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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O$r6-Buil(k D..la.do
<br />I h@by .flim ud6 parrlty ofrcjlry t.r I un dd fnm thc Conrtbn'Lic.tlc Lv lo.lh. folloeiry @o (!470!I5 Bulilr'a
<br />ed Prcfsim Codc): Any City or Cdlnry ihi.h r.qdE rydnit lo coortl*! dr6. iiP.ov., danollth { EP.ir a, ,ttc[r.' Ptid to ilt
<br />irude, .trc Eq{iB $. .pplicur for tu h p€nn ro ft. t siltod n.lgDor lh.t hc a thc it lic .d Faust lo tt. Paiddu ofd!.
<br />C6Eelor! Li@c.t Lrw (Ct.pr6 9, Cdn ixnclti *ith s*ti6 ?o0o ofDvition , of thc Bcin6t 6d P@fc..id! cod.) d tl h.n
<br />,h. i, d6fl thfrtm .rd $. h.it fc dE .|,.a!d .,6Pri6 .As, {ol.li@ or S.<rior' 703 1.5 b, e/ .pplicxt fc r Fhir tubj..{ tn.
<br />.lplicsr to r civil p.Dltry of... llw ltD firt hur&ld doll.n (lJoO).
<br />_t, s o,i.' of d,. F.!.ny, n 6y mployd eith e.8q { thqi. rct! .dnFE don, eill do lll. wort Dd lt. llru.n . i3 not anr.n&d
<br />or o6.fd f6..lc ( S.c.70L, Eqine! ud PrcfdiN Co& Th. Coti&t6't Lic@. trw dq nd rPPly lo & omq of 6. DtoFty
<br />who b!il& a irp.or6 $a!.a, rd *ho .106 .sh edt hid.lf q har.lf 6 dmlih nit a i6 om orlcrc6, Forid.d $u ttci
<br />ifrprc\66u e nor inr.nd.d or off.nd fd .d. I( hwc€, tn! blildjss or irnPm1m6t i! told witi. dc y..r of comPl.rid, $.
<br />Oq6-A!ild!, wiu h.v. ln! bor&t of povins th.t h. d llE ior build d i'nprcv. for d. PlrPqc of t.l.)
<br />_1, s oMd of $. prop6ry,6 qcluivcly co.h.rjna eirt li.d.d cdr&tor (o @&!.. th. Fojal ( s.. 70a4. Bqln{ Dd
<br />Prof6id Cod., I'hc C6E clorl Lic6r. ls rt(s nor .pply |o u oMa of rnDFty tho buil& d ihFovd tfictq , od *to
<br />6n&i! fd ,!.h lrojar wilh . Coit&io(t) licdt.d P6!an lo lhc Co .rDor! Liq@. trv ).
<br />_l m .x.npt ud6 S.dion
<br />-,8.
<br />& P C. fo. $it ...ron
<br />WONXERS COMTENSAf ION DICLAT TTON
<br />I h@by amm undr pa.lty of pajlry q. of lhl foll@in8 delmti6,
<br />-l
<br />hs!. ed eill ,Elnt in ! C.nficlt of Co (,ltlo S.lf-b!@ fa,6it.n'cmPar.ljd, B prcvid.d fr by sdri61700ofdt.
<br />Lsbd Cod., lo $G F.fo.ot@ offi. adt fd qhi.h d'. psmt h i$tt.d.
<br />_l h!r. &d *illmoilli *qlc6' cdp.8.rion iro! e, r rcquircd by s6don ,r00 of $c L.bd cod., for $. t rfotuc. of thc
<br />eo.t fo which tis pnir i! itsucd. My ?o*4' cmP6.!t o i.tur.n@ ceid m.l Poliqy nuhb.l e:
<br />Poli.y N6bcr:-EtPc
<br />b. @opla.d if $. pmn ir fd O.. hur&.d d6ll6 (1i00) dle)
<br />psfom&c. of Oc *od. fM i! i!ru.d, I rh.ll nor aploy uy pcton ii uy
<br />rh. bbc Cod.,I !h.ll, fdtl'wilh
<br />qdt4'.mDc..rion covcds.
<br />$olgd dollE (t I Oo,ooo),in .!tdiri6 lo d!6.8€ ! provid.d f6 rt. Sed.n 3076 of
<br />th. L$dcod., i 6Bl dd .noD.y! fq.
<br />I h@by .f,ifr sd6 pallty of pdjlry Ol1 I n
<br />rh. Bqinds sd Prcfsiw Cod., ud ny licar. iJ in tull fde ad.('.d.
<br />udd pcn.lty ofp.rjlry Oll lh* ir. conlElcrion lc'di4 tsacy p.rfomEcd of thc wdl for which $h Fmir n
<br />isu.d (S.c. 3097, Civ C)
<br />AIPLICANT'S DECLAN rION
<br />Danolir,dl P6hi!-Arb.na Nodticldd r.dad R.auldo (Tld.40. !4l 6)
<br />_ R.quirld 1116 ofNdific.lioo
<br />cbcsros lcholal dc no! applicabl. ro
<br />to comply efi.ll Ci9 lld
<br />$ovc !Mri@.d prcpdty tu inrpclid Ptadd.
<br />Waste & Vent
<br />Water-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipeing
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing EATIll .EU
<br />Final Gas Test ErD-t tnlli
<br />|AMC B-43, 29 ), 556, 067
<br />FINAL
<br />Notes, Remarks, Etc.
<br />UNOER GROUND
<br />Gas-Underfloor
<br />Misc
<br />Gas Service
<br />Meter Release
<br />c6pa!!ri@ provi3io
<br />f
<br />:
<br />t
<br />I
<br />r
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