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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG,COMMENTS OTVNER BUII,DER DTJT,CARAT'IoN
<br />I h.rchy afirn unddr ltidry of pcrjury rhd I Dm cxcn$ lmn rhc Conrrh^ Liccnsc l,s for rhc rollowin8 mrv (se70r1.5
<br />Ausircs $nn Pmfc$nnr Cdc) An, Cily o, ('ounl, shi.h rcqutcs a p.rmir t, .oi{ru.r, dlrc!, impovc. dcnmli\h or '6plt M,
<br />strucrurc. nrin ro irs nluancc- ulso rcqut$ rhc lrpli.r ntr \u.l pc'rn ro filc. \iBncd sl.lcmat thir hcor shc t li&nscd turuMr
<br />b rh. rnrli\nJn\ ol rh. Conrocrols l.i.ctr*d law (Chaflcr 9, Co'nmcncrnS qilh Sccln,n ?ffio ot Divi\n,n I ol th. Businc$ itrd
<br />Pmlisions Codc) or rhrt hc or sh. t cxcnu rhcrcnoil nnd th. busis nn lhc rllcscd cr.nll,rn,n Any vidlaridr of S(tbn '7031 5 hy rny
<br />f.ltr"d t.r.'F n'ir {,1.8\^thc rltl'i'n,rnJc'riltrri)nrni n{rthrn lrvc hunJrcdJ',11.tr\ r1\rc,
<br />f4)
<br />{&*,,**,,,rrt'"n",r"n,.urntrcrpl'trNsrrnq.qc\r.rh.r{ncoF,F1rrtr,n,s'llJ rh \'it axl rtr {tu1urc ^ nnr'7l"ru.i , " "nt".,r r"i *t r i* 7(!r B;nN.\ !n,t P.,l;si6N cdl., rhc (bnr.crois Li.cnsc ljw docs nor arply b ar owncr or
<br />rhcBrIfiy whl huilds or in{'mv.s rlrmn. ud who dl)6 sucn so hinFcllorhcrclaorrhol8hhi\DrFiji.an.mployccs.
<br />provnhd rhur such nnln,vc'*nh rd hn ihrctrdcd or otfcrcd lnr s L ll. hoscvcr. rhc hlildinS or impmknEnr is sll] *irl,h om,(tr
<br />or.l,nrpktnn lhc (rncr Buitld w htrvc rlE htrddr of rovin! rld h. nr shc dil n, boild or in{Du $c pDFiy for rhc rotte of
<br />-1.
<br />!s owicr of rhc rlodry, ah exclurivcly conr6lioS wirh li.cnkd coor,rcloB lo onslrcl rhc Fjc.l (S.c 7I),l4. Butin6!
<br />afll Ao6ssiod Con Tnc C,nlE.lols Liccnrc Lov dcs nor lprly ro do*..r oflrcpenywno huildsor improvcs rhcrcon.
<br />ind sh6 @.urcrs for .uch Fojers wilh . Conlrero(9 lk.nsd puBunl lo thc ConlBclor's Liccns L{w),
<br />_l M cr.npl undo S6ti.n- B. &
<br />^,\ ?-Q-lg
<br />I hcrcfiyatlinntr cr pcrulryotp.rjxry onc ofrhc t)lk,wi,t8 dc.larti(rs:
<br />in ll* lcrfornEna oflh€ wort for wnicn lhh pcrdn is kstr.d. I shall not cnploy any lEson in lny Me,
<br />{rhjc.r xrrhc*ork.^.onpci\,ridn hqs or crlironrir. .nd iarcdhar iil nmuH h(omc \ubj.ci h rrt
<br />$ork.^.omt.\dn,nI,n,vhbtrsofSc.rionlTmofrhctjhnCodc.lshlll.t)nhsirhcorulywirtrh,{pn,vhn,nr.
<br />WARNIN(;: Frilrrc ro $curc sorkch $mp.nsdion .ov.flgc
<br />,nil lnc. dn r', nc huhd('i rh u.rtul d.llJr. r1ll(].ovr,. tr1
<br />Sccrion 1076 ofrhc llhr Gxlc. imrh{ aftl d[oirrr's ltcs
<br />Ls unlo*lul. ond slEll rubicr !n
<br />addnion ro thc cost 01c
<br />r-/ -/ g
<br />I h.Nby rfirm undcr r.n.lryotFrjury rhar I !m liens{ undcr rrovisionol'Chapr..9 (o.mncing wirh S.clion 7tlo0) ofDivnion l
<br />of rtc Bx\ims nnd Porcssions codc. md my liccns ir in full lor..,trd clisr
<br />Licisc cbss:-Lien* Numb.t
<br />Drle: Contmctor
<br />Cj)NIiIaIJCUQNT}II!C_&A!!1;I
<br />i\\u.,I(Scc .1(D7, ('iv C )
<br />AIIUCANLI,IEIIA8A.IION
<br />I lf,r'by,ninn undcr t,.n0lty ol pcrJury orc ollhc l'ollosinr d(lurarn,n\:
<br />DcrBririon Pcrnir\ A\hc\ros Noriacotion FLicfll RcAUhr ions (rirlc 40, P!n6)
<br />Rcq0iNd tr(di of No ficltior
<br />-l.cnifyrhar
<br />llE l.d.rnl rcsuhiion\ r.!!dins !\$.{o\ rrnn,vrl irc ior rprli.rhlc lo lhn ntoiccl.
<br />&t driry rh,r t hNc &rd rhis 0prlidn,. nn,l (trrc lhd rlrc rntrt innmul ior i\ corccr I lrr& t, .o rJry wnh .ll Cny atul Coutrl,
<br />.rdirunc.s &d Siar. ljs mhri.g ro blildinS .on(rucrhn. {n rcflcscnirri\r\.lrhn Cirydh'l Coutrry b cnrs upn rri
<br />ADpli.{nl or A*enl Si*nrlurc:
<br />UNDEH GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipino
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{raplDrain 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 SeweriCap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL /-tu-19 JfuJAI,A 6gt
<br />Notes, Remarks, Etc.
<br />-,
<br />-l
<br />haie.nlwill mrinhin!Ccnifi.rrcotCo.scirrosclflnsurc r workoJ .onpcnsd n,r. rs Eovidcd lor b, Sccrii,n]?00 ofrhc
<br />lirxtr cod..Ior Ihc lf,rlbrmncc oIIhc wori lo, r'hich ihc pcrnril n is\ucd
<br />-lhavcand
<br />sill mainrain wor[cB c.hln.\ n,ninsuatrcc,x\ rcquimd byscdion]?0oofrhc Lahor Codc. fff rh. pdn,nnnc o!
<br />rhc work aor{hi(hrhi p.rhn is issucd Myworkcn L$mp.n\rrn r inntrarcc c.nic, ud policy numb.r u.
<br />tf,nd.r\ A,l.lc*
<br />rbov. nrtrrnn,cd pnp.ny ftn nuccrn,n
<br />^,.,,*-6 -1d
<br />u€ )^a-
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