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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNUR BTIILDFJR D!]I,CARATX)N
<br />I hcrchy ifinm undcr pcmlly,,f pcrjury rh l ancrc U lion rhc GdrdcroN Li.cn{ li* for ihc roll,,*lis rcNin (Scc.?n],5
<br />au\irc!\ un Pn'fcstt Cnrc)r Atrt ciry or County which rcqnircr r ltnir r(, on{tucr. lircr, nnPii,ve. dcmolish nr rnJn 3tr}r
<br />{fl.ru'r. tri(trk, irs 1suoncc..ho rcquncs rhc lprli.lnr hr\kn p.rdn h nl.a \i8trL'd ndcmnt rhlr hcor !h. '\ licctr{'d Nrsor
<br />ro rhc lnrirnnx.l rhc Corkrcroa\ Liccn*d ljlw (Chrprcr 9, Coflnncncin! wirh S..ti,,i ?OD ol Division I ofrhc Bu\ihc$ rid
<br />Pn'ic\st'ns Gnlc) or rhd hror rhc iscxc lnrrhcEaioaratrd rhcba\i\ tnr rtu rllcr.d cxcnrPrnnr. Anyvi{,lnrionofSccii,iT0 lShyrn}
<br />nplli.rnr ld rlxflnir suhjc.hlhc lpplirlnr lo rcivilpculrtotnor mftrhan firc hundEd dollan ( S5l$)
<br />-1.
<br />as ovftr of lh. p'op.ny. d my cq,lot!.s wnh $sges os lh.n sk conpensolion. wil do tlr mrt ud lhc sor&r@ h mr
<br />inr.ndcd or ol].rcit ftr sl€ (Se.7044. Bnsims sd ftolcrsions C.d.: Tnc Conhcrois Liccnsc lls d.cs .ol q,ply lo an owM of
<br />rh. pmpfiy who brild.or inpoGllEmn. !d who &Es shs himscltot h@lforlhmugh his orhdo*n cnphlEa.
<br />prorllcd rhal such itrp,lrm'ns e
<br />'Dl
<br />hrcn6 orolM fo, sle li h.mrc,, ttE hildir8 or irytumitl is eld silhi. om lqr
<br />of onIlLriotr tlE o|xM Build.r will t E rlE lrdcfl of Flling lhd lE m shl dil Nt t ild o. inpros the pmlEly for llE lluq$e of
<br />-,.
<br />{s oMcr ol rhc rmp.fly, an cr.llsivcly co ra.rinS wirh lacensed coitElor loonerud llt rmi*l (Se. ?044. BNiNs
<br />and Ploissiod Codq Thc Cd.rodols Lk.rsc Law des nol aplly lo M osnd of proFny who builds or iq,rcw! lhercon.
<br />sd *ho onrnds ror sch l,oirrs wirh . Co .elo(s) lt.ncrt turun' lo lh. Conlaloas Uccne Lrs)
<br />llmcrcmDt unds sNuon ,8 &PC lorrhi! rcMn.
<br />Omer--
<br />WONKFf,.S' C(TMPEI\ISATION
<br />IECLAIAIAN
<br />I hcrchyilnnnundcr prtrdtyolpcrlulyoncof rhcfollosi"gdccl r n\l
<br />I hrvc kl will.rn llnr !(tnificrlcoac,n,{nr t, Srlfltr\u'. ntr trork$r c nlplnorion.r\ Pn)id.d fd bySsriM]?0Ool'lhc
<br />tjtrr C.dc. fd rhc nrrfor,tumc ol rhc q'ork lbr $li.i rhc Ii.nnir i\ n{,cJ
<br />-l h!!c lndeill roinrrinqo*cn .onp.Nslion insurgncc, N EiuiEdbyS.crion 1700 orlh. Lthor Conc. fd rhe rcrfor@ne.f
<br />r.r uhnh rhn mrnrir i\ n\krt M!
<br />llut'Jr,nl falh
<br />wor*6' dnpcosarioo insurarcc caricr dd,blhy numbcr m:
<br />{.?r.111r-,1761furJ\o l.( .\rr
<br />-l
<br />ccnifrthut in rhclrcrr.r@k or lhc worl for whicn $is pcnnil is issucd. l $aU er cnPloy any Frsn in any mnmt
<br />n, $io lE .m slhjccr ro rh. worktrl oq,eNlliotr Lps orcaliiohi& &d J€Ec rh{ if I should tEtotu sobidr ro 'h.w.rkcn drqrnsarion pmvisions.f Secl ion 1700 o, rhc Lll'or Codc. I stkl!. iunhwilh omply qilh lhoc povni6nr..
<br />WARNINC: Failun l. sue srk n mmp.nerion corcne. is unhstul- ud shall suhj*r e .n hrr lo simin.l |lcolri.r and
<br />n' o,f, hutulrd rbu\rtrd dollds (Sl(X).UXrr. ir! dilirD ro ihc con of.o .rp..erion. druSes rs plolidcd fo. rtr
<br />Scrr io. 30?6 of lhc Lahor Codc. inlcrcar and atlomrt tlcs
<br />,if H.tr",.g."r*lpJa hlr I m lic.lcd urdcr proti.ion of Choptcr 9 (otlmeinS wnh sdbn 7m0) ot Division 3
<br />of rhr Busiflrs d Polcssiors Codc. und my liccnsc h in hill ro,cc lrl cfici
<br />tooal6t-
<br />ktt'v\
<br />COISIf,IJgIIONIENDINC.ACINCI
<br />I hcrchy,flnn trndcr Ftrdlyofnerjuryrhar rh.rc is ! consrtucri{,n lcndins d!c..y,tr lhc pctlo run.c or'hd wolk lorw[ichrhis P.nnit is
<br />h\u.d rscc :109?. Civ. C I
<br />kd.r'i AdrlBa
<br />-
<br />dlfuc lfDD(:Ll&4.:IMN
<br />I hs!+,y ufim undcr F.aht ol Frjuiy onc oftl[ li,lb*nrg dcclffili,tn\
<br />Drmlirion PcflnrsAsbcstos Norificrrnnr Fcdcrdl Rcgulrrntr\ ( lirlc,l0, P 6)
<br />-Rcqutcd
<br />krlcr of Norin.di,n
<br />-l
<br />ccniryrh rhc fcdc.ol rc8ular ions rcgarding astEslos emraltrc nor art,icablc to lhis 0roid.
<br />Gladiayrlrr I lIrc rcd rhisdplicdnnr ll {jc I asB ro d,mtly wnh rllCilyand Counry
<br />ordimrEcs od Strrc L{wsrcLrin8 rol,xiklins ilca oflhis Cny.nd Counlylo cnrc, lrD $.
<br />at'olc mnrioncd lropcny lor itrspcclion
<br />ApplicEnt or Aadl SiAn$lu "[{UGiSj@rip
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Building Sewer
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq 8rtQlr e0ty
<br />Final Gas Test
<br />Meter Release
<br />FINAL UrJt 5\i$
<br />Notes, Remarks, Etc.
<br />fre
<br />Area/Storm Drain
<br />Miscellaneous
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