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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNIIR BUILDER DELCAR TION
<br />I hcrchy rillrn udcr prn ny of rErjury lhll I onr cxc rpt knn lhc Co$acr,,n Lnci* I-,w ror ihc roll,'win8 rc.sotr lscc.?0lll.s
<br />lru\inc$ {n(l lrrni\\ior Cqlc)r Aoy Ciry dr Cou"ry *hich rcquircl d Fnnir b coDnrud, ancr, imP.ovc. dcnnnnh q ftnzn rny
<br />ntu.rur. nritrro irs hsurncc. rls rcquircs rhc ryll,c0nr for su.h lErn ro tilcu sisncd \rrcmnt rh hcor shr is licrn*d fu^urtrr
<br />ro rhc provtio.\ ofrhc Conkacktr s Li.cnrd tjR (Chrprrr 9. ConmcminS sirh S.ctn,n ?(D0 ol Divi\bn :l ofrhc Bu\incs\ ni{l
<br />Pnr,.$iont Codc) or rhrt hcor shc iscxcmpl lfurciomlnd rhcbrsis Lr llE rllcgcd cxcnTitrn Anyvn,hri.trofSc.riooTl)ll5t'rrny
<br />lpllicstrl ior a pcrn sunjcchrhc ipnlicrnib!civilFnoliyofnortrrrrhtrnlir.hundrcddoll0rslS5(x))
<br />-1.
<br />!s owmr of th. prlFny. or hy.mltotrcs wnh wag6 &r rhct $lc an!..stion. will do E !5* a.d |}r drErN n ml
<br />intcin d oi off.rcd ,or sle 1Sc,7044, Busilcsr md Ptotcssions Codq The Co.lJ!(ofs Lt6F L.s docs ml sPply lo o owftr of
<br />ih.I,6Fny wh6 build! d ir@tDE rh6tr d,n sfio des sh mrt hiMlf o.ltult or lhtuu8l hh or hcr owo cmplorGs.
<br />Dmlidcd rhll sEn imrrc\tfunls e ml i cndcd or oficEd lor slc. lL hokw, rlr boilding or iilhrftfl ii sld winin .ne Ftr
<br />of oq,lction. rhc Owmt Builds {ill haw th. bunhn ofpmvin8 lhd h. or slE dil mr hiH s iqmE dr Fopdry fd tn. Frpoc of
<br />-1,
<br />$ owncr of rlE pmp.ny. .m crclusilcly coftlcling eili Isn*d conradoN lo onslfucr llE I'Djel (SN. 7044, Bu\ircir
<br />ad Eftsio"Cod.: Ttc Co Ecroas Li..nsc tls dds nor aorly ro rn o*nn of pmpcny who buildr or imDole. rh$con.
<br />and who snkls for suh pmjels with ! Conrmdo(, liInsd puBunr lo thc Co relois Liccn.. tiw,.
<br />-l
<br />m .re npl urdc. Sedor.- B. & P.c for rhis Msn
<br />Ortr.i-
<br />IIIItrE8E.CQMPINIAIIIIN
<br />DEII.AIAIION
<br />I h.rch, alfirn undf pcmlry of Fju.y om of llE followin! ddl.mthns
<br />I xtr i)d..|,trrhctrn.oun.d ofrl'c*ork lnr {hlch thr rnni n ir{tJ
<br />-I
<br />h0vc.nd willtri.lai. Mrlcrc' .on{rcNalion itrsuEncc,.s rcqutcd byScdi.n l7(n ofrh. tjho. Codc. fo. rhc Frlorroncc ol
<br />lhc work for which lhn lcrnil is hsucd. My wo m omF.nsal ion insurMe 6id ard Flicy nunbd @l
<br />.1 Lil3 <Y.slzol
<br />-l
<br />ccdirylhal in lhe Dcrformarc oa rhc wolk lor wtichlhispcrnl h nsucd.l lhall ml cmploy any p.r$n in utry .urcr
<br />$ s 16 b..o E llbixr lo lhc wltm onp.nsarion hw3 or Cnlifo.tri!, ond !8m rhar if I stFlld lr .d iubicr l. rh.
<br />work B @on nsari6n pmririoB ol Selion 17u) oi lhc ribor Codc, I shlll, lorltrirh ohpl, wnh rhos. novirioB..
<br />WARNINGT Fuilu4 ro wurc vortcN' com!.nsarion srcogc n unhwtul. and shrll slhjcl an cmplotq b cimiarl Fmxi.s dnd
<br />.ivil finc\ ut ro otu hundEd rhous.ftl dolltrs (5lU),00O), in ddniotr lo ion. tta@gcs &r providcd for th.
<br />serion 1076 ol{hc Ltrbor Codc. i.t.rcn !.d
<br />DECIABAIIOI
<br />I hcnby ifllrnrdn NnalryorFr.,ury th l rn liccnsn und.r EovGion ol Chlprcr 9lcommnc ins wirh ssr hn '70fir) ol DivGkr 1
<br />ot rhc Busirc\s lnd Pmfc\rk,ns c(dc. aid trryli.cnsd n intuU lotoc,ndcifcct.,.8 tAfi1)tc
<br />lr" I t?A6C
<br />CANiIAIJ!:II!]NI.INPIIIGIGDNII
<br />I hc(hy dhrm undcr r.nrlry of perlury lhol rhsc is o constNdion hndins lgocy ror rh. pcrfolmncc orrhc *or* lor vhich this Pclnil ir
<br />nsucd I sft. :1097. ci!, c,).
<br />/Itfu( rfDltr BlrIoN
<br />, tr^-h\ rltnm u .r |rcnrlrl ol trillry !oc of rhc lnlkN nrs rlr.l i{rN
<br />I).nkniri{r, l'cnnii\ A\b.(,N Noriliurii I;cdcrrl Rcgrlxriotrr ( l[|c.11r. Ir.tr16]
<br />Rc!uirill-crrcr "l N.tlic i,n
<br />_l.cniiyrhrrrhc fcdc,alrcsulrri.n\ r.ludins !\rf,no\ rcnn)vrl rc nor,ftli..hlc lo lhir rft,r..l.
<br />dl.cniryi,nr llhc rc l rhi\rfflicrrn aM {rhrldrhcabrc rnlonndi(,r i\ corccl t iErlr k, con,prr q hnllt'ryrnd Cou ry
<br />ori r,trr(\ rnLsr. .1x\. tuLn oufioriz EprcsnlItirs of thh Ciry ort Co$ly l. cnls upon th.
<br />rhovc mnliomd prcpcrl,
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipino
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbing aJft/rg >\6x
<br />Final Gas Test
<br />Meter Release
<br />FINAL 1/t* /ls q\\ag
<br />Notes, Remarks, Etc.
<br />,"*--a/aolrg
<br />Fill Line/Back Flow
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