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HomeMy WebLinkAbout1583A (9) .._ 44'ORKEI2� CJ\ hSA.-.7�'Di.CL�RATOti: .-. �6A354C � . .. . , p��, �9 �gp'^ 4+^���,�' .� ,a'�y�, p,$�5 . � Ce-618I280) P'§�A-�..i'�,r�.��i�w.Yi� ��.J�$ ���dt"1!� I hereLc afnrm h i I ar �i�certEf�c tc ot c�n znt [r, szlf � . � _. �� � :� � � �� � � �. � . .� . . � ' , � � ��au,e,or cert Fcate�I�Yorl.ers'Compaasatinn�;nst:rance.^.i�� ¢iE�.4t'ING-�/"�'.PdY'4i..AT'I�1C.s-t'�.IF7 C:�Bt��v'�I'i"F�5"i;P�Ca � a ca;.hfied�ur>py tnzreof(Sec.7800 Lab.C.)- � , , ��'R ,� ��r' -�"�, .. J L \o. �4�.�ompan>'�'ovV_�i.�"__,_� . .. . � � . . ..�.� ... . ' ❑ c ertif�d copv:s hc-eb>'eurr,ishea, �� Oli.�''�Y�3e=LQS A�ICaf�ES r "�€Jil.Ul�1C`�F�tiiO SAFfTY �'I��n ,�� � �fSG �-f�y .. 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C'CRSbG1AT..FtE W Uete' � Appl�ant_.._� . . .-- ��CCvtPR OR 871, ... ------ � � � � � .. y �OTICE:O APPLICANI [f,after mu7.:ng th� ..eri�,.�nxe of ... - IyEYT��F.'lc'N SY 7cM I anLC,- �� ___ ��'��� y^` 2 t ae n�•tu�n �ou.}I.ould bkcoi:�� �+uDle�•r io .itc V✓�rxe:�. I __,,,, ,��,_ .,., �.�I�FaL � ' . _ _ . (>mp�nsxl � p[O��s�ons oF�1he Lal�oz Cotle_y0u inuya fGrel� � . lEVA'QRATIVw COOI.ER � �� �y . �/a�..E�A�f�� . ath com� y 4�tii.<_nc", P'�Y:Sions ce ;hic permit shalk be - . �_ �. ---..�- , . . . — dcemz<t;evoke3.. ' 1-j�L'R'JACE:. A 1�_�s�+L!�Y.--,--4�k� � ° .. LI(l.NS1�DC.O�fTRACTORS'�F.(J[.AiqTIOA � � IFL�GR_._.._._ 3 U.-1 4�__ �.t, " . . ._ . . t hereby:�tt rm that I am Ce 5ei urdee pro�so•s ot C�ap:er �y •NF_F.TER. S 1 P T3�E�^ ,':�� j I �� � . . . � � . q t R .• � �_�� . . ._WAL . .. . �`. . �Ss�and�Pr��� u�>ns Co�e��m� i�a�a�r sn.�ili�ihce�aU � _ � �- �..� �, �r• : i F -f1+.cc. _ /�`�.� � '-"�_�q-' � ' ' !t � __{___ i._.____�.._ .. . , . L�C �se Nurth.r-���z - C¢.Cuzs.-` � -- I � � . . .,. ._. . . . . . —�(_� __. �� . . • � .. c � ��� �7 .�' -___-._—".... 1 . '�����ro-��1,`'l�."SdQ.�� �)ate. �"G-. �-'-- . I { . . . . n e.empt fro n Yhe licensing requ�e-r nt na-�am a -�- --- � � - l . ... . . . ., .. L.' S� ti y �«•�rs�.c a e .ta i e z teg ter tl yrn ssio al en�,ineer � ��3���'eC�C f88�5°'c Lf d�Y VB. � , . . . � �1., � ACt:{l� A M� ti OFESSYGnJ1 Cap3 �fY.��JCCSI51��7(:$1, $Lti- � ���{� « I � �i�V �necs artd Protes,io��s Code) �. PEr�i+h3�ic3tis^9L:FFE� : . . . ��s,:.; . �.� ----- '-�- -'- (j . o ., 6 ' � . � � . .. llate __� YOTA' l E� �n0 , Lic or Reg�N�i. __. . . -..-�,_._..__�._ �� � . . . . �;, __- ..-_L-.0___. `,iOM11F�O�':KF.ft-BLqLDFit D;CL.Al2 XLipV .. .� pLAN Cii=..K APP�ICANT �� . . . " ��'`�r�^�� � "�:' ] h�rcby affiira ilia. 3 am exemp. !'mm thr. C��ntrzctor's� h,..F9r � . T-_ , .,.,_,_ �,�_ . � - � �� Licence La�v�tor 21ie foi(owir.g rea.ion (Section�^,03i:5. 9usi- ��------ ` . .- . . . . . a ies5asdt' fe :nsC��de): � � , ' F,DDRESS� � . .. ..�.� .. .. . :. . . ., � �. :I (1 CI�t)1�ttlE �].':1}1C�t' N•Ill"UO L ' S fk 314 1:� CITY � +--- �� T� �yN�! . . . - � ' stru.f�r�a �s�.naz intended .r offzred for s,:ie.