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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GHOUND
<br />Waste & Vent ,. ni(^ L
<br />Water-Under floor - rLcPlio" --. k\D'l ,".a./., u' /
<br />Building Sewer l'"" - (b J )(9Yut )' P( lvttt
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough 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 />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release ,/\
<br />FINAL Kl1lr< t A)rl.]r{r^)/
<br />Notes, Remarks, Etc t
<br />OWNER EUILDEI' DEI,CARATION
<br />I h.rcby lrn undcr Fnahy of F jury ln.l I m cr.npl itrD rh. Co,lmclon Liccns liw aor$e followioS E&sn (5(.?031.5
<br />Businc$ ard kofcssion Codc): Any Cir, or Colnry whi.h rcquiEs ! Fmir ro conntoc( ,ltcr. iortuvc. dcmlish or rcpair uy
<br />slructuc. prkrr ro nr ilsuarc., als rcquiB ih. alPli.lit for seh pcmir ro ,ih ! sigrcd .l.mfi lnar h. 6, sh. is lisn*d l,ursmr
<br />ro rhc lmvkions of dE Conksclols Liansn L{w (ChE rcr 9, Coomrcing *irh Serion ?000 of Division 3 of $. BBincis dd
<br />Pefc$ao.s Cnd.) or thll lt or ih. is cx.q[ [rcEtbd a.d rlE hssi. for rh. aucged .xcn0rion, AnI viohrion6fs6rion'70]l-5 b, $y
<br />spl,li.ant for 3 pcmit subje$ th. r0pli.!.r lo tr civil lendlty ol ror mrc thq nve hnidrd dolls ($500)
<br />-1.
<br />as n*ner Df r,E prer.nn or my .mployes wirt qascs ar thcn $t mhpctrsrion, siu do rhc wori ald rhc sdm is nor
<br />i cnd.d or ofcrcd for $le (SN ?044. Busincas md Pmfcssio,s c.dc 'l-hc Conlrelo/s Liccnsc bw docs ml amly ro u o$rcr of
<br />rh. tFrErty who brilds or iqFB rhc6n, !d who &Es sn si( himscltor hc^e!(or$D!sh his.r ho o*ncmployei
<br />providcd rhar such in{mwm.ts @ mt inrcflld o.6rLnii for sL.li lse6. rh. hoildin8 or inqmvcEm is$hwithhonc Fm
<br />ofstrpLriotr ir* O*nfi Bui[I( *ill h,vc ihc hrdcn 6f povins rhal hc nr stc did hr hoild or inl|mrc rh. petfny ror rh. plrF e.r
<br />l. a.qn$ ofrhe ropcay, !n c xc lusivcly .onrel ing wirh I iccn *d .onruc'ou
<br />'o
<br />coosDcr rh. pbjc.l (S(. 7014, Busnc$
<br />u EDfRsion Codcr Thc Conhclols t,iccns. Lrw d@s noi {tly lo on ownn ofF opcnywno builds or irtn!.s fi.rcon,
<br />od ato onm.lsfor $chrlojer, wnh a Co.hdonn liclT*d lo^uor ro rk Co rrclor's Li.enr t)w).
<br />-l
<br />a6crenfl und6 S.cl B & PC forrhi\ rca$i
<br />wonx*. {s' coMPENII{TroN
<br />DECI,IAATON
<br />I h.rcby affirn hdcr ltlahy of rc4ury otu ofrhc following dslararioisl
<br />lf,hor (i)dc.lir rh. Jtrli,rtrrrEc olrltr wo* lnr $[ich rhc Nrtr]ir is i$ucl
<br />I hav. rnd sill @inrain workcrs' coDr.nsrr io. iBuEec. 8 ,cquied by Serion .171D ol lhc L3hor C.dc, for lhe pcdomtuc of
<br />lnc wo.k ror whi.h rhis p.mir is isflcn. My workm omp.nr.rbi inrure.c .mir ad poli.y nunrb.r e:
<br />-l
<br />ccnily rhar i. rhc p.raor@ncc ofrhc work for whi.h rhig p.rnn i3 ksucd.l shall no! c'trploy lny IEreon in any tuoncr
<br />b ns to b.sm subF{t ro lhc wkcn'mmlrnslion hws of Crlif.mi!. md iEm. lh.t il I should t*com $bj.tl lo llr
<br />wortc^' corycn$lion povtions of Scclion 3T00 of lhc tihor Codc, l shull, fonhwirh .omtly wnh $oc p,olisionr..
<br />I,VARNINC] FnilxE ro surc Btr*.rJ s,ntEnsrion cowflgc is un L lnd shall subid !r cnDlolcr lo sininol FNltis ajd
<br />civil fin . up to om hudEd lhousd
<br />Sc.rn .l{) 76 ol rh. If,htr Cod., i crcjind
<br />I hcEb, offirm ufldcr p.nrlly of !'crjor I nEt und$ nmvision of Chrplcr 9 (conrnEncin-s wnh Sccl irn ?01)O) ot Division :l
<br />of lhc Busitu*s and Ptuf.sions codc, and my li.cnsc k i6 rull fd.r md cnccl.
<br />Blf cs?LiemcA.,:
<br />o". t$
<br />I hcrcnyrmrnlnds rEnllry of rcrjury
<br />isucd (Sc. 3s)7, Civ. C.)
<br />lcndinr ascncy for rlE Iorolfue of rhc *ort for $hi.h lhh IEnn is
<br />AIIUCANLDECTAf,AIION
<br />I tmhyannmundcr pcnlhyolp..ju!y oe olrhc lolkr{ilE dal i..s
<br />Dcnnfion Pciht$Asb((os Nori,loli(r l'cdcrll RcSuhrnrs (T lc,ltr, Pun6)
<br />-RcquncJ
<br />krrcr oi Notitc.rir)n
<br />fcd.nl dgulrlions nerding asb.sos rc Dral r. nor aprlhrbh ro rhis pm.iNl.
<br />rhallE lhorc iniornEiion ircoret.I a8xe to.odrly*irh,ll Ciry dnd Counr,
<br />[crcnrlrivcs oa rhn C yannCoomyrocnh
<br />-,",b(,
<br />"b
<br />Gas-Underfloor
<br />Gas Service
<br />,)
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