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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underlloor )
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Bough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />l\ilain 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 Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release I
<br />FINAL 'I0lct fr1 -mzhMr,t 6h)
<br />Notes, Bemarks, Etc U \-/
<br />)
<br />oltNoR EUtt,DtiR DELCARA',tl0N
<br />I hc(hy ntlnm undcr runrh, ofpc+ry thrr I rncimpr lmnr rhc Conrrncktrr l-Lctr{ Law tnr rhr lnu.wi'iA nN'n (Sc.7oll5
<br />It$inc\\ url P()lc$n C(klc) Aft Ciry or Counry wlri.h rcqonr! d ltnnir h ..t{r.r. rlr$. iNtovc. dcnroli\h ,{ ktli Jty
<br />nru.rtr . nri,n t, irs is{$n.., ako r|qun s rh. lldi.xfr i,, \uch Fnrir ki Ilc r \ign.d $icrri,i rhi tuor slr N li.ctrs.d pu^ar r
<br />h rhc p(risi{nr\ oI rhc Corrru.rors l-iccn\.d l,Js (( hafrc. 9. C.mmcrcirs wirh sccrn,n 7(Ix} ol l)ivi\ion .l ot rh. B,\inci\ and
<br />npl)lic!nlli,r{|Nrnrilsutj.cl\rhc r!|]lirinr n, rcirillt.Dnlryolmrnb.crlun livc lN r.d doll.rs (55lxr)
<br />.sowncr.rrhclk,t.ny.ornrt.nfk,tcc\*irhwar.sr\rhcn\,lcconfcn*ri r. sill do
<br />'hc
<br />sork {!r rhc sflEturc is nor
<br />intc(H or o,fc..d lor sL (Sc.?044, Busircss od prof.ssioff Codc: The Co.lr.dols Ltcr* Llw do.s ml ltply lo o os,M tf
<br />th. pbFny tho tuitts or nrqmc tlE@tr !,'d {h6 d@ sn srl haesclf or lENlr or rhouSn hh or hcr owf, .rployc.i
<br />Foridcd rhd slch imlmrem s m nor inrcnd.n or oficEd fot slc. lf, horcq, rlr ttuiui.s or iry@d is $ll wnhin o.e Fe
<br />oaomplcliotr dF OwBr Buildq wil hlw th. hrn n ofFDvi.C tul lE o. dE dn ml hrild or ir9rew 0E |,Dpsly for rlE porFe oa
<br />-1,
<br />as owmr of lh. pq,cny, .m crclusivcly coniroclnE *irh lic.rscd conrdoE to 6n(ru.r llf, lmiEl (S(. ?044. S$inc$
<br />ard P,Dltsri, Codc: Th. ConhcroC$ Li.cnlc Lae does nor spply lo anown€t oaphrcny who buildsor impr6v4 ocrcon.
<br />and who onh.k t , su.h pmjds wnh a C.nh.ro(O li.cn*d puMl ro rh. Conterol3 LtmE ta*).
<br />S6tion- B. & P.C. ror lni! cei
<br />a "r
<br />IIEC!.A8AIION
<br />I heEby dfirm ondq F.nalry ofpdflry onc of th€ follo*ing d..hrlrions:
<br />l:'Hr (i'dc. lorrhc Fnnrnmmcollhc \ork,nrshi.[ rlt Nnrir ir n\ucd
<br />_l hrvc lnd will lnainhin wort.s compensarion inshmc. as reqlted by Scct ion 3?00 of rhc Llhor Codc. for rhe F.fomm of
<br />lhi eort for *hich lth lcrmil is isse(l My qo crs mmlcnsalion insurare wicr old poli:y nlmbo e:
<br />nilirhdr in rh. lcrrormm. ofih. *ork ror shichrhi{Fnnir k hsn.d,I shdl mr cmpby ny Fcr$n in lny mnmr
<br />bccom slbicl lo llE wo cR comlEnsation ltrws olcolifomi.. md !8r lhll ifI sholld haom $bj.rl lorh.
<br />wo*sl omFnslion pmrisions ofSdlion 3?00oflh. rihor Cod..l dEll. fonhwnfi omply wiln tho$ ,mvhions
<br />WARNINGT F iluE t, *cur. workcs .omFrsariod oltngc i\ unhsrnl. nntl shrll suhj.rl an cn loycr lo aimiru, ncMltts and
<br />civil rincs ut' l,) on hundEd lhousand dollns (Sl0o.um). ih rddirion ro rh. con ofcomp.nsll dnnm8cs o\ pn'vidcd lor rhc
<br />SLrrn,n :1076.f rh. lrktra,rl. i.r...rr 3ndnr..m
<br />l)t( t,,\R,\ I I0N
<br />I h.eby lfrm ldcr Dcnahy of Dojury rh I !ft licnicd lnds ,ovision ot Chlold 9 (@,lrekinr eirh Serb. ,Olr0) of Division 3
<br />of llE Busincss and Prcfcsrioro Cod.. 8rn my tic.Ds is in tull foE .rd .iIet.
<br />rcxim!,tquoNrIrNDINc-&cINll
<br />I hcruhyrlnnntndc,,rnllryol'lxjurrrhrr nE is!.on\rrucrii,n lcndin8r8c,xy tn rhd pdrnfllBncc.r rhc $o.k tur q[ic[rhisF-flnn h
<br />ilsucd (Scc.l0i)7, Civ C.)
<br />Affl.tc xfD[ctltB Ill)!
<br />I hcrby rfinnr undcr p.trrlry nl pcrjury.rc ol'rhc lblk,wi"B daln,.rions:
<br />Dcodirim tunnns Arlrro\ Norifi.ariob Fcd.ral Rdtuhrn,n\ (Tirl.40, Pan6)
<br />Rcqut.d h f ol Noill.dion
<br />-l
<br />anify lhal lh. fcdcral rc8ulalk,ns rc8ordin8 lst*slos rcnrvdl orc .or amlicobk lo tnis trotrt.
<br />ccflifyth0t llwc rcod lhis trppli.lrion md stolc rld rh. otBv. irfonnali,n is concct logrerocomlly*irnollCnyandCounry
<br />odinamcs and S13rc t w* ehrin8 to buildin8 comrrucriotr .nd
<br />atbvc mnrioncd l,mFdy for irrstBlion ,urpo*s
<br />pDliconl o. rlg€nl sigEIuE:
<br />5
<br />COMMENTS
<br />ttrtrd.,\ AdJ,r\.
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