDlNcac[Ncr
<br />I hcrbt {ffr undcr lEnuhy or p.iury rh,l lhcrc is a dndodnn EndinB !8efty for Ihc I'.rfortue. 6f rh. wrt for shich rhh Fmn k
<br />i\\u.d lsc. 3017. Civ. C.)
<br />hi.l, AddEs:
<br />-
<br />AIELICANI,.DECT,AX{ITON
<br />I lrntryanimundcr n naxy of pcrjury one of rhc lollowing d.cl&{'ions
<br />O.mhion PcmireAsbcir.s N.rirrcorion FcdcBl Rcsulrr iof {Tnl. 40. Pln6)
<br />-RcquiR{
<br />t lls of N.tilcarion
<br />-l.cnify
<br />rhrl I hrvc eld I
<br />ordiMnccs u6d st c Lrss rc
<br />rion .In srar. rh fic alhr i.formarion h .oBl, I {re lo omply wnh .ll Ciry a.d Couflly
<br />ildin8 consrrucrion. lid hcreby aulk"iz rcpEsnralit\ of Lhis Cily tnd Counry ro cnt.r uID llE
<br />ahovc mcilioncd tn,p.ny lor
<br />*Saz'q-
<br />-l
<br />enily rhdr rh. rcdcrd rcSuLtions Egltdin8 {sbcslos Emval urd nor spllicsbh lo lhh lmixl
<br />..," z/zs!l-
|