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V v'pEpMT A.D- (� SSUED Dv DIRE aWrlw CLMA COUMY aULDING iNFP1AT IO OFF7C6 I notchy alarm artier DdhaRY at PerIUN mol I ern wemmpl ham the I treroby efsm under pendy el Petury that loam under
\V{'� Lf .�^61 70 W.FtEDDNGYi.BAfldDtIBCA ss'lio {40a)Zsoaa6t ContractorsUcenm Lswltrthofoltowmpresmn(See.70Ci7-S,Bltaf- Provislats of Cts 9(mmrencln6 6a�an TOoo)of 6M-
- O rens cad Profesdone Code:Arty alty or a0"which waquLoe a sEm a of ihe��nrflPr�d swy0rhs driln7 Urenw Is h
TaiOLOOY permit b consM4 idler.brnprare.demorollsh. IepNr8lry StnUslure.
,IOBADOR 1uY Intoe an fj.
n, Ptsim dBlssuanw.a{al boo reafsifoon apursutlnpathepml K
(7EAREDFORISSWNDE EY: /°'�'DA7E dopy of Contracb heorse Le (C haedpuraonsmoraproilh Liw^ee r?e�° �c.1"'-
et,
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NE1NESfCROBS s]RFk7 a MPECTONREAU Pti10II'oF)NALDISPEOTML Setlbn7Wo)cgDMslon3clih.$csYiemand Poolestlons Code)or
�{.SON rat he or she is exempt itwelrom and the bads lcrfte rdeged ax-
V qJR .. smpfon.Any rblaemot Sas1011 7031-Eby anyapplicen"Ofe Per > �
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SET KO(F :FRoxr , �- ' Rr;AR _ dred d7tars(SSOO).): "13I agsrrLy,for the pwetorm of Flak forvArkh Inde per.
H 124 i t t O S zS`7'7 g63 m,E ABA Rl O 1.as Owner of the property,or ay dnpleyaes with wages lrU b octroi(sea aD67,C
as lhelr9dacomperi®YOILvAIW fteC,,adttre Mtr Lender's Nems: {
p /�,,,,, /'� yea Is pot inbrslsd or Clime for sale(Sam 7044.SUM- LatdarsAddenes:
CITY 1-Q• fJt"IL. ��3`� �w qua t�-reg 3s c;EARW FOR WA ANC£Dv: Y I1ArQ J ?' --wd Pmfessfaucmq:The c atmOorst�snsOr a Law
(tj((QFckTiNO does not apply toasWho do Such mottowRderIno-
O 16PFCMDN REOUIRID PRIOR TO FINAL INSPE IL proyeslhdeon,end twho rbea ybh wok hlmxit or trar-
seff or ltnnugh his Or her own ea ikoyses.pr-RW that I mrty thud 1 here read*As aMUWon and 042 IMt aw Sbo"
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'Yt lam! 11 l L id J$(f LRNO DbYBOPIABlfT ENa)L a EYINe a rah lmprohe bulla ora rotfitanew rent 15 Oddror s a hle"helton is co" I agree 10 wmply 921 an CRY Mal county
1lAtUNGA how",the twlkling or#rprevarsrwt is Odd w lwln 0rro
�/� yearofeompl k%o*o w-huftlarwOhr the burden or nRnms find state laws slatting b ardlmng mrdWctla4 end
crrr 03 o G6MM� 1iJ�s✓� �S�Q8 cwAmo FOR Issumt;A B7: Ye ejG of p OYN61ha1 he Or she did not bUUd or Improve IR t e hereby au7gflis RpR9ontalke6 of INS mlRlly in enter upon Uw
DP Purpaee of seleJ above++raN"^• nrapady lOninaeetllon purpossnL
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n f Law,) Indcsle D Ute hnended oa-PWxy will use lhemerdous maMlals.
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fon:
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••t 0 I have and will nrelrrla(n a 0e1111CS10 Of wpR+erd b WP
TYPE OFI OVFJ4EM: REf10DF 1E11ViiCNAIlitllALlIEdLTiI' , lltsuretorwadoWe'mNipnnaeOoRas provtmd lerlI r+Rr•InrSn n.tr•+T!rt
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BUI ADO(iION 79(ATUts HEPAR MOVE CONVERT DfjAm1 ".. .. ton 3700 of ora Labor Coda lar the Performance of Ire r i.{i wvcn+w�u10 40
(sora for wlrk]w this pcmtl Is issued e;rr *,1,",- Tt• a^ .wl
MEA STORIES awat1Ne Uwe CL FARED FOR ISSUANCE B' F-��-•.i�lr-RP`T .�.LL. u+
. 7,21 d -To --�— � Ilrerewselwllwrabrtalnwoteera'aarylonsaEOlilostRaneo, Ds ?tri :�: y,.i w:w:
E UCOON OUIS MMERIAL6 AP rewyared a1r t-7ectlm 3700 of the Labor Cade.Ln the OEM
PERS t performance of the workbr%tich this pemdtla lswred.
U wxtR SYSTEM P AMY wottaW a�ctrtip,enyymfbnyInsurance cadwr and poltry .
O SEPtICBYEIEM pFS16pTY leltllbe[ �lc}l°lr 'v "s S�19S' a:•r#�J�'i''t14'a 1' i1'
a m9EerDNrtEoul R DISPEenoN PallcyNnmmr i txR� �yte��-tea
` (TNF section neap rot oY a Isd Y the pe nill 10 for �r� t ,,, a,•k5�1.'i i#36 I p.
_ one hundred doGue(3100)or lieu) s
IFerfifyIWJOine.pFnomaYtamthe we*Wwhich Ois
`p�mYt Is Issued,1 shall net smpiay Ary parson m any
CIEAREOFORI 8Y: D -rnannermasto heeomssut>)aoifollvwodCara'a0mpan�
COurail'.FILE No. satan mx6 at 0W11WrTs.and ap0.e tine 0 I Should be-
t] Uw TO FINN.IMBPEOTION. tome subjedt to the wotmma`sonp0nsairoa pro tis oneaf
y� Sadtbn 9700 of 1M Latior Code,l and kdyM h comfy
VAYI those protdstons.
t =MON
App(kyry �rIV
FEES ��
PtlrneallG S.KLR ISASI FAILURE W SECURE wDpl®IS'CO7UENSATION COVER-
` h 9fPRC ACENIUNLAMFIILAMDSNALLSUBJECTAMELfPLOTEA TO CAAa1AL
FIRE MARSHAL
r PENALTIES AND CIVIL FINES UP TO ONE RUMORED TIIOUBAND
FLAN Cl1E0K PEAID7 DOLLARS(Flm.aeat.IIT ADORION TO THE CCsT Or coaPENSATbN.
x OTRR DAYAOE6l5 DED FOR IN BEcIM 77x6 OF THE LADOR CODE. R IIaV.wM
OMREST.AND A7TORREY•SF®.