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PLUMBING.INSPECTOR HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underf loor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipinq
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trapi Drain Line
<br />Ir4ain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<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 />46',,Rough Plumbing 6FLT/ft
<br />Final Gas Test
<br />Meter Release
<br />FINAL tl/ttt I t c.1\<(,
<br />Notes, Remarks, Etc.
<br />OWNER BUTLDf, R DELCARATION
<br />I lErcby amm uodcr Fnshy ot !,crjory rh.r I d cenfl nld rlt ConlB.rou Licn$ t:w aor thc following ,te. (Se.70f,1.t
<br />Burincs lnd Pmfcsxion Cod.)r Any Cily or Cou y which eqlies r p6mi' lo @nr cl, dtd. inpNw. d.mlih or En n u,
<br />srrucluc. pri,r to ns issuee. abo nquiEs lhc applicDl for such F,mil lo filc ! *ig@d slarcmni rhd tE or sh. is liccn*d Pu*uul
<br />ro rh. pmvisions of llr Conlreroi ! Liened L.u (Ouprcr 9. ConrmNing with Scclio. 7000 oa Diviiion ] of th. Brsinc{r and
<br />Profcssions Codc) or rhar h. o. shc Lr crcnq thcEnom rd lhc b&iis for lhc alL8.d crcqnion. An, viohrion of Scdior 103,.5 bY my
<br />.pplkd ror ! Fmjr sbiet3 rlE at !lic& ro !.iril pcmlrt of nor malhe lirc hundF! dollfs (5500).
<br />-1.
<br />I oq6 otrhc poDcny. o. my cmployes wiln wascs as 6.n sE Nnq*nsarion. aill do dE wqk !d thc stu l@ ir ht
<br />inLidcd nofcrcn fq slc (Se.r044. BrsiBr lnd Plofeisbtu Codo Thc Coln.ebas Lis.* t!* ih.s rol sPply lo ao owE of
<br />thc Fopcny wtr hildi or invoa tuMtr and who dG sh s,t hioscli or lEelf or ftrc!8h his 6 ho o*n crptoy.cs,
<br />providcd rhrr skh iml'mErnrs m nol inr.nd.d or ofisd ltr EIc. Ii tFkw. tlr Lditdi.g .r itrtMlr ir eld *ilhin oic Fr
<br />of@trrpL&rtr llr o,"Gr Au hr wi[ lEw llE budcn orpmi,S lhd lE or sh. dn ml hild .r inF6k r]E F.Fry tor . p{qts of
<br />-L
<br />arowE.otrh.tmFny, mcrclusivclyco rrcling wilh liccns{ onl6.x,ft lo consEct llr pmiNl {S(.7044, BEims
<br />and EDf.sion Codc: Thc Conhcbas Liccnr. Law d.E. mr .Fply io !n .wncr of prcFny who builds or imrows rh.Nn.
<br />lnd who @mBk aor su.h Foiels *irh d Co.lracro(r) liensn puF@l ro rlE C.nhlo. s Lk.,s l2a).
<br />-l
<br />n,ncxcnrr' under Ssl A & P.C. ror rhls r.ason.
<br />loStrESgglMrllsAltoN
<br />DECIdSAtrq!
<br />I heEby afftrn undcr pcnnlly of psjury oft of rhc following del4srioBl
<br />-l
<br />h!v. .rn {i! minrain ! Ccnifrarc otcoNfl to S.ll.lBlE tor m.t 6 comp.trsrion. es provid for by Se'io. 37m of thc
<br />tibot Cod., for ti. Frfotrl@e of llE *mt for ehich lhc Prmn is is$c<t.
<br />-l hrvc rnd pill mintoin vo*cN .on{86!rion insumNc. rs r.quncd by Ssliotr 1700 of lhc tibo, Codc, for ric psformNc ol
<br />G n\ut Mysork.A comn n\rrion insui,tr.c crriq a,n,x,licy nun$cr arc:
<br />o S
<br />o 16yo
<br />-l
<br />ccrrify thar in rlr r.rtormN ofrhc work lor shtt! lhn !..nn is issu.n. I shll nor cnploy{iy p.Mn in 0ny mnncr
<br />$ * ro trr.nE subjer b rr* wortcc omFnsalion k*s ot Calitoniu. dd dlN $ar if I sholk h{tom subjccr ro rh.
<br />workdc onp.nelion pmvisions of Scclion l?00 of thc tibor Code. I slull. Lnhwhn on{,ly vith tho$ l,hvkions ,
<br />WARNINC Frilurc lo wur. wotk is conl,cnsorion cov.m
<br />civil finc\ un ro om huidi\, rhouqnd dol,s rSlU),UIrr.
<br />s*lbo 1076 olrhc trb.r Codc. inl.rcsl and anomy s t'es.
<br />e. is unhwtul. ind shall slbltl e y$ ro rimiBl ncialrh\ and
<br />in .ddirion ro rlE co{ or
<br />AUG {t&2+18
<br />I hcEb, ailirm undcr n n.lry of p.rjury thll I m liansd undr pmrisioi of Chll)lr 9 (ommming wirn Sslion 7000) of Divhion l
<br />of rhc Busirc$ and Poacsiont Codc. r.d n, li.nsc G i. 6ill foR aid .lftcl.
<br />6*e,ffc\-
<br />coNsrBlquo utNDllli.dcE!(I
<br />I hcNby rf6rmun&r pcnrhyofFrjury thd rhc,. i\ r onnrudn'n h dina rlcmy Ior thc |xrlbrmrcc ollhc work ror eli.h rhis Fnn, is
<br />i\u.d rsc. lr(D7. civ c l
<br />ATILICANfECI.AAA.IION
<br />I hcd/y sllinn trnd.r p.n,lry ol0(rjury orc oflhc fo,lowin8 d(luraliq!:
<br />Dcmlition Pcrnirs Aihdlos Nori6cr(ion tudcrrl Rc8uh'n NOnb40.1'on6)
<br />-Rcqutcd
<br />bncr of Norifi carbn
<br />-l
<br />.cnify rhar rhc f.dMnl rcguhtions rcBtrdinB 0sbcslos rcnFvul rc nol ap,tli.dbhi ro this Pmid
<br />rhlt I hovc rcad rht lppli.art n s,i rrsr. rhd rh.,bv. inaormlion iscorat.l !s@ roco,{,lysirhdll Ciryand Counly
<br />trccs !frl Srlrc Ii*\ rcliri"8 r. buildi.8..d{rucrr)n.
<br />nbok nrtrrioncd tmpcny for insFrrion
<br />Atlplio{nl o. ,\aent shnalu
<br />,h'| qrr rLr C,,! r) L, or' uti, '
<br />rltr
<br />Ari6 U ri cu r-
<br />Dalc:
<br />I
<br />a
<br />.<
<br />L,enk ctds\ 4- Lrcn\.
<br />,*uG-03 2018- con,nc,or
<br />-
<br />\0 o< r qc,t
<br />L.del! Nam:
<br />-
<br />P.mlreNm.(rrlr,
<br />Waste & Vent
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