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W 0 � ,1 HAVENA WIIINARlIAW Y/OPoCEHS'LOIAPENSATION INSURANCE,AS REQUIREO BY 6ECTKK1 � � _ � 37000F?NEtABORCODE.FOR7XEPEflFOPNANCEOFTHEWORKFDflWF1�GNTHI3PERNRiS � � ISSUED.MY NORKEltS'CWP£NSATION INSUMNCE CAAPoEA AND Pq.ICY NtRdgEH ME: CONSTRUCTION � CARRIEA PLAN REVIEW z �tiY�ER ELECTp4C 4 � (n�ssECllonNE�wT2EaoM1fLE7IDaFiT+EP6�irswaoMEMROPfDfJ�lvs45�S1o�oRLFSsy PLUMBING � Z ICEATIFITUTNI7NEPERFORMM1GgOFTNfWORKFOqWHId�THI3GERMii15�3UE0,1 MECHANICAL CS SWLLLNOTENPLOYANYPER9QN6�lMlYMMlNER50�5TD6ECOA/ESU&f£CTTOTHE (n WORKEAS'COi1PEM5AT10N UWS OF C+ILIFOfiN11M1DAOREE THAT IF I SHOUlO BELOME INSPECTION FEE � `- SUBJECT TO TNE NqAIIEAS'CqAPENSA71IXi VRpVIS10N5 0F SECTION nao OF THE tABOR S CODE.ISHAILPoliTt/WIh100h1PlYNT7HTrMSEPHOVfS1ON5. ISSUANCE � 0 ' p DATE: APPLICANT: SMIP � ENEflGYPlC '�:'�}'� n WAMlIIidFAIIUflETOSEGUREWORKERS'CONPEN3ATpNCOVEHACiEISUNLAWFUL.ANOSHALLBE � �- t SUBJECTANEMPLOYERTOCRIMINALPENALTIES�NUCNILFWESIIPTOONEHUNOHEDTfKK15AND h{i�� 4� LL UOLURS�f 100,0001.R'1 ADDIiION TO h1E fAST OF GOMPENSATION,OAMAGES AS PROVIDED FOR IN ENERGY PERMIT � •�� ^�" J SECTIDN 3]oe OF THE LABOR CWE,NTEREST.AND ATTOIiNE'�'S GEES. � ."� i'��"'i � RETENTION FEE: �� r'�` i'e PRE-ALT FEE: t� ` � CONSTHUCTION LENDING AGENCY -_�.�.•.,� �1 ^ 1 HEREBY�FFlHII UNUER PENALTY OP PERIURY THAT TNEflE IS A GONSTflUCT10N LENDING AGENCY fOR THE PERWRMMICE OF THE WOflK WR W}IICFI T7ifS VEiWIT�S ISSUED(SEC.3081,CIV.C). i �`��•� W .4} l_ ,.`�Y.° � LENDER'S NAME - � LENDEfYSADDPE55 � ��a�To�i�Y��cm"n�ro�r oaoTr�nE"o sT''�uws a�uTm��o ro°e�moim TOTAL FE ES � CONSTRUCiION,M10HERE8YAUiF10RREREPRESENTATIVE50FTHI5CDUNTY70ENTEHUPONTHE qn' �/J1 � ABOVEdIENTIOMEDPR�ERTYFORINSPECTqNPtIRPO5E3. �✓ �~�J a COMMENTS � � sO oeweirreeuu�ronnrt� . 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