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` CITY O ZE�'�.�YRHILL� <br /> 6 � <br /> "Ci of Pure Water'• <br /> Buil ing Department <br /> � = 5335 Eighth Stre t•Zephyrhills,Flarida 33542-4312 <br /> (813 78 -0020•Fax(813)780-0021 <br /> W.A."Bill"Bargess <br /> D'uectar of Building <br /> Licensing&Zaning <br /> Contracto� A►.sbestos No 'fica�ion Statement <br /> Per Fiarida Buildin Code 105.9 Asbestas. The enfor in a enc shall r uize each buildin ermit for <br /> tlie demalition or renovarion of an existin structure to c ntain an asbestos notification statement which <br /> iudicates the owner's or o erator's res onsibili to co�n l with the rovisions of Section 469,003 <br /> Florida Statutes and to noia the De artment of En ' onmenta�Protection of his or her inte�ntions to <br /> reffiave asbestas when� Yic�bi in accorclance wi state�nd feder�I law. <br /> 46�.OQ3 I.icense Require,�l— <br /> 1. No person may conduct an asbestos s ey,develop an opera�ion and maintenance plan, <br /> ar monitor and evaluate asbestos abate ent vuless trained and licensed as an asbestos <br /> consultant as required by this chapter. <br /> 2.(�) No person rnay prepare asbestos abate nt specifications unless trained and licensed as <br /> an asbestas consultant as required by chapter. <br /> (Y�) Any person engaged in the business af sbestos swrveys prior ta October 1, 1987,who <br /> has been certified by the Departrnent of abor and Employment Securily as a certified <br /> asbestos surveyor and who has compli with the training requarements of S. <br /> 469.013(1)(b),may provide survey se ces as described in S.255.553(2),(2)and(3}. <br /> Tf�e Department of Labor and Emplo ent Security may,by rule,establish violations, <br /> disciplinary procedures,and penalties f r certified asbestos surveyors. <br /> 3. No person may conduct asbestos abate ent work unless licensed by the department <br /> under this chapter as an asbestos cantra tor,except as otherwise provided in this chapter. <br /> I certi£y that I have read and understaud and will compl with the provisions of this asbestos notification <br /> s ement and that I 'll comply with all state and fieder 1 regulations pertaining to asbestos. <br /> . c-._.._._ - ��-�'�'-�1� <br /> ` nse Hold 1 ontractor Signature Date <br /> ��/� � �' �9 6�� <br /> icense HolderlContractor Printed Name License Numbex <br /> �i� � � ��Zt.. t��U�. �e t �`��t�S �� ��S-�I � <br /> Address of Construction Site <br /> �` 1 �t S" <br /> Pennit Numbez' <br />