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DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF TME CONTRACTORS LI-
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� I HEREBV AFFIRM UNUER PENALTY OF PERIURV THAT I AM LICENSED UNOER PROVISIONS OF CHAPTER � '
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� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP T N NDRED THOUSAND ENERGY PERMIT
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� CONSTRUCTION LENDI ENCY PRE-ALT FEE:
� 1 HEREBYAFFIRAI UNDER PENALTV OF PERIURY iHAT hiERE IS A CONSTRUCTION LENDING AGENCV
FOR h1E PERFORMANCE OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED(SEC.3oG7,CIV.C.).
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� Z ABOVE•MEMIONED PROPERTY FOH INSPECTION PURPOSES. COMMENTS "
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