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APPROVALS DATE COMMENTS Ohq'Build.r Dcdtrion <br />I hE !ry rffm B.Lf,Gn.lt, of pdjury th.i I !D qmpt fdE $c Coirrd6' Li@tr!. ka for 6c follorint r.etl (!.c 1031.5 Budn.t <br />sd Prcf&id Cod.), Any City r Coorry *tic.l i.qqta . p.mir ro .ostucl .lr.r. inPrcvq <Lmolth d r!?.,r .ny tl''rctfc Ptid lo iE <br />i$u.nc., rl.o Eqllrs rh. .!?li6l fd ru.t Fmit lo fil. r !i8n d tl.laBt $.t h. or th. h li.et!.d tllltur b $. P@vnb of lh. <br />Cofi..tn'r Usld te (cl[da q G'1l,6cl.r rilh S.cdon 7000 of Divilio ! of 6. Bulndr lnd Prcldimt Cod!) q $.1 t! q <br />rh. i! d6F lh@t6 ud tll. htt fd lh. .l.sql qdgtjoi .Any Fol.lid of S.cti6 7011.5 by sy dPrli@t f6 . pmt sbi..E $. <br />pplicst to . civil p6.lty of not moG l,)n fv. lMdtd dolls (t500). <br />-I, <br />s orM of lh. prop.ny, d ny onployq *ith w.ss s $.i. sl. Mpo!.tion, eilldo t. wqt sd dr. tltudr. n noi inr.nd.d <br />o offa.d fG ..1! ( Se.70a:1, Burii€! &.1 Prcfdi@ Cod.: Th. Cdt&ld't Li.d. l* dd .o! .!Ply t6 a o*.d of lh. PrcP.n, <br />pho boildt d itrrFwc' lh.r..d, &d rho &6 ruh wdt hiNcll d i6r.lf B thDudr hit 6 hd d*n cmPlord, FoYidGd $d och <br />i6prov6 u N .o! irlad.d or ofald fd tal.. If, h@46, tt. blildins or imprcvddi it told *irhi, on. y* of comPldid, thc <br />omr'Buil&. eill h.w tt. burdsi of Foving $.r h. d 3hc ,ot blild or iBFov. for th. Putp..c of r.l!). <br />_l ! omd oftn. prcpcty. 6 dcluiv.ly Mr..tira eilll li@d cmEsld 1o .@E!d $G Prcjer ( 34 7014. Buid4 sd <br />Prcleid Codr Th. c.nfidd r Licar. Lq d.a ,.n .@ly lo s oms of ptop..ty who bdld. a idprov6 d.f@. , 6il who <br />cmEel! for .eh ptuj..t! qirh a Cor&ro(t) lic.&d euduur ro th. cdEer6'i Licot. L.w.) <br />_l d cx.dfl udd S.cti@-.B & P.C. fo. Ut t.son. <br />IVORI(ERS COMIENSATTON D'CLARATION <br />I hdcby aflim undo p.nalty ol pEjqry oD. of fi. follo*ing deluttl6!: <br />-l <br />hrE ud willnd.trin. Anificrt of Cdqr to S.lf-htuft 16 eort.n' cmPot.ti6, a Fovid.r' lor by scction ,700 o f th. <br />l.bd Cod., for th. pdfonm@ of tic v6l fd ehid Ul. Fmit it it rcd <br />_I h.v. ad will n6in6in qctk6' .omp.nlrdo i!!usc., s pqutcd by Serion 3700 ol th. Llbq Cod., for $c pcrlomue oa d. <br />wtrk for which this pmir h isru.d My wnt@ coop...1ion irelm4 cuin d Policy nuhb., d. <br />Policy Nubr-ExPis' <br />Glir !cri6 tre! nor b. cotnpla.d if th. pmn t fd On. hu&!d .Lllr" {S 100} d l4) <br />,ln*^unf-* ",ii*. <br />th. prrf()l]Mc ot th. work for <br />&lle (t I Oo,ooo),i. lddnior io tt. cdt of cdp.n!|lid, d.m!86 s Provid.d fo 6. S..tio 30?6 of <br />i.rd.ii sd.nm.y! fc., <br />I heby srnd 6dq pd.lt of prjury $.r I m lic.at d oda prcvisim <br />tl. BGinar sd Profasiom Codc, ed <br />of pajury lh.t lll@ ir . @.rEudion lodi.t p,..fmec. oa th. vo* for vhich thi, Fnn it <br />cl ) <br />AEI.ICAtsI5LBECIABAUqN <br />Ddiolitim PmiE-Alb€t t Notficllid Fcdd.lR.rlhddr (T . ao. Psr 6) <br />_ R.qdod Llnd ofNoiiliodo <br />.sG to annpl, ,ith .ll Ci9 ed <br />rbovr ncnridcd pror.ny fd in!F!d@ <br />UNOER GROUND <br />Water-U nderfloor <br />Gas-Linderfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Rough Water Heater <br />POOUSPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing I :XPIRED <br />Final Gas Test <br />Meter Release F -Il : I 4UlJ <br />SAMC 8.43. 2gO. ss6 AA7 <br />FINAL <br />Notes, Remarks, Etc. <br />PLUMBING.INSPECTOR RECORD <br />Waste & Vent <br />Roof Drain <br />Tub/Shower Test <br />Water Service <br />liccnsc is in iull forc. ud.ficcr <br />L6da! Ad&.!. <br />- <br />tl <br />tlt l_l <br />t ---_r_--- <br />Ff <br />-------r----- <br />tD/stG.