|
PLUMBING.INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main 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 />Bouqh Plumbing 74"{r Y.VJA
<br />v-zs"ty \v/t1")
<br />Meter Release IA
<br />FINAL (-15-ly E n
<br />Notes, Remarks, Etc.v
<br />OWNER BUILDIiI DSLCARATION
<br />I hcrchy rmrn undcr pcnrlry ol perjury rhsi I !n cxcmpl from rhc ConrrucroF l-iccnsc Ii$ r,n rhd rolbwin! r.0vnr (scc 7031 5
<br />ll!\incss ad Prolc\\i{,n Cod.): An, Ciry .r Cornrt shich rcqtrn.\ r Fnnir kr con\dd. 0lrcr. iDprov.. dcnnlish or aFn ant
<br />{rucrurc. Fior b [s i$urmc. lko icquicsrhc nmli(anl lor ruch t(nnirro ilca sigrod {arc.tnr rhrr hcor shc il licchscd punD.ir
<br />b ihc pmvisi.nq or rhc ('onh.ror's l-ic.tr{d L1w (Chrfrcr 9. comD.rcirg wnh Sccri(r 70(xl ol Dirision I oi rhe Bu\i"t$ !.
<br />l\ora\\i.triCodc).rrhrrhc.rshc iscxc.rrrrlkrclioDdnd rhc hlsi\ 6r rhc.llcgcdcxcm tin Anyviohli.nofSccri,iT0-ll5hy,oy
<br />rl,lrli.od lnra ljcnnr suhjRrs rhc rp!li..n' nrn.ivilN.,xyolmr nxtrc rhar firc hundr.dnolh6lS5ln)
<br />L r\ owncr.rrhc pmFnt. or mycmtl(D$! wirh wa8cs N rhct $lc.onllkn$riotr. willdo tlt wolt arn rM {nduru i! rn
<br />idc cd oron.rcn tu llk(SN ?Or-1, Btr\i"cslnd E(nt$bn\Cod. Ih.6nt|.tr'\Li.cn\.hwJ.c\nornprlyror owncrof
<br />nE Dn,ncdy (ho hikl( [ i'!rphE( rhcrsn. lxlwh. dms slch *h* hnDsclidr hcncll or rhmugi hk or hcr ovn cnpl,)yscs.
<br />l[ 'vdcd rhd such i'npnr c *$ tm Nr idendcd or.lIcEd for iL ll h,scvcr. rhe tDildin8 or iNpmunrnr is v,Ll sirhi, dc }lr
<br />orcorll)Lri,r rltr ()wior Buildcr wil]har rlr budctr.flovin! th[ h..r sh. dk] trot huilrlor impnM lhc pmFny lo.lhc |uqffc oa
<br />-1.
<br />as owrer of rhc ImIEny. am cx.lusiwl, onrmrang anh li(ensd conr&r6 rc on:Idd rt! Fsj.d (Scc. 7044. Busircs
<br />Md Pitturcioa Cod.: Thc Co.tm.lols Licc.e Lsw des f,or rpply ro m owrcr of poncny qho n.ius o. improw. rhc@n.
<br />and *ho @ntr.crs lor s!.h lnoirs wnh a Con6<ro(s) lke.sn F6urd 'o
<br />ltE Conlncldr LiccM L!w).
<br />I n rcrcfi0 !i(l.r Sc.rtrn, .ll & I)C. n)rrhN {
<br />Dole: O{ner:-
<br />}ABf,ESII:I:OMIINSAIIO!
<br />DESIdBAIAN
<br />I herty i(Im ond.r pc alry ofFrjuy om of rhc lollowing &iLrriotrsl
<br />-l
<br />hrvc d $illtruinhin !Ccnitiorc.lCon\cirn, sclrltr\urc i(r *orkcrr $mp.n\!ri, ,l\ ,)t,! cd for brScclnr.lTlx).irhc
<br />lih.rCodc.lirthcpc onnuneolrnc*or\lorq,hichrhepcnnir ni\\ucrl
<br />-l
<br />h0vc and will n.inrah worlcn compcnsatiotr insurnncc. as mglimd by S(l ion 3700 of lhc ljl'or Codc. tot rh. Frlomrc of
<br />th. worl forwhi.h rhi\mrmi is irsu.d Mv*orLcG! ;-:t Icrhr f -- u^,Pt
<br />.onrrcnsllion insurrrc. clricr ud F,licy nunibcr r.:
<br />WARNING: Foilurs to surc erter
<br />civi! rincs ry lo om hundrcd thouend I ).i
<br />sc i\ rntu*aul. ud shall rul,,rr e mploltr ro aiminll ,8Nlli.s and
<br />n oddirhn ro rh€ coir oa comp..$rioo. damg.s as provard lor thc
<br />DIcl,AAAflA!
<br />I h.rby afllln rnd.r len yorp.rjtrryrh0l I ur liccni{undcr ptulndr ol Ch0pts 9lconrnrcNins wirh Sccin,n 7uD) or Divtion l
<br />ol rhc Busincssand Polc$n,nsCod.. ind nry liccit is in,ulllod ddaltati
<br />6 Joiit"t
<br />?fzot ta 9ectou 6(Z;4:c >
<br />CAN,UBI]CUONIINIIIN!;.&GINCI
<br />I lrruty l,rm und.r lrnrh, orFrjury rhd rh.E is !.oniru.rbn lcn,lin8.8cry ior tlrc lcdonrumc of rtE work ln, whi.h rhn tEmn is
<br />is\!L.d (Scc. ll09r. Civ C.)
<br />-l.enifythrt
<br />rh. fcdc,llrcBubrbns rcrurding ashcstos rcmvrl lrc nor arplicablc k, rhh pmj.cr
<br />I c.diry rhnr I hnvc rc rhis anpli.dri.n .nd sitclhar th..tbrc inr.iiMrbn tcomcl.l !8,e lo mnlply wilh 0U Cily rnd C.unry
<br />,!Ll (.\ rnn sr .l r$\ h ro build in8 .onshdiotr dri h.Rby ourhortc Rltrcc.rotiws ol rhis Cny a.d Colnry ro emc utEn tlx
<br />ab{)lc m.rioned pDIEfly lb! i
<br />Arplicmt or AEen( Slaml
<br />t
<br />DilgMI
<br />/Lllui,ri rl'. rrlrtHritrrtr'n.ri rl'c*itrr|,tr*h'.hrhi!nri,nirti\{ro,l.lsl llnorc rtn,yrryfrcs.r in rDynunNr
<br />q, r\k, h.ronr strhjrd n,rhc w.rkcrl cotrrt).tr\dnr lr$.rCilintrtrir. dllBn.lhd ir I \hotrld hcmm n'hjd i,rhc
<br />workr^ cdn,Fn\rrn 8,vi\ion\ ol So.r i( :1Xl).frlf,ltrtxrGtlr,I shill lonhrirh.omfl) tr ilh rhos nn,vni,'n\
<br />AITLII;ANLDEILASAIIO!
<br />I hrtby lllm undc. |xnrlr y of p.rFy om of rhc bllowina dcchrd ionl
<br />Ilcmlilion Pcrnils.Ashcslos Nori[carion !-cdcnl R.Buhtioos (Tnt {- Pm6)
<br />R.qnircd L.ncr ol Norirkrrion
<br />^,",a/zt/tt(
<br />Area/Storm Drain
<br />Final Gas Test
|