(tii.t;tir _.__ . �-��� � � 7(i43 u ic s rnz Y ofessions Cc de} ��/l/� 1i' !'�� ^� _��, � � . . . . . OYY'VEi3 ��h ..! 1. ,y� " � �I:a e,-n of I e pmPer:7 rr e c.us vuY conti a-t.ag . _ . - sJ 11'� . . _ -� ,jitf 7scensea c rt ac ors to co�i[ Yhe Cro,�c4 A44�L �(_!7-� /'������.�+t�hl j` .�'^�'�� s 4 " 1Seclioe �Ob4�Bus.ne,cund ro�•,sionsGndel. ' A �RESS LC1��� � .. � ���-- � . .� �.. . . COVS7H[.C7lON L NI>�vC AGLh Y� � - I i Y (^ . ... . , . . , . .. . �..�r� ---- ��a � : hereby nffrn �i� ehe •�is ,�co-st �ccian te�dng t�ncy� -�-" � tur che e f .i..nce:<. the aor�c tor u�i�acu , �.s �_ro.it is CC�TRAC70F y� t c �-� " .Y>„ze cs� ,o�;,c,,..c..�. ___ -�--V i�4C.-� �' ._- '}�,..��� - � ;. l.tnder's Ya.re__ . '--�..`. 4CORESS �I��1 �, �G 1�j�"�n'�l .. �_.� . � � Lznder's:lddxess_ . � .. ..... �Ty -.. ��-:�-%��.' ,�.. . . . ' ... . � � y����l�t� _- __� . . .. . , _ . I ce�tifv t*�ni 1 hc� rea� li�34V Sx ion a��� +Cate e nt tht G.�,,,4 n '} -� � STATE Y Z S Cy�` abo.e mform,.i<<�n iy wr.e.0 T?S�e_:o�rnmpiy w�f1:af]{uunty LICFNSE�,O ,��'�,'--. -?�,.:<.(., ....,....� -,.�--..>..,.,r��._..-9 � ,, . nrdina�ices and Stale lau's YegutuUne Heat,�g �e x 1 t� 'and � �� . . . . . . �. � Ain OordiCronmE,and�h�re�? zutho��u n,p...sintln�cs of thi5 .. . SEF.R}..F1RSF_I:1ft 74Xp(.qV3TQR4 7�AVGl;AG�e" Cnunty w �aier ipor. :he aboi�e�mentiu4ed ,roponY Fm� � � � _:,��.�,_�����z�-� Signux��f.;�,f Yern��..r.,, S)c4e � �..._..__.. _.-__ _------------------__.__�... �svs�ccr�;�s�a�s,�Es . _..'.'____._____ . .__."_�—__�.��.�___.��_ . . !)�VIl�;AL-ijlJi^-�:ix,i�.>4'�!:a;:,�.,[..e:s'.'� . . . ..�..�__._._,��____�_.,..__�.._.. ._....__----�.____._._._._...____..._._.. ���h. . , sP&rrv�•....ao,-:.n v�ten.pt Fr.>rz,troE Gc;air..c:..:'; ,�, , _:_.....�__...�.....__..___..._.._..____...._'_"..__.___._,_._.,_�_�_..._.._._.,-:...�...,� �',cer;s�:`�aw eor tne fallc�m�":r.:g r:.:rnm(5er�'on 7C�5i.�. : . .. 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LD::ser:�aa ar:a 'rrofessic.ra�(aiel.or t'rtcr ne�is ezernft �. ��kerefroin and rh.e baai.e for ihe u:�eke.exev;:sial.Anv� .. . -.� . ....___. ..._�.._....�____,..__.._..._.._�__�______._._.._._�........,.__.�.__...... a. a;ior a(S e.q.v f.;!S r� . . . . . Y n.,y riFPlua:2t tc�a r.-etrnf7 - rub;ec!:tH,e n}��ficar;r,�o l.cis�ii penllq���;"ot rr;>e e;xare.. � ..._._.._....._.___.._�_.,... . ....,..._......—. "'_'......___....._.. ,.,._._,...., FlbP ...i.l1rAGGJ� ' i;.iJOj.: . .._._._.._. i' F,nti cwner c.thc�.rupe.:g��c�i€i.de t ..���k..an6 _.. ,. n.��.. ._�_.__,_.___----,-------�..__.._.___.___.___.._.._.._...._....._...._.__._. �_�e sxct;:;�uce is n^.t�ie�ncei:u.oiiemd sor s�.Ce. . � '� � � ISec. 7�31,;. Lliesiaes�s crrd 'Prn,fzssfnns.�CaZc-: rY,e Cur.� .__�---------..-----._ . —_-'..._'_--'_. 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