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PLUMBING-INSPECTOR RECORD
<br />(,IVNI:R IIT'II-DDR DF]I,('ARATIoN
<br />(tu.rur.. t).i,n h ir\ nlrmc. rlvr rrlun \ rh. trppl'.rnr tr \u.h p.fnir b fL r n!i.d nxrc r rhri hcor rhc N |ccnsil nur\urnr
<br />ro rlE [ovi\ons ol rlE ('o0rri.r.l{ l.iccn{d l.rN lchi cr L C.r]nr.ciog uirh Sccrion 7(IxroI [)i!i\i .r ofrhc ll!\i'rc$ rntl
<br />npflio r turr F.'rnir \uhlrd\ rhr rrpli.r r b r.i\'lp.nrlryotnor nxrc rRn lnc hutrdr(dd.lh^ (S5l)0)
<br />-1.
<br />as owncr of Ihc pn'pcny- (tr !n, cmploycc\ wirh wlscs rs lhcn st (,nrDcn\!rirn. will &, r.ln w.rk uJrl r,t slturm i\ n r
<br />i c ldl oror1crcd lar slc ise 7(r:1.1, tlusituss ndPn,IcsionrG cThcGr rr.t*'sl,iccn\cLrwdocsnorlpplrrornowmrol
<br />rhc pmFny who t'uildr or impoF\ rh.mn. ud $ho des \!ch MrI hn \.llrrh.rsclr.rrhrcu8hhi\orhcr.wncnDbrcD\.
<br />pn)liilcd rhd sudh im,n^ctrEnrs m ml inrMltal or oficEd ,itr \ih lI nov.vq. lnc hoildir8 or impmtnrnl i\ $Ll *iihir .nc ttt
<br />of.rrnlLii,n. rhr Os,rr Auiklrr willhx\r rh. budoofrovin8 rhar tE.. \h. dil mr hoilil or ir{,rovc rh. p6lcn, ior Ihc pur[,{ of
<br />-1,
<br />&roeMofrle propcny. aociclusiel,.onrding qifi lien*d co 6d06 ro oosoct tlE prnic{l (Sc.,044, BusBs
<br />and EDn*shn Cod.: Th. Conlra.lols Li.cnsc Llw dms nol apply lo 0n osncroftmpcnywl$ $uildsor im!rctes rh6con.
<br />snd sho .onmds for ruch phirl3 with , Cont a.ro(s) lier*d ,u^ua Io rh. ConiEc'oas Lkcns riw),
<br />lrtrtuctr, undcrS.cri(m .a &l'C lnrr[nr.Jvnr
<br />l)nh olrnrr
<br />lllatrE8s:taMlJlraua!
<br />DECI,ATAIIO!
<br />I hcrby afiirn undn p.nally of p.rJury oB oilhe aollowinS delralionq:
<br />-l
<br />hiE lti viu mi.ni. ! C.nificx. of Co.* io S.lI-lBue fo sqt6'onpcMlion. s pmvidcd for 6y S@don 31D dr$c
<br />kbor Code tor rha p€,IoM. 6l th. e tq vhich 0E pcrml !' iscd-
<br />_l h!rcandrill minllin *ork s'compcnslrion iNunrcc. N rcquircd by
<br />rhc sorl for *hkh lhhD.rmili. isu{d Mysorlai comnctrshtr
<br />'nsurmc
<br />c._h, * tlll /hrteaca*
<br />Sdion l7O0 olrhc t$or Co<k. for $e p.rfollre. of
<br />@hr .!d polhy nunbs a.:
<br />U'8(7841
<br />-lccnifylholinthepcrfonunccoflhewo
<br />lor which rhis t'€rmil is issucd.I snlllnor ant lEron n my mmlr
<br />w' rski h..om nlbi.r t,rhc trork.r\ .onplisnrtntla*\olCrliaonrir. md +rcc
<br />*.rkd\ co.rpcn{rii pmvisk,nr.lSc.rion :17fl)of rhc u}sr (idc, I rhril.
<br />WARNIN(i: Flihrc b sc.urc w(rkc* .omlcnsdnr .ov.ragc is rnlr$aul M cmploFr lo cininal I*Mlras dnd
<br />.nc hund(d rho$rnd dollns ($10O,0O0). in sddirn,n ro ion. darogcs rs providcd 16, rhd
<br />I)li(],,\lt,\I](rN
<br />I hcEby lmrm undcr p.n!lr, of pcrjut, rhar I rn ltqe{ lndn Fovirior of Ch.prd 9 {6nmeing shh Sfttion ,000) of Divisior l
<br />of lhc Busims aBd Pmfcsions Codc. oid my lk.M is in nil foN on cild.
<br />-t0
<br />I hcrby lnhr unds Fnahy of pcrjury ltul rhLE h a construclion lcndirE rsency tor rh. IEdnrM cc of lhc rort for vhich this FrmiI k
<br />issucd(Sc .1097. Civ. C )
<br />AIILICAN[DSCLATAUON
<br />I h.njry alttn undcr Nnilryofpcrury orc olrhc r'ollowirB dccliri'ions
<br />D. dirion Pcrnlii\ Askn.s Noriturrbn F.dcfulRr8uldioi{ (Tiilc.10, ftn6)
<br />RcqMc'l lr orufN.ria. i,nr
<br />-l
<br />.cnilr rhur thc icdeBl cgulorionr resuning a l!r nor rtplnnhI tr rhi\,'i.jcrr
<br />I rc 'fyrhxr I h !c r.rd rhn rppli.rridrlil {rrct n cm.t{. I o8,s ro coq,ly wirt all Cir, rnd Counry
<br />orth rn.c\i n Srrlo lr(vvchri horiz RpEscntllircs of lhis Cily hd County
<br />$ovc mnriorcd ,ronc y lor
<br />Applica orAg€trtSiaml
<br />APPROVALS DATE COMMENTS
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Bough Water Heater
<br />Ptrap/Drain Line
<br />Main Drain/Pool Piping
<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 />Rough Plumbing e/e-//8 4PAd n-bd t
<br />Final Gas Test
<br />Meter Release
<br />FINAL 3/3//8 +FZv ZtwGor-
<br />Notes, Remarks, Etp.ub "1il-(J *o (-Lo-". R,'77 Z<tfe Ja.r s
<br />ID/SIG.
<br />UNDER GROUND
<br />POOL/SPA
<br />Back Flow Device
<br />l
<br />trlktc,'\ AJJc\.
<br />d"4
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