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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS oIVNI]l. AUILDER D}jl,CARATIoN
<br />I hcr.by alli,m unler penally of lerjury rhal I in excnfl fnnn the (onrractri l-icensc Las, lor lhc lhlloNin!.easn (scc70ll5 ,
<br />Bu{n.s1 ind Pn,lr*i.n C.d.): Any C[y or Counry *hrch Equr.s . Ii.rmi n) con(rucr, ilr.4 rnrtmle, &molish or r.r any
<br />sru.lurc. prtr(, [r 6suaR.,.l$ rcqlnes rhr.prli.dnr litr such rtmnr kr lil.. {sn.d srrhnr rh hcdr.hc ie [.cns pur{Mr
<br />ro thc rmrismnc ol rh. clr r.dors t-iccnscd l.iu (Chir{.r 9, C.nnncN,ng *ih Sccrion 70i)0.lDtr1son I olrM Busn.$ ind i
<br />l'mlcsions (td.)orrlrr lkorshe is.x.n4 rlEr.ion.nd itu h.ss hr rhc0llcrcd ctctrrprion AnyvddionofSrcrionTl)ll.thyany
<br />q,p[crnr fo, rpcn![ Ruhjslslhc rpplic..r to ncivil,r.Mliyofnol morerhan ny. hund.cddoll.rs(S500).
<br />_,, $ o9E of rh. pop.ny. or ny .nplo)cs wiut qgs $ rh.n $L @dp.a{thn. vill <b rtE wort !d tlE irurE n mr
<br />i.rdd.d or ofler.d for slc (Sa.?044. B!si.6! ed Pmfcrsioro Cod.: 111. ConrEclois Licdr La* doa nor apply to rn o* ftr ol
<br />thc ,mp.dy vtb b{il& or imprbB tlE6l\ .d who &'6 sci mlt him.llo. h.Mlfor Inmu3h nh or hs own .hployce,,
<br />provid.d tl',t o.h !,plb\Ed.B G br i.r6i.d or.,Ld tu sle l[ h6wffi. rlE ltrild g or oplir{llrH L $b wnnr oR F.
<br />6l6nphriot\ rlE o*c Buikl$ aill h.E E hrdoofDrovns ftri tE or CE did ful loild tr h'lmc rh.l)srdy &r 0E O{r46f
<br />I amcx.D und..S(lio. .B &P.C forlhi...a$n.
<br />Drt: OrD.i
<br />lryonrr{s, coMPENsaTroN
<br />DECIAf,A]IO!
<br />I h.rcby 6mrn uid* pcdlty ofpaj!.y oN ofrh. follo,iis dftl@riodr:
<br />-l
<br />trE .td {ill mit .in ! C.nif{.rc of Concr io Sdf-|tr@ for qut6r' @mp.@lioA ar lovid.d br b, Scti,o l70o or$c
<br />Lrbor Codc, for llE pEfoilm of fi. m* fd snich llE Fmil ir is.d
<br />_l h.v. and will miolrin wortcru' @m!.nsrion insnrcc, 6 EquiEd hy S*rion 1700 oflh. bhor Codc. for lhc p.rtomnc. of
<br />rn mrk for whict lli! p.mil i3 iecd My wor*6i @mp.Mrnln iBUBrc. @ir .rn policy numbd m:
<br />S'zrrr= -Fvtt/
<br />lLLlTnn->-ol 4 | {-o ( ->. t
<br />_l.rnifyrh.r rn ih. p€rtormare oalh. Bort lor whrh this p.mir is is$.d. I shau mr.oploy a.yt rsn in any md.ftr
<br />$ as to h.om rubjet l. !h! worlca'oq'.Bdion laM ofc.lif.mi,. and aER rhd iI I should h..om Nbjel lo tlE
<br />*orkc6'comt.nstiontmyieionsofSelionlr00oath.LrhorCode.IdDll fonhwnh ormply wnh lhofl,mvi3ions..
<br />WARNINC: Iailurc ro KU. *o*m' onyEMtion 6r6s. Lq lnln*tul snd shall shjdr oplorlr lo oihitul FElr.s ltd
<br />civil find up lo oR hundEd lhousnd dolh8 ($100.000), in r.ldnion ro rh. m.r ofotrrp.trqtio4 rLtus.8 !! ,mvil.d hr rh.
<br />S.ction 10?6 of fi. Lator Cod., in!.r.d rnd cnom.y's f.6.
<br />!r- Jtww Joa
<br />ucrBtl:tll9lraacr(x
<br />Dlct ASaIa!
<br />I h.rchyamflDnndcr p.MltyoaFrlury th.l I am lic....d uhdfi pmvsionofch.prer 9(comnrRiry wilh S.cliotr 7000) ofDivhion l
<br />of rh. Busimss ind Pmta$bnscodc, rl ny liceNc r
<br />'n
<br />rull ior.s l.rrcr
<br />E iccnscNumh€r: ' \8Lq1$
<br />\Ll 11 /'t-o t+,Jal'f, J oo
<br />g)I TBUCIIONIETDTNCIGIICI
<br />I lrrchy.fllnh u d.r Fn.lryotrrjurynd rh..c h a condtucrion letul'nr x8.rcy rar r1[ ncrlornitur. of rlB rvolk lnr shich rhN rirnr n
<br />Fstred (scc .1097. Ci! C )
<br />^]fuc.AttlD};cl.^aatl()rI lmhv i,Inn n ds rcn.llr oi nenury o,r. of th. follotr ilu n.rhnrknN
<br />D.nml'rnn P.roirs Fh.nos No.ficaxon ledrrrL Rerul0l on\ ('li'le a0. Pxd6)
<br />li&ut d I crr.rofNori[.rrion
<br />-l
<br />.dify rhd
<br />'h.
<br />fcdchl ..suldiom rcE..dtru rsbrstN R.x,r.l .r. m( .,,plicabl. ro rhir pml..r.
<br />Ul c.nili thdr I ha!. e.d rhir lmlEarion rud rhr. rlul rhe alnv. infomi on h corcct I rsra t, conply enh .ll c y rnd c6umy
<br />ordnsr.s B.d n!r. l rH Eln ins ro Suldins con{tucrioc and n rchy .uthxrzc Gr1rcs., .riv.. ot rhB Ciry .nd Cori'y ro ..r( uF'n rhe
<br />abov. menlion.d nmFny lor mercd ion Durl,ors.r\t-l 11 | t- 1!.,
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor 17-24,1Q x-wto)l
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Wqter Piping
<br />Gas Piping l>"7,t.{ r x-v410
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P-lrap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn S prinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test +-\tst1 kwfi,
<br />Meter Release f It- 11 9-W)
<br />FINAL G-U-4\\"u#a
<br />Notes, Remarks Etc
<br />6A{\AIY 6 PJ I B-a-19 xa)0)
<br />-D
<br />Roof Drain
<br />I, a, owmr ol rh. 0mr'61y. .m qclBiv.ly.onrmlin8 sirh lier*d mi'mdou lo mnslruct rh. I,mj..l ls.c. 7044. Bu.ircs
<br />.,i Abt$o Cod.: l'h. cont.clols Lic.n* Lls d@ ful atrly ro n. oeo.r .ttNp.ny sh6 buil& 6r,npmrd ih..6.,
<br />lnd who mnln.re for zuch rmj.{s wnh r Cofldo(r) lic.n-d putur'r b rhc Conrrcloar Lic.M L.w)
<br />o,,, ' l.L / l> />e t $
<br />Ldda'3 Ad&Hs
<br />-
<br />Aeproni or A*.nr srg,trae fZ-==-='--
<br />U- 'Tt^o Jao
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