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OWNER.BUILDEB DECLAAATON
<br />I HEFEBY AFFIR' UNDER PENALTY OF PERJUFY T}IAT ,I AM D{EMPT FROM THE COi{IHACTOBS UCENSE LAW FO8 THE FOIIO],,IIAIGEE @N (sEc. mol.5, BuolNESs AND pBoFEs{$s-_gqDF A}ry cny oA corniry !fuLi BiEoJinE-a iifriirlci cc,usr*'o', n,=o .lMPRovE DE''tousE oR HEPAJB At'ty srnrrcruBE, pRroR To rs rssuar,rce, aGd neritifieriile;$Fuc ifi iijRs'rii
<br />"eosrr ro nrt aslGNEo STATEMENTTHAT HE of, sHE,s UCENSED punsurrr.ro rre pRovidriNs or rue Cormncrons'uiler.r#Gi"tur,qrrm s( coMMElloll{G_wml sEGIloN moo} oF Dlvtslo_N3 oF THE BUstNEss AND pRoFEssto}.ls cooE) oB Tt|At xr on sge s ri}Mpr THEFEFRoI,AND IHE BAsls FoR rllE AtlrcEo Dq!S!qt.Ar.{y vtot ATloN or secror.izosrs sy ANy Appuc,qxr ros r, pEtr/|rili-rulili i#.APPTICAJ'IT TO A C[i4L PEMLTY OF NOr MOPE T}IAN FIYE TIUNONO POI-LIN6i+6OO.I:
<br />J.49-9ryq ql!!E PRoPE?TY, oa- rY ElrpLoYEEs wrH wAaEs as inni solr ooi.rpENs{trofi, wnr Do r}tE woR|! A!{D THElEtlglllE F ig-.r $rrEtlDo oR OFFERED FoR 9ALE 1ssc. zoll, eusnesd lHo pnoressrolts cooe riqe coMrnAcrons ucENsE LA\yDOES NoI APPLY To AN O{rl{ER oF r}lE PR@EarY WHo Eutt-bs oB tMpfiovEs THEREoN, uro wtro, oOrs surin woax musa_r 6nHEffSEtr on THBot GH Hrs oR HER o.rrN EMptoyEEs. pBovtDEo llAT sucx iuinovEuefrc drE tgt tmettoo on C,imp Fofl sArE tF,
<br />!!'lryE_vq& EF. I'JltDlNG oq nrPBovEuan B slLo WTFHIN oNE yaAn or couplEnolr, rxe oivNEiiiijrujEh wrli ne-vE nre aunuer oapaovNGTHAT HE oR sHE DID NOI BUtt"D qn tMpBc)\,tE FoB TltE FunposE oF EAIE).
<br />-J':Ao OvrNB oE TllE PnOPEBTY. AM P(cu,stvELY @+IIRAfiHo wmr udelso cot{IHAcrofls To coNsrBUcT TuE pRorEsr (s€c7o'+4, Btr8lNEss Al'o PqoFEssloNs coDE:llE coNrRAsroRs ucErce I w DoES Hor ApFLy ro Ax i]wNEn oF iEopErirv wno zuus oelMPaov_Es_fiEFEoN, Alo.wtto coNTRAcrs FoR sucH pnqrEcrs wm A oolnucron(s) ucelrseo rurisueln ro ire cor.rrnng.ronsUCETISE IA!iIJ.
<br />_I AM EGI,IPT (hDER sEA
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<br />, B.(P. C. FOB IHIS REASON
<br />arA l
<br />.UCENSE c36
<br />LEE}TSED CONIRAC'OBs DECLARATION
<br />I HEFEBY AFFIRM ullDEB PEI{ALTY oF PER.IURY T}[AT I AM ucENsED UNDER pRor,nsrcNg oF GHAPTERq!9.o\rygsryg_qtt_wno|,r 70oo) oF otyEtor{ 3 oFrHE Eu}tNFss ANo pnoressrors 6r,.rxb r,ii uidiss rs $tFUI,I FORCE AND EFFECI-
<br />877489
<br />gllls sEcTlO{ NEED NOT BE CO|TIPIETED tF THE peRllr lS FoB oNE HUiDRED OOLT.AFS (trml oR LFSS.
<br />_ r cElry}ry N.rtlE PEnFOFI!4fEF OF THE woft( FO8 WHIOH THrg PEBr T tS tssuED, I sftAlr Nclr EMpLay ANy p.ERsorJ tN ANyrt NNER so a9 To EEooME &,,Ei,Eor ro rHE yyo6re$ oot{FENSATIo LAv{s. oF cAllFofllllA AND AGREE nur r t grour-oigeor,r
<br />EI|{$ffiH tHE WoRKERS'o:oMPENsAxo\t PBovlsloNs oF eEqrtoN szoo oF rHE t-eeori cooi, i aHAi itnnrwmr cot'rpt-i wmr-rrcse
<br />DArE 3114107 a-,@Y)kPa.,ka?
<br />WONKERS @IIPENSATION DECLABATIOT{
<br />I HEF€BY AFNBM I'NDER PENALTY OF PERJIJBY ONE OF THE FOI.T-oWINO DEd-qFANO}TS:
<br />J [!E8!o:wtLL lrAlNrArN A cEFnHcArE oF c-o$EiENT To srEtr.{NsuRE FoR IToBKERE coi/rpENsA'noN, As pRol4DED Foff By sEclorr
<br />3?OO OF II.IE LABOR COOE TOB THE PERFOFMANCE OF tHE WOFK fuH WI]ICH T!8 PERMTT ls E{IUED:
<br />' ' ' ' ' ' ' '
<br />!'. ryye-4ryg1qt q44ryrn wofiKEns, colrFElrs roN rrilsuaANcE, As moumED By sEcnon eroo oF rHE r BoR cooEFoB rI{E PEFFoBtIA}'lcE oF rHE vYoE( FoB wHEt nts pe$fir s ts6ueo. uy woFxens coMpeNserix iltsuRANcE cnairEn mo poucv
<br />NUHEERARE
<br />CAFIRI California State Fund
<br />POLI 1761660
<br />APPUCAI TS DECtrqRANON
<br />DEMOLITION PERMTTEASEESTOS NONNCATION FEDEML BEGUIATIONS OITLE 40, PART O)
<br />BEOUIFED LET'M OF NOflFICANON
<br />I CEf,TIFY THAT THE FEDEML FEGUI.ATIoI.IS FEGARoING AsBEsTos BEMoVAL ARE Nc,I APTCAaLE To THIS
<br />PflO.IECT.
<br />X
<br />X
<br />(b,;*72 qz,.-zaa?
<br />slcl'lArunE oF APPucAtgrcB ffiFW RrnO"ll
<br />ICERTIFf fiAT I HAVE FEAD THIS APPUCANON A}ID STATE THAT THEAEOVE INFORMAI]ON IS CORRECT, I
<br />AGHEE TO COMPLY WIT}I ALL OITY AND COUNTY OBDINANCES AND STATE IAW FETANNG TO BUILDING
<br />COi.ISTHUOIO . AND HEREBY AUftIONTZE REPRESENTATIVES OF THIS
<br />'IUNTY
<br />TO ENTEF UPON
<br />'TiE
<br />AAOVE.
<br />MENnoNEo pAopERTy FoR tNspEciroN punposEs.
<br />3t14t07
<br />DATE
<br />PER,\,ITTEE NAI/IE (PNIffi)1025/m FOR S/BN
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