Laserfiche WebLink
PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipino <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />lrilain 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 tr-41r <br />Final Gas Test {-r+49 <br />FINAL q -z+"tv ).tr 'T <br />Notes, Remarks, Etc. <br />I)WNER BTJII,DER DEI,CARATION <br />I hcrcbynftn und.r plfuhy ul pcrjury rh ln rcxc Dr fro'n rhc C.trtr.roN Li.cnsc trq l(trlhc lbllowiog rcN)n lsrc 70.115 <br />ausircss n Prolassiun Codc) Any City or Cotrtrly whi(h r.qui.cs . pennil lo c.n{rucr. rlrcr. inlmvc, dc slish or rctrn rry <br />srR'durc. flt,ro irs is$'uEc. !ls, rcqutc\ rhc lmlicrnr rbr such p.rnrir rii filc r \lsncd nalc.!.nr rhd tror shc is liccn*d Nrsurnl <br />ro Ih. provi\iofs or rItr Co rndo.'s Liccnscd lnw (Chifr$ 9. (1mncncin8 qith Scclbn 70ul of Dirtn,n I orrhc 3u\inc\s n d <br />rlonsionsCodc)orrhdhc.rshckcxcnDrthcrclroNMdrhc[$isforlhcal]c8cdexcmfln,n.40,viorrri.norsc.tidrT0ll.5by ny <br />rlplicrnrn)raI)cnnirslhjccr\rh.rmlicrnrbrcivil!.nrhyolmlnmrcrhrnfiv.hundrcddull.h(5500). <br />-l.rso$ncrolrhct'tupcny.ornryctrUlo}lcs*ilhwr8cs$lheirs'lccomncr\Jri,n,.will.lorhcs.rkardrhc{tulurckmlii ctrdcd or ollircd ior vlc ( SLr 7l),]4. B0sin.$ r'{l korisi,n,\ (i)dc 'l'h. Cofurctor's I -i..N. hw docs nor mlly tu ownerol <br />rhc pnJpcdy who tDikh or improvG rlrcrmn. ,rd s h. d.cs {'ch w(trk iiD$ll oi hc clforrhmugh hi\ or hcr o$n cmfloyccs. <br />fn,vidcdrh rsd.h impRr$.nr uc orircrdr{o'oliadlar\rk.Il.l.i,we\erhclnriklin!o.in\nrovcnr i\{nd*irhi"!tr'LFrr <br />olrotrDLri({. rhc Owncr Build.r *illhrvd rhc burdcn ofp(ri,'A rlld hc or shc did tr.r huild or irnf.vc thc Imtcn} Io. rh. purF)s.f <br />-1. <br />as oqoer of ttu ,m,)cny. rmcxcllsivelyonrEctins wnh licenscd co.rract^ lo onrtu t rh. lrojct (S.c.7044. Busms <br />and ft.aL\sion Codq 'the Co.tnctor's Liccns. Lde docs nol artly to an owncr of [opcny *ho blilds or inrrovci th.tcon. <br />and who otrhcls for such Dnj(c wirt a Coahclo(s) ltcnscd ,u$uaor ro Oe Coortut s Liccosc hw). <br />I amcrcn'd undcr SNton . B. & P.C. forrhi. rc.\o. <br />uoxKEBs_cqMrINtaro! <br />DECI.AMIII}N <br />I hcrcby afirm undcr p.nalty of periury onc of lhc iollowinS decldllions: <br />l hrv. nrdBillnmi! air aCcnificrlcofConsctrllo Sclllmurc lor workcn conrpcn\ ion,nsprovidcdlnrbySc.rtunlT0Oolrhc <br />t..lxtrC.tu, tur rl[ p.ra.nnanN of rhc work fo. shich rhc p.i,nir h issucd. <br />_l navcandwill minlain Borkcs compcnsltion insu.ancc. as by Scctio. 1700 .f lhe hhor Codc. lor thc p.rfonuncc of <br />lhc qork lor which lhis Dcr. l is issled. My workcrs e insurun.c crdcr ud poli.y numbcr dc <br />l.cnny thil in thc pcrfonmncc olrhc work lhr ich rhk pcrmir h hsucd.l \hall.ot cnploy any lcmn in my mmmr <br />w es ro b.cotu suhj*r r. rhe $orkc6 con,cnsilion laws o,Cdlit mi,, ind aCft th0t ial snould tlTom slnjd to lhc <br />{orlc6 conpcnsorion povisions olScdion lT0oofthc bh,r c.d.,l sh l. fonhwithcomply wilh lhos pDvhion.. <br />WARNTNGT Fdltrrc ro surc vorkcB ompcnsilion covmsc G unlavful. ond shall sutjecr an 6tloy& ro nif,inal Fmltics and <br />civil fin.s up ro onc hu.drcd Ihousrtrd dollaN ($100.(x)0).lddition lo thc con ot.dmFns tun, dnrog.s ns orolidcd for $c <br />Sccrion .l{r6 ofrhc lrbor Codc, irtrcrcsl and allor <br />llllt &rlDN <br />ol rhc B!\i,,css rnd P('rcsi(nr\ Codc. ud.ry hcn\c i\ i. fulllnrcmdclfc.l <br />CIIIEIBIJCIIANIINDINCXiETI <br />I hctohyrfinnund.r!.Mltyofpcrjurythlt lhcr. isicotrnrudiotr h ingo8cnc,f lhe Dcriormrncc orrhcwork forwhichnis Fnnil is <br />tsuc.l (Scc :1097, Ci!. C ) <br />ATTUCANLDECIA&TIA! <br />I hc'!b, afinn undcr Fmxy orlxrjury on. ol thc followide dccl,turionsl <br />Dcilolitiotr Pcnih-Asbc(os Norinc ii,! Fcdcr0l Rcsu!Erions (1irlc.l0- Prn6l <br />-ltcquircd <br />Lcrlcr ol Nolifi crtirn <br />I ccnily rhar rhc f.d.dl rcguhlions E8rditrg ashc$os r.nrvnl rc nol .pplicoblc lo thh pmj&t <br />-l <br />ccnify rhat I hivc rcad rhk Blplicario.undstarcthor Ihc ahvc iilormarion is.orel I ngd ro .onqrly vilh,ll City lnd Counry <br />odinamcs 0nd Sratc tjws ehring ro buildins construcrion. Dnd hcrcby authorizc rqrcsntarivcs of rhis Ciry dd Cou y ro cnlo upon dE <br />,b.v. nr ioftd pft't.dy lbr <br />Applic! or&ulSisnulurei ^"-1L22a <br />k.l.{rd) <br />DWIt) <br />Meter Release <br />Pcmile nnm€ ( Drinl): <br />-------T------