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GRADING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMIVIENTS <br />Prelimina Soil <br />Excavation <br />Fills <br />Sub Drains <br />Buttresses <br />Soi <br />Statement of Com <br />nRe <br />Flood Elevation Cert. <br />Sub Grade <br />Base a <br />W ater Test & Seal Coat <br />halt Concrete <br />Soils Cert. <br />h Grad Release <br />Final Civil Cert <br />FINAL <br />Notes, Rerna rks, Etc <br />l)cc lnrnt iorr <br />irsuatrc. ako rc;uircr tlE aFtrlitant roa srch lcnnil r, lilc n sigmrl starcrnrl tlnt lre or ilr is liccnrrl pursrnr* to thc pmti.rrn! or tlr <br />corrrracttr's l.icctrsl l.nw (clsJrrcr g, colrrncrcing Birh secrho 70(x) of Di.isi.n ! ofrlE llusin.sr n,d p.ofsii()nr ('odcl or tl$ hc or <br />shc ls crctrrF llE GfroDl n(l llrc lNir lit. llt illcgcrl cxctrrnti('n .Any riolrtiflr ofsrtidr 7t)l I 5 hy nny npllisti frlr n ndltil suhjr.cts tlf <br />lpplicnilt to I ciyil pcmhy offt{ nxrrc tllu livc huillrql (kiln6 (S5(I)}. <br />. --. "1. ni o\tlEr o f llE propny. or my cutplo) (s lvilh $'n8cr ir ltrcir srlc conDcnsr trn. will (lo thc $ork ir(l thr (tnKtfic F ilil tril(Blcrlor olltrql for rnlc ( Sr:c.7044. Ilusim$ nxl ll ofcssiotn ('odc: llts Cotrrmlor jr t.ic.n((. l_nw do.r mt inlly to in oslpr of tl4 pmlrd r <br />s,lxr huilds or irDlrors thdqrn. o&l rvlxr tlos sch *ork himscllo, hcrrclfr,r lh(Nfh his or lrcr nsn r.rnpirrtcr. n dykl(rl tlfl ntchinnrorrnrsilr orc u{ intcildl o. orfcB{ ,irr iilc, l[, lx\rcr!., th hriltling or irnFrorrmnt ir srkl rvithirionc yoiof gurpkliu. rhe(httr(r-lluiklcr will hn$e tlr hurdctr of,'nrvin8 tlHl hr (!r rlE fiil buikl or irnprorc for tlE nu,tnrs ofsk ) <br />-.,1.ilo$mroftltProp$ly.flNcrclusiltlyconlmclirgrithliccRrlcontmctorrkrcnrlrlr((tlrcrn,icct(SE 7(H4. lturin$(iulI'rolc$i'tr (ixlc: I hc ('t)dfflor'r l-iccnc l.rrv drrcr nrt nplly tr iln ottrd of In'pciy rvlrr huiklr rir irlproucr thcmn . xrrl r.|r <br />cor[frcrs fir. inch prcjtcti silh n ('oltirnch(rl liccnkd lursuint (, lhc Cont.ilttr.i l.iccnrc lt$.). <br />.........1 nrrt ut(crnpt urttlcr <br />l)ntr': <br />& P.('. lirr tlris re:tson. <br />.. (.)n,rrer; <br />rv()RKt Bs c(rr}rI'tiNsA I t()N t)ti$t.,\tt^'t't(ra <br />I lrlchy nllirtrt ttnrlt:r pemlly ol'pcr.iury nne ol'thc t?rllon.irrg <ie..t.rx,ri,rrrt <br />l.nlxlr Cotlc. tirr tlrc pcrfrrnrrnnce of thc srrrk lbr rrhich tlre pclrtrit is issucrl. <br />_. I lrn'e <br />work frlr <br />( -arrit:r: <br />nrxl tvill nrninltin rvorkers' cnlnpcnsrtion insurlrtce. ns rcquircd hy section.lTllo of tlr l-nbor ('6tle. lirr rhc. pcrthrrrurrrtt nl'the <br />s'hiclr tlris pcrrrrit is lvly rvorkcr.s'[lsurnncc lxrlicy lrunrber nrc: <br />a <br />Policy .t <br />_r.rprei:LL <br />pcrntil is firr Olrc rrr lessl <br />_..1 cr:rli tlmt irr llrc pcrftrrrnnnce of tlrc utrk firr which this is issrrt(|. I shnll mt <br />a <br />ilr lnv rnin,lcr so ,rs l(l <br />thc wtrrkets'het;trrrc Itr llrc ' ctrnrtrens;rtlnn lrtvs crf C:rlilirrni;r.that il <br />1700 of thc l,nhor tlnse provision.c.. <br />I <br />thc l,nhor ('odc. ilrtcrcs alxl altnnrv's fccs. <br />I hercby nlTirrrr unclcr pcnalty of pcrjury rvillt Seclron TlXt(l) oil)ivisinn .l ol' <br />thc llusincss nrxl I'nrtlssxrns :uttl <br />t <br />l.rccrrse Clnss: <br />Datc:L <br />C-QllS'[R L,(;l tO N l. li N lrl N(; iUiLl!.CI <br />issucrl (Scc. 3l)97. Civ. C.). <br />l-crxlcr's Nnrrre: <br />l .orrlt'r 's Atkh'css <br />dPl'!.(:ANt',sl)I.:(:I,UlA'l,l(lN <br />l)cnxrlitiou I'crrnits-Ashcslos Notifrcaluxr l:etlcrnt Rcguletion3l ;irlc 40. tr:rrt (r) <br />.__. . ltcrprilcrl l.elt:r of Notilicalirrn <br />.-...1 ccrlify th"rt tlrc hdcral relulnlirns relrartlirrg ostrsto.q rcmovolnre tmt opplicahlu. lu tlris prrrlect. <br />___. I ccrtify tlrnt I lmve rcad erxl ilnle thrl tlre nhove infonrrntion is correct. t ngrce to comply with nll ('ity aml Counry <br />orrlirrnrrccs nlrtl Stnte l-ows arxl hcrchy nutlxrrizc rcprcsentntires o[this City nrrd lo c.tlter upllr lhc <br />:rhn'c nrcnt irrnctl propctly <br />Applicnnt or agelrt lo <br />I'crrnillcc tntttc <br />L )-1 <br />('l'his scctiorr <br />irrlc. I <br />I ):tt t'' <br />n Mch;