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<br />(PIeas3 us3 a bla,;k or blue ink b al!'point pent
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<br />(7!1ii.l-.5d')t)
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<br />Srncke & CO
<br />AI arm Affidavit \
<br />Proj 3ct ACd,'ess: 2e /./ t4f/,t( a?.{L4'\r(z S',4'u 7fr ,4t/1 (zt 1Z 716
<br />Permit N,,rrnber
<br />Prcperty Orrvner: H Wt ,vtt yt,J
<br />C c n tre;tcr:Lice n sa #
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<br />Cl ril,',.i,-r i:;,'j:.:,ll C.:,-le ilPli j::: rlrl i3Ll lr^d RlL5 2 st:::; in plr': ll13l:(ii: i^g d-'rl;i1i; be
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<br />tl^.. rarlr.iii':C loCl :;,:r j.
<br />{)3,:th bo.<:s belo'ru rnusi be ch,-'ck:c;
<br />dcr,bo,.t monox,,le a'aims: A,':'n;::il:,1 0,.r1:j;l: oi er,:h ;le:p,rg a,-.1 : itr :;^e imi-e ji-1 ': vi6;1'1r'7 Of
<br />5e,ji'l,lrrrs airrj al;o on :rcn le'r:i of i:e d',vellirrg A,ar.i; ?13 i'-"qr1i1;j in bed,-cor'n; witn gl;-fir:'l
<br />l'lor ir;.c: ; ( r. : hcl'ai :i:r- he li :r', c l,lk:)p f t rnaie r,t,' a iii-:piace
<br />VS,roke aiarms: A;: in;irrle,j rr^ :r,:: i-f,)ir u;;d i.rr;ie:ping. rn e:,:l hJIl'/vli cui;id-'oi a;ie:oing
<br />roory), ai^C orr ea,:h le'rei :f t:e d'ru'etiing
<br />ft;';1i,i--1ij de::,:l)ri in.l,/ be brt::'l-oce.lr:,.d frr b,riltlirrg; /vne.: no ini:r'ior alt-5rlliorls ar?
<br />9srf,;r:^Ed. Crr-'iiCrr"J:,or S,-nol<:/-l 3i3;-:i:; rnu';tCo'nply with ail ro,3ii,:rcle ;t:nClr'j; ln,-1 be l;:orc'red
<br />b'l tre SrJ:r Fir: i\l,rr;hail i;;i\1, B::::i''7 liie rnu:i be 1J year;
<br />I her:c'/ certlf T t;.ai I am tne ccni-lcior or tne prgoertl o'r/ne," of tne abo're prlleCl, I furthe6 certify
<br />lhat si"no<e al,ei'rr"; and c3r'5')n rnon,tx,de al ar:ns 1a'ie 'oeen installed in ccmpliance wrth the governtng
<br />Cc,jes anC h,r.re be':r. i:;t:,1 lc be i,-lr'rctrcnai. l, asc, hereby ,:€r'rif'/ 1t'31 lipiil rel3st lhe aiarns oer the
<br />manuiacturei' i inst,-,lct;on5
<br />5 ig natur t Datz \v-
<br />(check o tr cenie'J Contr-actor prOOEftrT Crr,'uner
<br />rrrOI!: This;etf-certificat:on is oniy used t'or prcject; that $fzct the EXTERIOR ci the structure. This
<br />pr)c?;i is npoliceble OfttL'r to proiect; wherz dc.es5 io the intzrior of the d,uelling by a Santa Ana
<br />lnspectci is not requirzd.
<br />Ha.re ih,s completad fcrnn arr.J the job-cr rd rea.lil'y avaiiable on final inspectioni
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