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PLUMBING-INSPECTOH RECOHD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDI'R DTLCARATIoN <br />I hcrehy li,irm uDdcr p.mlly ol pc.jury n l rn .r. $ fm'n lhc Conltact,F Li.rtrs tiw rhr rh. nnhein8 rc6on ise 701 1 5 <br />Brsind\s nd Pn,fcssiotr Cqlcr Ady Cny or Cou.ry q'hi.h Equnc\ n F.nnir ro cotrsltucr- alrci nnlmvc. demoli\h or tPnir Mv <br />sru.rurc.prinrons nsurift, dho rcquncs rh. apdicffr ror \kh Fmnl x' rilc ! \irn.d qmcnEnt rh hcot sh. is li.ctrKl Pu! r <br />t, rht Frvi\ions olllE Co.r.!.ktr \ Liccn{d trw (ChaPlcr 9 Connrtuins wirh Scclioo 7m0 or Division I orrh' Bn\in's 3nJ <br />Pturcssions Codc) or rhollt or shc ii ctnrrr rhcrch,n lnd rh. l!6( r.r rhc lllcscd cxc,npri.n try vn dion.fsk_riotr?0115 bvonv <br />trlplicnnr hrr pcnnii suhjfth rhc lPpliclnl lo !civilpc.axtol nor nnrc lhln fivc hunded dollars ( S5m) <br />-1. <br />$ oens of lnc Fopcny, 6. ny cmplorccs virt w!8cs as lh€t $lc coq.nsslion. qill do dE wort ud llr smdE k mr <br />inrcnd.n or otrcE! {o. sk (Ss.7(}44, Busincss Md PDLsioB Codc Thc Co.rrutols Lien* Le &* nor 3l,Plv to ro osnn or <br />the tmFny who buitG m ft9mEs r€n. sd qh dc skh s* himscll o. hcelr or fimu8n ni! or hf ovn.q,lovccs. <br />provilcd rhlr luch inpmwdr m mt ht .Ld n otu tm $h. lf. tEvcE. ltr hlilding d inptmmnl is eld withi. 6m )er <br />olconpLtbtr lhc O*tur AdB.! will hlw tlt hren ot pD{in8 6{ lE or slE did ml l ild 6t in{,bw th. PoIEnv for 0E PUTIDeof <br />-t. <br />as osncr of ih. |,or.ny. an ciclsilcly contlcrin8 wnh liccn*d .onlrsct's lo o.slrucr rlE po.ic.l (sa. 7oaa, Bulim$ <br />.nd Pioi6sbn Codd The Conh.lols Licensc L.w d*! nor tr|)tly to atr oMcr olprop.rlywho blilds o. ispotr rh€ton. <br />lid who co.rEds for such noi(k with t Contmclo(s) licensd Pu^unr ro $. Conradofs Len* tnw). <br />-lancxcnni <br />uodcr Sd <br />(rvE :- <br />wonrr'{s' coll!PFNsaTloN <br />DECI.ABAUON <br />I tsrcby affirm un icr lEMll, of Fjury orc oflnc folloeins ddlaErions: <br />Ihrv.,,xlwillfluirrdnaCcnific.rcoiCotr*orx)S.lfln\x(t(traort.6 (nDM\niioras Pmvided fo, bv sR.lion 3?m ol rhc <br />libor Cidc, rd rh. Frrbrmncc of rh. work ntr which lhc !'smir is is\otd. <br />I hlvc lnrl will mdrru irr sorkcrl coup( nslri.i inrurocc. d\ rl\luncd by Ser ion :1700 ol thc titxt Code. nr rh. F lbrruicc or <br />rhcworkforshichlhispcrmirisissucdMy*orkcn.o'nldnurn'ni$uruncccrtri..tudPolicynuorbcts.: <br />tt\t1 <br />S <br />CaIEIBITCUQN!IXI)ING-dCDN.CI <br />lhcrcbyrnn'nond.rtrn,lryof,'.riurrrhdrhcBi\rconslrucrbnldrdinrrS.nylorthclcrfontu..coftbc$orlttrwhi'hthhPcmiris <br />is\xcd (S.c.109?.Civ. C ) <br />t ndd! N.ft: <br />- <br />IrflLr's Addrs <br />- <br />AIII.IIII.DESIdMIION <br />I hd,y !firt ud.i Fialty of Fiury om of rh. following ik hmlioni <br />Dcmlirion Pdmils-Ash.sros NotilEarion tu dl RcErLrioB (Tirlc 40. P3n6) <br />-Rcquircd <br />L.llcr oa Norifmlbn <br />-l <br />c.n iay rhal rhc Ldcrul rc8rll.tions rcg!.diog sbcnos Emvol d .ol lPplklbh to lhis pto,rt <br />,r ion aftl shrc rhnr rhc ah'!c infornEr rtr is corecr I xsm tu .o rdy wilh rll Cny ond Counlv <br />nfllinrn..\ Yl stir.li$c rld huildi.g comlruclion. und h6cby lurhortc rcpE*ntari!.s ol lhis City cnd Coumy ro .ntcr uF . a <br />\Dpli(ur or \[.ni Sisnrlu ^, 7/zz/ ft <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipino <br />Gas Pipino <br />Roof Drain <br />TubiShower Test <br />Rouqh Water Heater <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heatercas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitarv Sewer/Cap <br />Back Flow Device <br />.a\ <br />Rouqh Plumbinq -7_1o _t t *"u91 <br />Final Gas Test ve-t{1-trl$fl <br />Meter Release ua <br />FINAL V-?z1Y V.V-{tO <br />Notes, Remarks, Etc.v <br />POOL/SPA Poli.y Numhcr:-iptcs: <br />- <br />-l <br />ccrr iay rhrr in rhc !.rtirrrone ot rhc *ork lor which rhG p€rmil i' Nu.{. I snlll nol cnlilov !6v p.son in an, tunmr <br />s ,sto tr.om suhrc€l lo thc wo*.ts con{Ersatioo l.ss oicllil.mia.ord osd lha! ifl rhould tE om sub}(l lo dE <br />workcs ohl,cnslion pmlkions orSeli{,tr l?()Ooflhc ljlxr Crdc.I shll l. lodhsnh .on ply wilh lhoe ,rcvisio.s <br />TVARNINC fflIurc ro s.uc workc( cornlcqsdiuo corcEgc is unlnrfll. !.d th,ll subFcl m cmrJlorr lo aininul l,cMlris 'ndcivil line\ uD ro om hundrcd rho!{id doll0rl(51u0.lJ.b). ii lddiriot ro lh. co( ol.o{p.netion. damgc. a\ Eovidcd for lhc <br />sccrion .1o7; or lhc trbo, codc. intft< md drdnE 7f$';:," :-i);;/i ]ffi g*ru^n <br />'l'' ucElrEDlt Nra{f,aB <br />DECI,ASAIXD <br />I ncE$yntlirm und€r ltnulry of r.rjury lhlr I r'n lien\.J undc. ,lsviion of Chptt 9 (ommrcins {nh sdlion 7Un)o{Divhion 3 <br />o, rh. ausin*s ond Prcfcssio.s Cod.. and ny ltcns t in tlll f.re {d cftsl. <br />'(2\- <br />al$c nr t'ncd nnp.ny n