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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS (,WNIR Bt'ILDER DEI-CATAAloN
<br />I h.rcb, a,lirm undcr FcMlry,,f perjury rhar I a cx.q)t lmm rhc Coita.ro6 Lic.n$ I rw nx rhe f.lhwin! r.a$n (se 7011.:
<br />Busnesr and Pnri.$.n cod.,r Any cny ur c.umy *hi.h r.qur6 . Drnntr b connruci, ih.r, nnDrcve dcnFlish or tuTdir my
<br />nruclu.e, pmr lo rls issuaDce. alm .eqlncs lM .pplkanl lor such l.mil to nb a sisn.{ (irc'ncnl llul he or shc is liccnr.rl Nmanr
<br />lo rh. Dovhions ofrlx contmclois Lic.nscd ljN (chifl.r 9, Co nncncing with S.crion 7000 ofDivkion I ofthc tlunnetr ond
<br />fmf.sionsCodc)orrh.i heor sh. is €xemrl the!.Lor ..d rft h.sh nnrhe0lLer.d.x.mpiion AnyviolarionolS<lion70ll5 hy anl
<br />lprlica for a pcmir nrhJcts rh€ amlicanl k, r cNil FeMhy o I mr nFrc lhin nE hund.ed dolh,s (5500)
<br />_1. a ow. otrh. pDp.ny. o Dy .nlploFs wirh w8!! ar rh.t bl. @mp.retioi. will & tlE aut rid tlE .IndG ir mr
<br />inr.od.d orotr Ed for $,.(Se.7044, BuiHs d.d Pmf6ioBCod.: TIE Co 6ctoi! Lic.e ti, &B tur.rtl, lo e 0[6.f
<br />rh. pmpcty wlm t{iltr or irDmE rlEEl\ !r'd wih &6 Mh wd{ him..lf or h.slfor rhmu8h lir .. h.r om .mplor{6.
<br />lmvidrd thd $ch inlotft.t G bl inr6d.d o. oit.cd l.r sL. ll howd,llE hiihin3 o. opmEm.l is mld -ilbin orc rE
<br />of@trrpl.tio.\ 0E (hd., Blildo qll hlE $c b{dd ofDrivios tfl h. .r !h. did mt h{ild or inleE rh. pm!.rry 6r ltE purlss of
<br />L a owRr ofrn pmFny, rn .xclNiv.ly conrtui.E wirh li.s.d conr6d.R lo smldcr th. pmjct (56. ?04.1, Bu,iNB
<br />d PFEsi.n Cod.: 'l-h. corkl.locr l-accnsc L!*.106 mr aFply ro an ow..r o I pop.rly vho build. or iDrov.! rh..6.,
<br />and who ordmc for sch Dorft with r codmdo(, la.tu d plls ro rh. conlroclois Lic.tr c Lw).
<br />I in cxnnfl und$ S.cr
<br />]laa[E8tlc0ltfrNtAllN
<br />DECT-ANAflON
<br />I h.Eby .flirm undd !.Mlty of pdJury oN ofth. foll.wing d.cL6lhN:
<br />Policy NuDbdr_ExpiE :
<br />-l
<br />c.niryrhat in thc pcltorturceoflhc work for Bhichlfii3 p.rmn E bsued.l ituller .nploy.ny p.Mn in a.y m,nkr
<br />$ n b b6m. iubjel
<br />'o
<br />rh. m&dl .ompcNr' ioo lowi ofcalilonir, .nd .!R lhrl if I rhnuld b.com rubjel to llE
<br />wod{d' smt nslion,mvi.io.s ofSclion1700ofrh. t?tior C.d..I stEll. tonhwith com, y wilh lhoE pmvi.ionr..
<br />D .:_ ^DEU"'ri_tlcrNffi
<br />![g,aaauo!
<br />I h.cb, ailm undcr p.dtry of Frjory fid I m lienkd und.r Fmvhn'notch.fl.r 9 (s,bmcminS wirh Sdio. ?000)ofDivision l
<br />of th. Bwimss. Pmt ssiotrc Cod., lrd my lic.nsc h in tulln cc unc{lsr.
<br />Licctrs Ct!s:-Lic.$. Nuhbd:
<br />-
<br />D.t conttr.tor:
<br />CQAErBlCll0llr:[l)lNCiIGliNCl
<br />I lk8t'y rmrm ufrlcr Fnilrr ol ntqory rhar iho. h ! q,nn dirn hnd'nr rs.ncy ror rhr l)trfonmmc olrlEtrork f.r trticnrhic p.mn is
<br />nsu.d(S( 1097,Civ C I
<br />A.CIIICAN:LIICI4TAITOX
<br />I hslny atrm und$ n nally olr.rlury oE of lh. followin8 &.hr.l ions
<br />D.mlilion P.m s-Aib..ror Noifielion l..dcEl R.8ul.rbN {Tirlc 40, Prn6)
<br />-Requt€d
<br />k(erof I'lolifi 4ion
<br />-l
<br />cedirylhat lhr ltd crs l rqolal ionc rctardrry rxbslos renFvnlaE nol rrllicahle t' lhi ttujd
<br />-l
<br />c.nity $.l I h.v. E.d rhi9 lpplhaiion ad .r.r. thd th. atoE infomriro ir cordt. I r8r ro endy wnh all Cny 6nd C6unly
<br />odiMsB d slar. L!a. Ehrin4 ro building codcru.riol ard h.r.$y.utlbriu r.rMriv6 orrhi! Ciry sd Couty ro dl6 Won {E
<br />ab.rc traIbEd pop.ny tr irgriion pu.po.d.
<br />ADpuc.nl or Al.nr sltn.r{r.:
<br />P.mhccnsm.bnno
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi ptng
<br />Gas Piping
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />FINAL 7l-71t").{./l-*r,/
<br />Notes, Remarks, Etc
<br />Roof Drain
<br />Water Service
<br />Meter Release
<br />I h.vc ond srllnmrltun r C.drfic c olconknr lo s.la-lnu.. nr\rcrkcrt conrp.nsalion,.s pmvidcd lor bySccnonl?(x)oflhe
<br />Lslxtr Codq for ltc p6foorm. oflh. work ,i, *hth rh. I).m is rsFued.
<br />_l hav.andwill daornrn work.ts' .omr.Brr ion itr{ance.,s Eqund hyseclon r70l)ofthe Lrnor Code, lor lh. ne,fo.nmrce of
<br />ih. worl for wh(h rhir r.nln is hs.d. Myworkei omr.ns.ron rnrurincc c.ri.r ind !.licy numher nc:
<br />CoEi..
<br />WARNING: l:aihE lo Elk worl.E ohDtetion @vms. ir u.la{tu|, sd dull !ul'i6r ro nnploFr lo dnial lEEhic and
<br />civil fin.r up to oE hu'dnd rholsid dollan (3100,000), in .ddirion ro rh.6r olomFtretiol\ di@BB .! pr.vil.d for lh.
<br />Sdion 1076 ofln l,ttr Cod., inl.r.c aid !fionEy r ft*.
<br />tl
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