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' .W 04�+ONMEqOFTHEOROPERTY./UAEXttUSNELVCOMMCTINONrtTNUCENSfUCONTMCTORS. �✓ . . � TO CONSTRUCT Tl/E VHOJECT(SEG 70H.BUSINE55 NJD PROFE9310N4 CODE:iME OONTMCTORS U� V81U8I1q1 �� p AQI.AREA � W CENSELAWDOESNDTAOP�YTOANONTIEROFAPROPER7VMRqBUIIDSONIMPAOVE9TMEREON,AND � YMOOOrRMCTSFOR3UCHiRO.lECT5M7T1ACOHTMCfOR(9)LICENSEOPURSUANTTOTNECOMMG pUANTITY DESCRIPTION � � FEE � TORSLICENSEUW.). . . .. . , Q O IAM EXEMM UHDER SEC. B.L V.C.fOR TN15 REASON � � V LL' DATE OWNER � Z W ' �Q UCENSED CONTFiACTORS DECIARATION W LL IHENEBVAfi1RMUN0EHPENµTY0fVE1WRYTHAT1AAIlICENSEDUNDERiROVIS10NSOFCHAOTEH V. � p,,, o�COYYENCWON7THSECTION7000)OFOMSION]OFTHEBUSINESSANDPROFESSIONSCOOE,AND Z X IAY LICENSE IS N illL fORCE IND EiFECT. � . . , , , LL � LICENSE�CsUSS ���� LIC.NO. �G�?�� � j.�1 �V DATE / �I~�7 � CONTMCTORCLCv�C/QiytiJ I�'/1C . p, W � � WORKERS'COMPENSATION OECLARATION � I � � � IHEREBYAFFIiWUNOERVENKTYOFVEIWHYONEOF111EiOL10VnNODECLA7tA� �/`� ZQ � � � . � _INAVEANDWILLI.WNTAINACERTIFIGTEOfCONSENTTOSELF�INSUFEFORW�ORNERS' �� S COMPENSATION,ASPROVI�EOBYSECTqN370oOFiHEI/BORCOOE,FORTHEPERFORIMNCE W OF THE WWiK iOR WHIp1 h113 GERMIT IS ISSUED. � w ��II/�VEANDWILLt1AIMAINWOHKER5COMVEN5ATI0NM5URANCE,ASREOUREDBYSECTION � � d 77ooOFiHEUeORCOOEfOiiTHEVfRiORA1ANCEOFTHEWORKFORW111CNTNI4VERMRI3 �f � 65UED.YYYNMtaE+RS'COMPEN)StiT10N�N5UMNCECAFIRIERANDPOLICYNUMBERME: � CONSTHUCTION .�+ I � 1" � CARRIER J T�/ � ��1�� PLAN FiEVIEW r � va�cYHu�.reER v -2- ELECTRiC _ . 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OCODE,ISIULLFORTI/WITNCOAIPLYWIIHT}IOSEGROVISIONS.��> A/, ISSUAN p DATE: 7�I�/7 APPLICANT:�[,�!/���'� ""� � ENERGY P/C WARMNQ FIULURE TO SECURE YVORKERS'C04PENS4TION fbVERAOE IS IINIAVVFIR.�AND EHALL BE � � EUBJECT/�NEMVLOYFRTOCRIMRIALOENALTESANOCMLFNESUPTOONEHUNDREOTNOU4AND ENERGYPEFMIT OOlU1RS(f 100,000�,W ADDITION TO TNE COSi OF COM7ENSATION,OMIAGES A4 PRONOED FOR IN ��- ¢ 6ECf10N]7a Of TME LABOR COOE,t1TERE5i,ANDATTORNEY'S iEES. � �� - RETENTION FEE: �� � � � � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ' - O � INEREBYAFflRAIUHDEP►ENALTYOFPERIVRYTHATTHEREISACOfiSTRUCTIONLENOMJOAfiENCV �.- � ' fOR iME iERFORYINCE OF THE WORK FOR WHIq1 THIS GERMt715155UED(SEG]oY7,qV.CJ. � IENDER'SNIA�E �11�l�� . . ' . . � . ' '� LENDERSADDRf55 � � ' � - � - � . W ICERTIF'/TMATIM�VEREADTpSMPLICATiONANDSTATE7w�TTNEh80VENFOiWATONISCORNECT. 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