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GRADING-INSPECTOR REGORD <br />APPROVALS DATE ID/SIG COMMENTS I Orvmr.lluiklcr Dclnctrirltr <br />I irsnimc. nls rcquiB llE iFf licnilt lilr rlch pcnnit rr filc n si*ft(l rtnrcmltr ltmt lE or alE is liccnrerl pursmnr to tic provi.tnrr oI tlE <br />l(ixurador'. l.iccrwll-iw(('luptcr9.(hrrrFxinl(ilhsero[z(]tnofDir.isi(nr!orrltltusinss.ul profsiilNcodrrorrlHrlEilr <br />lshciseicilplllEctruolnnlllrcbisisforllf,nllcgcrlcxenntion.Arryriolitiorofsrttint70.]l.shynDynFpliafllirrifc.nlilsuhf'ctrthc <br />I nfplicnilt to I civil lcnnlty of fttt oxtrc thtril live huxlrcd &rh6 (SS(X)]. <br />I <br />| -1. i' ottlki of llrc lron(d y. o. nry curf hlG rvlh $nFcr ir tlrir erlc corrpcnsl ion. sill (k, tha $o.I irxl the {n(nrc * n{ Nrrdc(l <br />I orolltrc(l_for $lc ( S$.?0{4. llusimsr nnl llof.ssinN ('odc: llrc C(nilmr}r'r t i(cFc l.nu rLrs mr itlly to in owrer of tlE pmNn!, <br />|.\'lt)huiklsrl.irnl^rvslhncon,uxlwlxr(l(rcssrcl*orkhimiclforhorclfo]lhrou[hhisorlrcroancnrpioymr,nrdtklcrltlfl$Eh <br />lr[lt(rrcfiEtntnrcrxxinlcftk\loroffcrdlitt$lc. lf.lxr$cr!r,tlEhuiklingorimprorttBnlit$ld\eitlririoncytliofconrplctiur.rhc <br />I(htrrr-lluil(lersill lmrcltEh,ftlcrofplrrin8tlxillEUrsl*lxrlhuiklorirnlrmrcfirrth.nrupocofqkl <br />I <br />I . . l. ar owr.of thc propctly. itn erclustltl!, qnltmcli[g Nith liccnt\l mttrict(ls h coilrtroct llr ],r)ifrt ( St+ ?044. Ihrrinctr norl <br />I l'rolbsk'tr,(ixlc: llEconrhcro.'il-iccnrel.iivdocrfitrnpDly(itroo$ncrofp(!psr]Nl$huiklsrrhirnrowrltrcon.rildslx) <br />cotrrriltr for rilcI p(tjcctt silh n Cootnc(tr(s) liccnfl{ lnrsuatrt (r lhc CootrilIor.a t-icrtrsc lnw.). <br />.........1 au cxcrnrt uulr Scctinr _-_.. ,.,*_.1]. & t'.C, lilr this .clsotr. <br />l)iltr': <br />W( )lr K ilRS C(),t I PLNSA l l ()N l)li(,'Li\ ttA'l't()N <br />I hcrcby nllirrrr un(l(:r pen:tlty ol'pcrjury orx: (rl'lhe fotkrs.utg aeci,,r:tti,,rx <br />l.alxlr ('orle. lirr tlrc pcrft)nnflnce of tlrc lvr)rk ti)r.rr.hiclr ttre Jrclutit ii rssur-tl <br />.*l lnve nrxl sill nliintnin workers' <br />s'rlrlr <br />farries: <br />t <br />trccrl lrol c()nrylclcd <br />. .*l ccrlify tlrnr irr <br />hecanrc $th.iecl l() I <br />tlrc perfirnmnce of tlrc n,ork ftrr whir:lr tlris is issrrctl. I flny pcrs(,n in so Is ll) <br />llre s'olkers ' ctrnrrrnnntfutn hrvs thal il'l hecolnc l(l <br />of lhc l.rhrr ('nclc. I llpse <br />I <br />ljniltrre to secure s,trkers' cornpcnsrtinn i.s unlnwful. orrl slrnll suhjcct on ernpkrycr lo nml citil <br />r .l(l7fr ofIirrcr up lo one hunrlrerl tlrousarxl thllars ($ I fi!,fiXt).in <br />thc l.nhor Codc. intcrcs otxl altonrcy's fees. <br />rrd<lition lo lhe cofl of cornpcn$th)t\ darnages ar prrtrtrletl <br />I hercby n{Tir ru ufiler Fn:lhy s,ith Scction ?{Xllll ! ol'llr llusincss uxl <br />I hcrchy uflirnr urxlcr perrnlty of Jrcrjury tlnt lhcrc a nSerlcy tlte;rrftrnrnnce rrf tlrc s'ork firr u'hrch tlris pcnnit is <br />isrucd (Scc. 31197. Civ. C.). <br />l-erxlcr'r Nrrne: <br />[.crrrler's Atklrcss: <br />A PTJaLCAN 1".$ D EC l.A ll^',t'l ( ) N <br />Dcnxrlitiotr Pcrtttits-Arlrc.slor Notifrcntiorr Ferlcral Regul:rtions ( I itlc 40. ttnrt (r) <br />.__.. ltcrpired I rrter of Notificat ion <br />.--...1 ccrrify lhnt thc fcdcml rcgulntirns rcganlirrg ashtstt,s rcrnovalnrc lxrt opplicahle lo this prtrlect. <br />__... I certify tlrnt I hnve rcatl this srppliciltinn lh:rl lhc with nll ('ity urxl (lourrtv <br />ittr rvr. ltrc rll ir rncrl <br />or agelrl <br />P'nlicnnt <br />\nircc It.lnrc (prinl): <br />lo otl(l arxl <br />I <br />lo enter ulrrn tlrc <br />Prelim Soil <br />Excavation <br />Fills <br />Sub Drains <br />Buttresses <br />Soils/G Re <br />Statement of <br />Compaction <br />Flood Elevation Cert. <br />Sub Grade <br />Base rt rWaterTest & Seal Coat <br />It Concrete I <br />Soils E Cert. <br />-Gradin Release <br />Final Civil Cert. <br />FINAL CT <br />Notes,Remarks, Etc <br />D \ 1ll Arrrrlrc,,rr: <br />-{fccnsc Clnss:\3[Lt ? oJ9- --... - .-c.trl ntclttr: <br />rrrrliruutccs <br />GoDDAb <br />- <br />72'Zb?4