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I <br /> � <br /> � D ���� \�/. � f-+.w#../��-R.3,1��'�dl�'!-�-3�i�iIN <br /> ' ,.�0 �� <br /> " _.."�'�.. �`City of Pure Wa�er" :� <br /> Buitding Department - <br /> '� '' S335 Eightl�Street•Zephyrhills,Florida 33542-4312 <br /> � (813)780-Q020•Fax(813)780-0021 <br /> , <br /> W.A."Bili"Burgess <br /> Director of Building <br /> L'zcensing&Zoning <br /> �ontractor Asbestos Notification Statement <br /> Per Florida Buildins Code�05.9 Asbestos. The enforcin�agencv shall reauire each buildin�aermit far <br /> the demolitian or renovation of an existin�structure to cantain an asbestos notification statement which <br /> indicates the owner's or operatox's respansibilitv ta com�ly with the provisions of Section 469.003, <br /> Florida Statutes,and ta notifv the Denartment of Environmental Protection of his or her intentians to <br /> re�move asbestos,wlien�n�►lic�ble.in accorciance�vitla state�nd federal law. <br /> 469.003 License Reqtai�red— <br /> 1. Na person may conduct an asbestos survey,develop an operarion and maintenance plan, <br /> or monitor and evaluate asbestos abatement unless trained and Iicensed as an asbestos <br /> consultant as required by this chapter. <br /> 2.(a) No person may prepaze asbestas abatement specificarions unless trained and licensed as <br /> � an asbestos consultant as required by this chapter. <br /> (b) Any person engaged in the business af asbestos surveys prior ta October 1, 19$7,who <br /> has been certified by the Department of Labor and Employment Sectuity as a certified <br /> asbestos surveyor and who has complied with the training requirements of S. <br /> 459.Q13(1)(b),may provide survey services as described in S.255.553{l),(2�and(3). <br /> The Department of Labor and Employment Security may,by rule,establish vialations, <br /> disciplinary procedures,and penaltias for certified asbestos surveyors. <br /> 3. No person may conduct asbestos abatement work unless licensed by the department <br /> under this chapter as an asbestos contractor,except as otherwise pravided in this chapter. <br /> I certify that I have read and understand an.d will comply with the provisions of this asbestos notification <br /> statement and that I will comply with a11 state and federal regulations pertaining to asbestas. <br /> ' .� � �s � <br /> icense er/Contractor Signatuxe Date <br /> /.,7�K �,/� /�s'�� CG3�/,ZS'"7 6G � ' <br /> License olderlContra r Printed Name License Number E <br /> S�S�"S% S`�� 5� �-e �, �i,`I�l � <br /> , R �f � � <br /> '�— h <br /> Address of Construction Site � <br /> r <br /> � <br /> . � <br /> Permit Number � <br /> � <br /> s <br /> � <br />