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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OtlNDT BUILDIN DELCAR,TTION
<br />I hcrchy rfln r lNlcr Fmlry ol pcrjry rh l !m cx.mlr rilD rh. Cont,cro^ LNnsc tjs lor lhc fdlowing r.,\on ( sL{ ?011 5
<br />Btrsnr$ . P,ori$ion Codc), Any Cir, or Cotrnr! which rcqui$ i ncrmil lo con{tucr, ilrcr. nntrovc. dcmlhli .r rcl tr Jny
<br />nrucrurc. nrftro i( i\suin.r, rho rcqnncs rfu rpdicrtrl lbr nrch p.flnir b rilc a sigrsd stdcnEnr lh0i tr.r \nc is litrtr*d Punu'*r
<br />h thc Dn,vi\nnrs oI rtE Coorftcttr\ l-i.cnscd tf,w (Chil,.r 9. CoDncnci.a trirh Sccri{,n 7fir ol oivieon I ol lhc llu\inc\\ rnd
<br />l,rulcssionsCodc)orrharh.o(shcr.rcnqlhcrcliomlndlhchr\i\li,rrh.alh!.d.rcmprmn.AnyvnnrlionorSccrir?0.1l5by,ny
<br />rpplicmr rn! Nnnir subrcck rhc upplicrnr to(civilpcnrllyolnor nx,rcrhrn fiv.hutrdt ddolhniS500).
<br />-1.
<br />!s owr of rhe ts|xny. tr oy cmploye! wilt wo8cs as thcn $b @mrensation. will do dE wot std llt slftl@ i! mt
<br />inr.i&d or otier.d fn sL (Se-?044. Businc$ .nd kofcisiotu codcr Thc Co r&lol3 Liens law dci nol upply lo 4 owmr ol
<br />dE FoFn, rlb hlil1s or in{sw3 tlt6n, ,rd slE de! sh wrt hiosclaor lEelf or teugh hk or har o*n cnPlqei
<br />povijcn rhll .u.h inE lEmnlJ e rol inr.d.d or ofr.td fit st' lt h.M.0E hlildi.E d i,Ptol\funt i.r $B wnhin o* Jtr
<br />ofonpLrio rlEOwr Auth. will h.w ttEhidcnof poij,g dd lEsslt dtl ml hlldor itprDw lit pmFry for0E tulF ot
<br />-1.
<br />ar owrcr oi th. tmFny, rn ciclusivcly coilrtcdng wirh lie.rcd coilacroB ro consmct !h. prcjcd (Se. 7C!4. Sulinss
<br />ond hDf6sion Codc: Thc Co.t,slor'3 Li..ns. tiw dms rot arply b d o*nd ot pr.r.ny who builds or improvcs ih.d,n.
<br />and who onrkrs aor sch roj.ds enh a Co 6.16(3) lietr€d puBqr b tlE Conlreiols Lier* bw)
<br />-l
<br />m cxcnpt undcr Seion- B. & P,c fo, lti! 4Mn.
<br />!I}Bf,!BS:C!'!dIEAIAIIAN
<br />DECIAMIIQN
<br />I h.rcby a,lid und.r p.n lry of F:jury om of thc tolb*in3 d6Lririon.:
<br />I hrvc rnd q,llmiNrhr acnill. colCotrsctrrn,Scllltr\uroritr*orkcn'.onl4-n\Iion.a\ prulidcd nn btSc.riM 370(rolrlt
<br />hb.r G c,larrhcr.rtun rn.c ol'lrc wolk ntr \'hiuh rhc Dennir i\ nnlrd
<br />I hlvc .nd will lnoinrain !oac^ compcnsdrion insnrsnce, ns r.qrir.n by S(lnrn 1700 oflnc t$or Codc. for rhc pcrfortune ot
<br />h L\seil My qtrk6 6np."sdion insure cadc, ird Flh, numbc. m:
<br />U RruO6I
<br />-l
<br />ccnity rhlt in rhc rErformN orrlE work for which fiir Fcrmil ir irt!.d. I sh,ll nol .nplo y any p.ron in any ME
<br />$ ar rd i*sm 3ubixr ro rhc wo*cn'omp.nstion lssr oacnlifomi!. and aBrcc lh,l if I snould tt oe NbiNl lo lhc
<br />soi*da onlF.slion pmvkions of SErion 1700 of dE Lrhd Gxlc I slEll. fonhwilh otrll'ly wnh $6$ pDviions .
<br />WARNINGT tuilurc lo scurc sortcrs ..mpcr$inrn .ovcngc is unlowlul. ind shlll suhlccr e cq)loy.r lo oininal l{tulricr and
<br />.ivil ones trP to one hundrcd tholsand dolhB ($l in ddnion to Ihc cosr or cdnp.nsrion. dlmBcs 3s providcd tor rh.
<br />Dltcl,AR,\IftrN
<br />I hmby affirm undcr F.ahy ot lcrru.y tlur I am li.cncd und.r prcrhioi of CIuPlg 9 (co@miry wih Selion 7000) of Divhion 3
<br />ol rhc BuriEss Md Prof.ssions Codc. &d hy lieN Lr in tuU fo@ ,rn .lIccL
<br />obN
<br />CoNSTRUCTI(}N L}'III'INC A(:EN(]I
<br />I hcEhyrffifln id.. FnJlryofNrjury lhalrlEE n a connfldi{)n lrndir! r3ctrcy li hc t^_rlorron.c ofrhc qork f.r trhi.h lhi\ |Ennir i\
<br />i$uql (S$ .rlD7-( iv C )
<br />fffITANIIEII.ABAIAN
<br />I hcd'y oihn !ndcr pcnrlry ot perjury otrc of rtu lollowins dccl0rarions:
<br />D.nnrlirion Pcrmils-Ashc(o\ Norificlti.n rcdcmlRc8ularion*llillc 40. Prn6)
<br />-Rcquncd
<br />lJrrc, o, Noriiraii0n
<br />-l
<br />ccn iay rhar the ted.6l rc8lldions r8arditrB lsbcstos rcmval ac nor anplktbh b lhh l,ojcct
<br />I cdiry tld I htrvc rcod rhk nprli.alion ana slnrc rhd thc alr,v. inlomrioo iscofrtt. I !s.e ro.onlly wnh,ll Cny lnd Colnly
<br />ordinan..s Md Shlc tiss rclnr ine hoildingcooitucrion. a t hcfthtnuthnrizc rcflcsntlrives oarhi\ Ciry nnl Coutrly t. cnlcr uF,n llE
<br />xh,vc nrtrrnrcd Im,l.ny for
<br />*,,,@JdlleL
<br />UNDER GROUND 0
<br />Waste & Vent X/u hl a*4 )
<br />Water-Under Iloor (
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Slorm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent /,4oz- /t,l'f-/tu/f--lD7 -
<br />Water Pipino fra ti?//t/tfi a6z -Gas Piping
<br />.L
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvain 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 I *nlrr I 'rngrl-lh/'
<br />Final Gas Test 1
<br />Meter Release
<br />FINAL 4h-t/tt Ellnr+/ t1_
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />L..d6t Addn*
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