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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEI{ BUILI'ER D!]I,CARATX)N
<br />I hcruhy rlnnn lndcr Ic rxy of |crjry lh l ur cxcnDr lroD rhc G,nrn.r,r Li.cr* llw tut nN nnk,q4 rciu (Scc.7(r'11.5
<br />ansifcs\ rtr,l Proris\io Cqlcrr Any Ciry or cl,t , which r.qrin\ a Fiinn to .or\rtu.|. llrcr, imnt,vc. dcnmli\h nr tunrn rn)
<br />srru.lurc. pri{rr.i ns nsurtrc.. rl\o dquftrrhc l)thrnr nn ruch pciinir h lilt r siln d {lcnf,trr rhd hcor shc k liccns.d rrsurir
<br />k' rhc F)vistr'ns .1 rhc Corrrr.l[ s l,i.c \cd tlw (Chrrrcr 9. Co mcmnrs wnh Sc.rion 7 noIDirisdiI ofrlE Bu\inc\\ !trd
<br />mtlicrnr tur rN n sublccF,hc lpplicrnr lo ncililpcn h!ofnot ndcrlrn fivc hunircddolhn(S5U,
<br />-1.
<br />r\ oq ncr ol lhc nn,pcrlr. ff 'n, cnlployes wilh snsc{ !s th.n v'E .o.rIri$hon. vill do rhc wo,k nnd tu nturm i\
<br />i'nflxlcd oroficFd k ulc(sR.. 7(41. Bu\inc$ lnd tLfc\st,nrCodc Th.conkidols Liccnsc l,rw docsnor qrtlyt,a owE!of
<br />rhc$,p.ny who hurldsor inlrow\ rlxNn. rnd who docs such sod( himsclior hcr{lfor rhrouSh his or hq own c,nploy..s.
<br />pnvidcd rhrr srch inlJ,ft*. r rs dgmr i cndcd or nllcBl tur qt li h.srvcr, rhc buildinA ff nr{K'\qrclt is v'U *irhnr on. ,r:tr
<br />ol c.llrlrtrion. rhc Ouncr BoikLr will lurc rlt bunlcn ol ttuvin8 rh.r l'. or shc {li] tror bdikl or nnnnru $c !n ldy fo! rhc lurrxM of
<br />-1.
<br />!rosrcrollhc pro!.iy, m€rcllsiklyco rading witn [ensd @nr!.loB lo onsmtl lh€,rci(l (S4. ?O44, BBifts
<br />md Prtrl6sbfl Codc: The Co.rocroa. Lk.ns. Law dms not lp0lylo oo*n.r oaP.6Frly who blids or ihPmves lh.@n.
<br />and who onrlck aor $ch [mi*rs ei$ , Co'nhdo(t liersd puEuer lo th. Coflrmlols Li.eM tlw).
<br />-l
<br />M ex.mp u.dr Sciion- B. & P,C, fo. fiis EMn.
<br />uI)lf,!8fIOMIEMAgqN
<br />DECIAXAIION
<br />I lEeby sfti.n undr p.rulty of pdjuiy onc of lnc following debrations:
<br />-lhovc
<br />und will,tuinunr a Ccniff,atc olConscnr lo Sclllnsu,c ao. w.'k.rs .omFnslrion, 0s pmlidcn f.r hy sccrion l?00 ofllE
<br />L or Codc. aor thc rcrfonutuc orrh. *olk lot whi.h rhc Pcrnln i! isslcd
<br />-lhrvc
<br />atol willDin Dinwoltcn compen\lrn,n io\finncc. a\ t.quircd by Scct ior 3?m of lhc l-trh.r Gdc. fot thc Pcrlortuncc of
<br />irrir is issucd Mywo &s c.'np.nl n,n insurarcc cmicr mdF licy nuFh.r -c
<br />{Co 7t o
<br />I ccniryitut in thc pcrlbrmne oflt rork turwhich rhn pomir t hsucd., sholl nor.nlloy u! l.t$n inan,tuer
<br />$ !s h hcrom subjcct ro rhe {ort6 omt.nsolion hws ofc.lifomi!. lrd ,g@ thar r I rnould bccom slbrc.l ro fi.
<br />{oltql cofi,cnsarion D@vhions of Sdiofl l7m ol $c Lltor Codc, I shr!, fonhwnh omply *ilh lhoe lrcvbions
<br />wARNIN(;] l' iluc n) \ccurc sfr[.^ .o rpc sxrtri] co\c
<br />;:rl,fi tisr'0iifl {CIs}il:r:ll'fl '
<br />loyc, to dhi@l Fmki.s {nd
<br />Nm8cs Bs trovidcd tor rhc
<br />UEILISAIT,IN
<br />I hcrul,ynrl'.nrurlcr FmrtyofFrjury Ih l !m liccn{d rndcr ntuvi\n,r oi(hnrlcr 9 (conrmnring { h sccliotr ?m() ol l)ili\iqr -l
<br />ni rhc Businc$ ond Prottsion\ Codc, ud myli.ctrsc h in Inll lnR! runl crlacr
<br />5,\oala$1
<br />-,1t1€ Il&fAttv
<br />r:trls.rntx:'rytx r rtoINd,rcliNcv
<br />I h.Eby.lnrnund.r p..ahyofpdjory rhdr rhcrc n a consflcthtr bndins rscnry tu Ihc Nrfoirrrrcr ofrhc work ror shi.h rhh lr"ril is
<br />issurd (Scc. 3097, Civ. C.)
<br />APTLUANLDECIAIATTO!
<br />I tu$y nnnn undcr p.trolry oi ttrjury on. orrhc rollowinS dL{lrr0tnrns:
<br />Dcdolirio PcnnirsAsl{{or NniiiQlion Fcdclrl RqoknrNlTnlc {0, P0n6l
<br />Rcquncd bltcroINolilic,rn r
<br />-lccnilyrhur
<br />rhc rrdcrxlr.Cuhiions rcgadins osh(slo! rcmvll rr. ndr qrll{ihk ro lhh pr+rr
<br />!h*,nr, n*"*,u,nn rpllicorionard {rrc'lx rhcnh,rd irl.i,mrio. G.orccr Isr'.{i.cohrlyw hrtlcnynndcotnry
<br />.rdinlNs a.d Srarc kws El inS ro boildint .oosr ,***,*. ",,i.J"$ ru,8"?mr
<br />UNDER GBOUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />Interceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Rool 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 />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq $/dk6 5br6i
<br />Final Gas Test
<br />Meter Release
<br />9\r\\ti ,U,AqN
<br />Notes, Remarks, Etc
<br />t nd.r'{ N.mc:
<br />Itrrl. \ AdJn -
<br />ove mnriotud pbFn, lor hspc.tion
<br />Appllc.nl or A8.Dl SIgDtoB:b;*
<br />FINAL
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