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GRADING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Prelimina Soil Report <br />Excavation <br />Fills <br />Sub Drains <br />Buttresses <br />Soi Report <br />Statement of Com <br />Compaction <br />Flood Elevation Cert. <br />Pavi <br />Sub Grade <br />Base a <br />Water Test & Seat Coat <br />alt Concrete <br />Soils Cert <br />ReleaseRoGrad <br />Final Civil Cert <br />Notes,Remarks Etc., <br />I tmhy nllirm undcr Jrmlly of naiury lhl I lnr dcnrF irntr rlE Conrffiorr' l.i(rn* Lnw [r th. R llo*i.U rc.m (s.?o.r1.5 n!.i|6 <br />ilxl l'mlt$ion Ch.hr: Aoy City or C'ouily which rcguiq r pmir ro olrlilcl. lltcr, imflmrc. rlcmrlidr or rcpnir ony nDdrE. Jrir rc ittisrnmc. llm tqluim thc oFttlicntrl tor sh [Hnil to nh ! ritNl stdmd thot hc s dr ir lhcmd grommm n tire pmrirlmr oftlts . <br />Colllmclo.'i Licqwl l-iw (OhFGr9. Comrrcrcint wllh Sclion TrIil of lrivhkro ! of thc Rurin6ron t pmfsioN Codcl or lh{t lE arihc h GrorDt lhGcfntor !il| llE h(rii for tlF nllcg.d crcmlrion .A[y violiliotr of S6tion 70J 1.5 $y my n]Tliqil lbr a lsmt rubjNtr tlE ' <br />orTrlioil to r civil rcm[y ofrx{ mrsrlntr liyc hnnlr€d &rlloB (tt iltl. <br />*Lir osrcr of lhc Fm|Eny, o. fiy csrtloyc vith *ogo ar t|Ei slc qx||troqtioG sill .lo th. sort nill thc {nEtuG [. mt iilcrdcal <br />or oflLtd trr hl. ( ss.nHd Buitw nd Plofsbm c'irdc: 'llE coomrci t .hre hv dG mt .Fnly to nn ow* if rlrc p-pny <br />.slrr huildr or itnpmq lhrdn oxl sln &16 reh cuk timslltr hareltr thmugh hir or lrr orn cmpLycr. lmrilql tlil ehinnntrrnffir ar. not irlcdcd ororfqql t)r er,., lf. lxrw$s. thc lililding or impmitmn is mfrl qffiftrcni Giof rxinlrtcriu. rtrOeE?-lruildc. will h!rc tlE hod.tr of ,myin! tJH hc0r dE r[ hoitd orinpmr:c lrrlE puqre of Elcr. <br />---1. ar osE-of lhc prrrt'ly. am crclurilcly milmlil[| rilh lisor.d eilmctm lo @mrruct tlE rmirt ( Sc 704.{, JtrNiffir ilrtPNfcshtr Colcl llE contmor'i LiqE Llw doa nrt npply to on o$B olpmJmy wlxr b[ikk m impmn thcmn. nrxt dn <br />contrutr fo. relr preJsti with, Contmclo(r) liccnNd nxGuotrt lo tlE Coilrrctor.i LieNc l!v.). <br />..--_-.1 nrrr srernpt turxlcr Scction & P.C. firr tlris rs.'tson. <br />l)nt t':.. ( )rvner: <br />w( )tt ti tiBs c( rt I rEN sA t t ( rN tl!.;ct.A RA't't (rN <br />I lxrchy allinn unrlcr pr:mlry ol'pcrjury one of thc rottrri;rrrg accl,,rnti,,rx:- <br />l.nlxlr ('otlc. lirr tlrc pcrftrnunnce of the n'ork lirr rrhich the Jnrrrrit is issrrerl <br />rrork fttr s'lriclr thi.r pcrrrrit is issucd. lvly rvurkv.s' cotrrpctrs:rtiorr innrrancu r.ilrritr :rnrl policy rrurrrhcr are: <br />Policy . l:xprr cs: <br />('lhis scction lxrl Jx crrnrylelctl pcrnril is dollnrs l.$1001 rrr lcss) <br />. ._l ccrtify tlrnt in tlrc prrfrrrrnnnce of tlr srrk firr <br />hctnrrre srrhjeet lo llrc norkers 'crrntrrcns.rtion larv.s <br />wlrit:lr thic rq in nny m.lnncr ro lts to <br />axl thc workers' <br />corrr;x:nsnt ion provisions o f Sccl krn Ilrosc Jnrvision.q.. <br />lYAltNlN(l: t;:rilure l(t sr.cure rvrrkerr'suhjcct on ernployer to ctimirr,:rl pcnnltier nmlcitil <br />lirrer up to onr hunrlrerl tlmusarrl tlollars ($ lfi).fi)0).in <br />lhc latxrr Codc. ilrtcrcs nrxl altnnry's [crs. <br />of crlnlrcrr:sntirrt rhmages as pnrvirkrl ftrr the Sectirrn J(t76 of <br />I hercby n[Tirrrr unclcr lrcnrlty of pcrjury <br />tlr llusitrss alxl I'nrfesskrns (.'orlc, and <br />llral I irrrr liccnserl (orntrncncing witlr Scction ?(IXl) oI l)ivision ] nl' <br />rny license is in lirll lirrce nxl <br />l.re cnse <br />l)otc: <br />I lrcrcby rrflinn urxlcr pcnnlty of nerjury tlr:rt $Berrcy fir llte yrrfrrnrmncc of thc rvoik firr which this prrlnit ir <br />Civ. C.). <br />l.enrler's Atltlress: <br />Dcnxrl it io lr Pcr rnits- Anlrcst os Noti licnt iotr l:etlcral <br />._-... Rcquirc<l l..etter of Norilication <br />APPI,ICAN'l"S Dt:('l ,tR \'t'loN <br />Regul:rlirrns ( l itlc 4(1. Part (r) <br />._._l ccrtify th"rr rlrc rcgu lal irns rt'grrding nshtstos txtl opplicahle to tlris pnrjcct. <br />rerd this :rpplic:rtinn nrxl rrrfonrrnlkxr is corrccl. I ngrct to corrply with nll ('ily alxl ('ountv <br />:rhorc rrtcttl <br />Applicnnt <br />I'c.nnitlcc <br />tlurt <br />protrcily fi)r <br />lrcrchy nutlxrrizc representntit'es o[this City arxl Courrty ro olrcr uprn rln <br />rl the <br />l-ou,r rclat irr;l <br />4:,t <br />lo buikling <br />l(