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PLUMBING.INSPECTOR RECORD
<br />COMMENTSAPPROVALSDATE
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor X
<br />Buildino Sewer
<br />Area./Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Rouqh Water Heater
<br />POOL/SPA
<br />\P-trap/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 Sprinkler
<br />Sanitary SeweriCap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meler Release
<br />Notes Remarks Etc.
<br />FINAL
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<br />OWNDR BUII,DER DEI-CARATIoN
<br />I hcrcby rffifln utrdcr prnnlty (f FrJury lnd I .rcmpr rnn rhc Co.rrro6 Liccns Liw lor rhc nnl,qiig rca{,n (Scc.1r:11.5
<br />tusircs\ r.d ltofc$ion Cqlcr An, ciry or C.utriy whirh rcqxnc\ !,riNil to c.isltucr. (116, i'nDtuvc. dc mlnhorrcnrtuy
<br />dtu rurc. priff io ir\ i$uan.c.,ko rcqur.s thc !f/t.nl ror such Frnil h tilc d riln.d sarcn*or thit lEot sh. n liccnd Pu^adr
<br />tu rhe Fovisions ol thc Conh.ttr s l-ic.nsd lrw lchryrcr L Co'nmcncing wnh Sccrioo ?(x)O or Division I ofrhc Burinc$ and
<br />Pn)r.$i{,n\Cod.)orlhnrh.orshciscx.nDllhcrclionrandrhc&si\anrlltrllcg.dcr.nflion.Anyviolntionol'Sccrii,n70.ll5hyrny
<br />Jtlnhcrdr.rJFrnrir.uh,.rFrhcar,tli(,nrL,J.,vilpcnJl,yi,rnurmcrhannrFutrJrcdJnllor\r9:rO'
<br />,l-:1. otrffrrrh.ri,Fny. r ryc 'rl lccsl h w!sc! a\ rhct srlc co'npc .nriotr. will d(, rh. work and llt sl41m is nor
<br />L cn&\t or .licrcJ lor c,h ( S-.' ?(},4. Brsn$s nnd I'rofcsi,,n\ G cr l lt (hntrac(tr c l-icen\c tls d,.s nor !Ppl, to .n owrcr ol
<br />rh.Fn,Nny *ho buildr or inprercs rhcNn. rD.l who dcrsch +ort iinscltor h.r$lf.r rhn,u3h hn or hcr osn cmlk,yccs.
<br />prorilcd rhai such nnl)rolcn.m{m frn idcMcd or offcNd tur slc ll. hosc$r. rhc i ilding or in{'tuknEnr is sold wiihin onc ,!
<br />ofcrnlrLron, rlE owncr 0uil+r *ill hrtt rh. bodcn orr.line rh.t h or shc dil nor hliki or iqmlc rhe ln,Fty f.r $c I'u{Esot
<br />-1.
<br />0s owr of rhc l,olsry. !m .r.lrxivcly om6.rin8 with liccrsd .onti.cloF h on5lftl llE pri6r (S€. ?O14. BBims
<br />ond hnfe\sbn Codci Thc Conlrelols Liccnse Law dod nol lpnly to a.6sncr of lJb,,.ny who builds or inlrcw. lhcr6n,
<br />strd who onr6cl3 fo. iu.h poi*ls wirh a ConlBlo(s) licn$d pu6@t lo llE Conracroii Licns. b*).
<br />lArr,6"*.r,,"a. s*,."-. B &P.c lqrhiiE0son
<br />{,,'. \''"'c t9,lB &.\l.r."rcq-
<br />UQBtrE85-CODIIENIAIION
<br />DEq,AAAIION
<br />I herch, aafirm unde, pcnllry of pdiury om o, lnc followinB deldalions:
<br />l-rlxtr (idc. ntr rlt ldnnnrncc ol rhe $ork lnr r[(h rhr Il.nn( n a\u.d
<br />-l
<br />lulc Md *ill minhin workcis .omFnrarion insumm.. ,s Equncd by Scclidi :l7m ol rhd bbor Codc, for lhe ,'erformrcc of
<br />rtc work for Bhich rhl\ Fmir L1 issrEd My wtrtcB @m!.nsdlion insur*c .dtr d!x! polky nunbcr m:
<br />D.l'cvNumb.r:
<br />-trFrc
<br />./\-
<br />[1."nityrr,,r,nrr,"p.,ro'mntrorrh.eo .Ior$hkhrhhFrmr t i.tud. I (hrllmr cmploy any Fmn itr otry mner
<br />so s Io trronE subj.cr ro rhc *oltql cohpcnsrkin lasr ol Calitumi!, ed s8r.c lh if I sholu td'ft subict bltr
<br />workcs omlensslion pDlisions olScctioo 1700 ol rhc IjtnrC.d..I sh,ll, fonhwirhodply Bnh rho* povisions..
<br />WARNINC: Failurc lo *curc vorkcr' @ pcneri6n.ov..!ec ir unliNfril. ud sholl s!br.{l !n cnl9lo}tr ro diminll lcMltieJ and
<br />civil fincs up ro om hundcd rhousnd dollds ($100.(m). i. addilio. lo lhc coir of onw.sarioa dtrmgcs &r P$lidcd for lhc
<br />r
<br />DECI.ANA.]IQN
<br />I hcrh, !m n uMcr lcnally oa pcrjrry rhtrr I d lic.r.rl und.r ro!i\i.n ol Ch0Ptcr 9 (..m'mtuing uiih s.crion 7ux)) of Division 3
<br />of rhc BusiBsrnd I'of.s rio ns Codc. rryl myliccn* i\ in tullfu$udcffcc!
<br />-
<br />ContEctor:
<br />(J)NSIBIJI:IIONIENDING.AGIN(:I
<br />lh.rrhyaffir undcr l*trdry. f r4ury rhd r hcrc h r con{rucrion kftling rrc .y for rhc FintuNc ol lhc tr ork fitr which rhir rrrnril h
<br />nsucn lscc .109?. Civ C.)
<br />AtfucltfDuclABA.ll!,tN
<br />I tmhy lllim u ndcr Fnalry ortrduly o.c ofthc lblk,wnre dcchralion\
<br />Deftrilifl l,c.nirsAsbc{os Norifi.arn,n Fddrr$l Rc8uhrnnrs (Tilc 40. Pln6)
<br />-Rcquncd
<br />l,cllcr.f Norifi.!ri,n
<br />I ccnify rhar lhc fcdcrll rc-qllarior Esddins Nlr{os rcnov,l ur. nol olplicablc to lhis |)rotc.r.
<br />F-lenifyrhd Iturc Eldrhtarplr,rmn ld {0rc rhd rhc rhovc inibrrorion is corr<l I agre b omply wnh all C ylnd C.u.ry
<br />odh,Nc\ und Srsrc tj*r Ebrins ro buildrng con{do'on, trd h.i.$y,ulhoriz rcprcscnrarirci ofrhis Cir, mdCounlylo cfllct lron lhe
<br />dhovc nE.rioncd pmpcny ror inspccr
<br />f,\ppli nr or,\(rnr si(n ture
<br />I PemilN nonr I prltr()x
<br />tEilvmtt7.reft
<br />ID/SIG.
<br />t ndcir NJ rc
<br />-
<br />LctrJcr'. \J,l'u$
<br />-
<br />Rool Drain
<br />Tub/Shower Test
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