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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent 1^\\7 \\(0e
<br />Water-Under floor r4\J 'JUw((4 ./
<br />Gas-underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent ' ,-\6 (,fl.
<br />Water Piping g'\\1" (9
<br />Gas Piping
<br />Roof Drain
<br />Rouqh Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbing
<br />Final Gas Test
<br />Meter Release oth.l9 Jle\llo 'g)
<br />Notes, Remarks, Etc
<br />owNER tltrll,DItR DIll,(:,\ RA l-l( )N
<br />I hcrchy rllirD rrl.r Ftrrlry 'rf t.rJur rhJr I M,.xc f fr)n rt Coihr.r{\ Li..tt l:rv lar rlt ln11,,{i',3 rtrqD (S.r7o.1i!
<br />{n'.dd. prir n' ir\ l\\uxn...3l{i rcqtirs rl'. rptlicrnr ,,,r n,.h lrn irt) lilc r n3tc(l qiicnrDr rhrr hc.r shc !\ li.rn\.d pu^urn
<br />rppli.rtrrlnrrpcrn r \ubjccrsrhc xnplicr !)rcivilpc rlryol or ntr rltrtrrlnc,rufdr.dl.lh,\(15(xrr
<br />-1,
<br />trs owm of rhc Fop.ny, or n, crplotr.s virh paB.s as rhct $lc .lntrnsario.. will do [. *ort atn lho lrrEte il ml
<br />htcd.n or offcEn aor sk (5@.7044, Busies ed nstcsrione Co<hi Th. Co n.iols Lien* llw dcs ml irt ly lo M owftt ol
<br />ihc pDFny who buildc tr inrlrors ilEmn.0 *ho d*s uhqo* limsclforl$*lforrhFughhi, orh(ovr.nplorcs.
<br />pbvi&d rhd $cn inFowctuGmi htcnd.dqotrEdfr$t..lt hoEE Ebsildiq orin{mwEnl iseld whhinotu rte
<br />of<,rFkrio[ tlE Oe*r Buildtr will haE ltE burn n ol pmving dtrl rE or dE did ml hild or ir{,mrc dE prcFry lor rlt ,u.po* ot
<br />_1, oc.wM olrlE IiDFny, amdclusircly.odEcrir8 wirh liccn$d conrdcroB roo dru.r tli poi..1(S(. ?0{4. Eaims
<br />ad PEfcsrid Codc: Thc ComebCs Li.ers. Law d@. nor a ,ly lo D osncr ol pmp.ny who builds or improvcs lhcMtr
<br />and wfio conlEck for sn plsj.{is {i ! a Coir6clo(s) li.cnscd Iu^Mt io rlE C.nrr&Itr's I-ien* lw).
<br />-l
<br />mcxcnrpl undcr Ssl
<br />l)3t.
<br />UO.BAEII:COMIINSAIIOII
<br />I}ECLIAAIIAN
<br />I n rchy alfirn undcr Fdlly of lsjury orc of llt ,ollo*inB dtlqariors:
<br />-lh0vc
<br />xlsillnui tu ! Ccn irEarc of Con\cnr r,, Sclahsurc lbr w.r*.rr s p.nv(iotr. os pmvidcd fo! $y Sdn,n 1700 oI rhc
<br />Lrb(lr Gxlc. for rh. ,cdonnn.c or rhc wo,k for which lnc lcmi n isucd.
<br />-! h!!c lnd will minllin uo cs conD.nsrrioo imur!ft.. L. requircd by Sdl hn 37m of ll* Llhor Codc. for rr'c P.rl.)mBe of
<br />lhc *ork for which thh p€mit Ls i$ued M, workdi comp.Bation inru&cc cmicr oid policy ntmbs m:
<br />E olTo r k (."
<br />W( ?a tf.,*l ro I 0(lra rr 1t+ 2oil
<br />l..diry rhdr in rhc rdlormoncc ofrh. work for wtiLh lhis t.rmil h issu€d, I shall nol chploy.ny p.rs8 i. lny munncr
<br />s as ro txronE sbisr ro rhc wolt6 conpcnstio. hss ofcllifomh. md {g@ rhar ifl should t com slbjcct rd itt
<br />workcs' comFnsolion pmvisiotrs of Sclion 1700 of lhc L,bor Codc, I sh{ll. fonhwnh conrly wilh lho* lrmvhions
<br />WARNINC: Failurc t, suc workcrr.onlEnssrion ovcrlgc k unl.wtul. a rtull \uhjccr an cnnlorcr b diiDinal lxmLts and
<br />.iil fincs or ro oft hlndr.d rhousand doll6 100.000). in addirion ro rhc cost of conFn$rion. dlMgcs 8 pEvidcn 6r rh.
<br />S!.rion.10'76., rhc lnhn
<br />/1,L I .5-r;-
<br />trt(l,'\RA'l.l(rN
<br />I h.Eby oft"h undcr peElry of Frjury drll I M [e&n ui<lcr Fovi3ioo of ClEplq 9 (o,lwmiiS wnh Scdbn 70OO] of Diviib. l
<br />ol rlE Ausircsr .nd Prlf.ssions tuc. 0d h, lisn$ i. in tull fore std Efaer
<br />l q*
<br />b
<br />I hcrch, afiirn undcr lcnlty of pcrjury rhal
<br />isrucd (scc -1097. Civ. C.).
<br />ion lcnding rgcfty lor rhc pcrfofluh-'c ol lhc sork lor shirh rhii f*mir is
<br />AIIUCANIDIIJLAAA.TON
<br />I llnh, allmr utucr pcnrht of p.rjur, orc of lhc follouin8 d(larar ionrl
<br />D.,i,ttir)n Pcihhs Asb.sos Nori'l.nrion Fcn r0l Rcguh'ionslTillc 40, Pan6)
<br />Rcquncd lIner of Nolifi olhn
<br />-l
<br />ccnilyrnd rhc fcd.ra I ft gulario ns eeuding arbcsrosr.ndvrlm not lpplicobk to lhis prcjer.
<br />ic ion and slnr rhar ihc ltsvc infomr ion h.orsr. I l8re Id condy uith ,ll Cily nnd Counly
<br />h{ildir8.omrru.liotr rd hercby surhri.c rcpdsnllrivcs ofrhir Cirya.d Counlylo cnl( upotr lhc
<br />Pemi(\hr \r
<br />(z
<br />TOP OUT
<br />Tub/Shower Test
<br />Gas Service
<br />FINAL
<br />(
<br />tJnJc''\ ddr..
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