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PLUMBING.INSPECTOR RECORD
<br />APPBOVALS DATE ID/SIG.COMMENTS OI?NEf, BUILDER DELCARATION
<br />I h€Eby .rm und.r p.nall, oa Fdjut, thd I m q.n{'l 6sm lh. Conl,ldG Lice,F L"w fordE lollowing Ea{n (56.7011.5
<br />BBitus .d Pmfslion Cod.): Any Cny or Colnry shijh cquircs a p€n l lo 6nsmd. ahs. nrq'reE. &mlith or rcFn mv
<br />srrl.lrrc, p.i,r lo ils trume, also equiG ihc .pPlianl aot so.h |ndit ro rtL a sAEd sl,l.eol lh r E or dE is licencd Pumam
<br />lo lh. tftvhions ot th. Co Eclols Lien*d trw {Ch!Pt., 9. Conmfting enh Scclion ?@0 of Divilio. 3 of llE Blsincss od
<br />Prefcasi,.r Codc) or tnlt lE d rn ii€rctpl rh.rciiomgnd lh.t&sit for rh. tlhecdcrcq'lion Ary violalion of Selbn 7011.5 bv sv
<br />applic.nr for a pcmir subicclr rh. ry,rliclnl lo . civil l,enalry of ml erc lho five hund.n dollas ($r00)
<br />l. rs o$rcrolrhc lrrt,Nny. ornrycmpTo).c\ wirh srtc\N rhcir (il..ont|{r\iriotr wllldo thc!orkr drlrc{nErurc l mr
<br />rhc |rtl^-ny who tdild!or i'nF\r\ rh.(nr. m (l!,(l c\{'chwnkhnn\.llorhc^cll.rrh(ni8hhisorh$.str.rPltivc.\.
<br />-1,
<br />rc osrcr oldc pmpcny. dcrclnsiv.lycontlclins wilh licc.sd conrelor ro conntucr rrt polcd {SLt.704rl Bu(ims
<br />aa'l Profca\io Codc: Tnc Cont,crols Liccnsc L!* docs not apply ro in o*nr ot pnrp. y wk, huilds o, inpmvcs th.rcon.
<br />lnd who ontmrr for such tmFcrs *ilh I C.nlmcrorll) liccn*d pursuMt h thc Cont{.ioi. Lk!trrc l!w)
<br />I an:cxcmpl undd Sccri6n- B & P.c. iotlhisrcason
<br />Dde:- - Oa,er- --, lll)8tr[Bl:I1)M8DNSAtrON
<br />DICIA8IIIIIN
<br />I h.r.by affirm undcr pctulry 6i pcrjury om of lhc folloqios d..le,l ions
<br />I hrvc ot *ill .Einluin r Ccnirtotc of Conscnr lo Scltln$t lor workcc ompenerhn $ Imvid.n for bv sccrion l7m of rhc
<br />Liho, Cod.,lor rn lsfornurcc ofrhc ror* for whkh lhc F,m ! i\tud.
<br />aol sill roinr.in sork€6 .onpq.Mrion insutam.. ri rcquiErl by Selion l7m oa 0E Libor Co& for lhe Frrollrw' or
<br />&tr whkh rhn pcflnil is issu.{
<br />' 3*z-r\r
<br />d,nlcnsolnrn insuratc .mi$ md lolic, nr'nb.r c:
<br />\3lrl - 7-\- I 4,
<br />-l
<br />cenilyrhlr inltE pcrforrokcofth€ wort lorwhichrhis Pcrmn is hslcd.l shlll not criPlov lov l.6on inMv@rcr
<br />$ rslo berr sut'jd lo lh. wo*6 omPcnslion lass ofcrlilorni0, ord a8@ rh il! should t(om slt'itr bltE
<br />so*en mr{rnslion pm*io.s ol sdion lloo of ltc Llhor CoJc, l \h.ll. fonhwirh.otply wilh lhos pDvisi6B..
<br />WARNINC: Failua 16 sur. mrt6 oq,€netioo ov.E8. ii lnh*ful ud snal subFl an cn9lorlr ro cininal FMxas ond
<br />civil nncs up ro orc hr.drcd lhousnd dolla {Slm.m0
<br />Sdion .1076 ot rhc Lak" Code i crcn ed ari(,my 3 lc.s
<br />). in addnn,. to (h. cosl of cotr{f,
<br />,,,,", . lr-B-\< app,i6ni:
<br />ol rhr llu'n.\\n d t1.li\\i,nx L-lxlc, a d nr! lr.cn\c i\ | li,ll nftc r(i tJ L.r.
<br />1 11s77
<br />f5-\3-(4
<br />CANIIIBISNAII.ENDINAIIjINCI
<br />I lErch! rlttn u crlEmllyolpcridryrh,rrhcrcisr.onsloclionlcndirgnBc.cyforlhcpcmtr'tun.col'lhc*orktorwhichr[isFrnriri\
<br />issucd(Scc. llrT- Civ C.)
<br />tfndcr's Ntrm:
<br />-
<br />L.lrl.r'. a'll'r.
<br />lfrllGl{fl)xcl,aaarl(xi
<br />IlErcbynllnnund.rrt rlryolt'crJUryoNoathcfoll.*irtdccliraln,n\
<br />Dcrfrnnt Pcrnii\ A\h.{.\ Noirlicdioo Fcdc.rl RcgulnnN ( l itlc '10. Prn6)
<br />Rcqutcd lxrrcr of Notillcdion
<br />urc nor applkrblc lo lhn pmirr
<br />in nri( is cor.cl l u8rcc h.onrfly
<br />.nd Colniy to ..16 upon tlE
<br />.t-19-tt.'\0nli(i nr,\xt l Signnn'rt
<br />UNDEH GROUND
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area./Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipinq
<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 />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />FINAL g//s7 tg./,q40 1/
<br />Notes, Remarks, Etc
<br />+-
<br />d srlrc taws rcldirB to l,!ilding con$dclion. ud
<br />Waste & Vent
<br />Meter Release
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