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HomeMy WebLinkAbout1583A ___ 44'ORKE�2$ CO\ hSA,.-27ti Di.CL�RAT Oti: . . ^6A354C . � � 4+^�:�' � . ..e-s�aczso� l����...��.f�a���,rl�i ��� ���'��� � I hereLc afEirm ;hai I ar �i�certEf c tc ot c n znt tr, szlf . .. �� � - � �� . � . � . .� , . . � ��au;e,or a cert f:cate�i�Yorl.ers'Co�npaasatinn�;net:rance.�i'� �{��-r��t^y-�'�,�{}'4�..}�(';{yy�-}9.�� [�j)��{'���y�ja�g("y . a ca..hfied�cr�py tnereof{Sec.7800 Ls�.C.)- � . . ��'�� ,� ��r',-�"�, .. J ]� \o. �i 4�.�ompan>'�'ovV_�"�,_� - _ . . � . . ..�.� ... . ! � c ertif�d cop��s he-eb>'eurr,ishea, �� Oli.�''"Y�3e=LQS A"1ECaf�ES r "d€Jil.Ul�1C`�F��iiO SAFETY �'1�Y� �t�,n � _., �{SG tii�y � .,� . �`_ �,..,.-�m�,,.�� - :`.�-" ..4-.,� � ` ! /t��2 iF ed co } is t 1 u��v.th ii:e<o �t�7u d"�inspec ior, �6Uf L 7uG ^� �� �ti� `" c.e d+ime�,P (� /�(�,�I ,,g�/� � FOFt APPLiCli'lT'S.`3 Flt1 1R! a��aEss 4c' '- ���.�1� z ' ���y� ' !S_ 4,`�-+�n..fl1�"rr 4_.....r.__ (PRl1 OR TY? 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G00 �f 17 e s �n 4 0, the Buer �_ Rr � uc�s Go�e aAd m i a �r sn i 1 Y ce ad � __G__ �_.._.____�"�'" . . . . .. ... . _ , . . . L�iC�(�se Numh r, � _ C�a Cua,c,_ _ I �. . . _.. -. - . . ��A` �N1�'t���fi , �.� : �._:_-------- . � �� 5z� r `��3 _._ � , 'N' �_ I I G I 5 r>i.'"� u y n e.empt fro n ihe 1'censing r_qm e-t nt as-1 am a --- � ' - � �C«•�rs�.c e e 4a e [eg ter tl yrn ssio a,l engineer ��3.„�?eC�C f88�5°'c Lf d�70V8. . .. . � � � , a actip� n mt n oFEssronal caDa iiti !SecLou�7CSY, B»x- �-`-- � � ' l�jn,�C -M � � � '-�'� �U� PE6�i1h3�iSSt3p^9Z:FF�$ �ness.u�d Pro4es,ions Code). � ..� .. . f 0.J � o - 6 4 a .� a . .. _-- ._.� .y- - ���p.3 l�� Lj .�LC , Lic orReg�N.i.�-- dJ3tt'_._ _ . _..- �_._...�_�.._.r.-..-1-!_.:.-! � . . , F ^,, HOA1F�O�':KF.R BU7LDFit D�CL.Al2�CFOV .. .� pLAN Cii= K APP.ICANT � .. . , . '. ��'`�rl �" , . .�.. . ,;. .. � —�_ �..�. ,. .-�.::. �.... ] hrrcby affirra ilia. I am exemp� !'mm thr. 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