HomeMy WebLinkAbout025-030-052_ �o2 ,
AP 25-03-52 — -�
Ln/svOakwood Lane 1000' E. of Hwy. 70, ,POOR, Ralph 1338-71Blle (?�#7-s
355-71B
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—03.-
B07-1598 025-030-052 n/s Oakwood Ln. 100 t E-. Oroville H '
MISCELLANEOUS (demolish -carport
Electrical I )' �=� `
�f ELECTRICAL REPAIRS TO UNDERGF , (� krelocate buil ng &convert to shop)-.
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79 OAK WOOD LN F �
KUHN,ANGELA
I B08-217.7. 025-030-052
MISCELLANEOUS Re -Roo
REROOF 6 SQ'S COMP
79 OAKWOOD LN
I JOHN KUHN /DEBRA YVONNE TREW - -- -
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION (IVR): (530) 538-4365
OFFICE: (530) 538-7541 FAX#: (530) 538-2140
ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds
PROJECT INFORMATION
Site Address: 79 OAKWOOD LN
Owner:
Penult NO: B08-2177
APN: 025-030-052
JOHN KUHN / DEBRA YVONNE
Issued Date: 10/24/2008 By TMP
Permit type: MISCELLANEOUS
187 MOUNTAIN VIEW DRIVE
Subtype: Re -Roof
OROVILLE, CA 95966
Expiration Date: 10/24/2009
Description: REROOF 6 SQ'S COMP
(530) 533-8945
Occupancy: Zoning: U
Contractor
Applicant:
Square Footage:
JOHN KUHN / DEBRA YVONI
Building Garage Remdl/Addn
187 MOUNTAIN VIEW DRIVE
OROVILLE, CA 95966
Other Porch/Patio Total
(530)533-8945
FEE INFORMATION
DBMSC Re -Roofing $119.00
Total Charged: $119.00 Fees Paid: $119.00
Balance Due: $0.00 Receipt No: B8946
LICENSED CONTRACTOR'S DECLARATION
OWNER / BUILDER DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license
pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000)
is in full force and effect.
of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
X 10/24/2008
the applicant to a civil penalty of not more than five hundred dollars [$500];
Please check one of the following:
Contractor's Signature Date
AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE
( COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR
WORKERS' COMPENSATION DECLARATION
OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
the work himself or herself or through his or her own employees, provided that such improvements
11I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
are not intended or offered for sale. If, however, the building or improvement is sold within one
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
year of completion, the owner -builder will have the burden of proof that he or she did not build or
performance of the work for which this permit is issued.
improve for the purpose of sale.).
❑
❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
The Contractor's License Law dows not apply to an owner of the property who builds or improves
My Workers' Compansalion insurance carrier and policy number are;
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Carrier: Policy Number: Exp. Date:
(This section nee not be completed if the permit is or one a hundred dollars ($100) or ess.
❑ I AM EXEMPT under Section B. & P.C. for this reason:
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
SSUED, I shall not employ any person in any manner so as to become subject to the Workers'
Compensation Laws of California, and agree that if I should become subject to the workers'10/24/2008
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
provisions.
is Signature Date
X 10/24/2008
I hereby certify that I have read this application and state that the above information is correct. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
Signa Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
injury, including death, and property damage caused by, arising out of, or in any way connected with
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
ATTORNEY'S FEES.
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
property owner or am authorized to act on the property owner's behalf.
10/24/2008
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Name of Pe mittee [SIGN] Print Date
the performance of the work for which this permit is issued. (3097 civ. code)
Owner ❑ Contractor OR; Agent for Owner DAgent for Contractor
FILE COPY
Lender's Address City State Zip
' Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-2140 Fax
www.buttecounty.net/dds
OWNER -BUILDER INFORMATION
An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified.
For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed
by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from
possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by
law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and
protection:
° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire
project and such persons are not licensed as contractors or subcontractors, then you may be an employer.
° If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal
° income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions.
There may be financial risks to you if you do not carry out these obligations, and these risks'are especially serious with respect to workers' compensation insurance.
° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small business
Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through thier own employees,
without a license contractor or subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is
providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321
-CLSB (2752) or by accessing thier website at www.CSLB.ca.gov.
PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE
AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED.
OWNER BUILDER VERIFICATION
PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING
PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED.
1. I PERSONALLY PL TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY
IMPROVEMENT.R NO)
2. e/HAVE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK.
3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION:
NAME
ADDRESS CITY
PHONE CONTRACTORS LICENSE NO
4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE
THE MAJOR WORK:
ADDRESS CITY.
PHONE CONTRACTORS LICENSE NO
5. I WILL PROVIDE SOME OF THE WORK BUT I HAVE CONTRACTED (HIRED) THE FOLLOWING PERSONS TO PROVIDE THE WORK INDICATED:
NAME ADDRESS PHONE TYPE OF WORK
Description: REROOF 6 SQ'S COMP
Reference Number: B08-2177
Applicant Name: JOHN KUHN / DEBRA YVONNE TREW
Owner's Name: JOHN KUHN EBRA YVONNE 7REW�� AP # :025-030-/052
Signature of Property Owner.
Date:�G
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION*
OFFICE #: (530) 538-7541 FAX #: (530) 538-2140
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www.buttecounty.net/dds
PLEASE PRINT CLEARLY
PERMIT
NO.
Fo'-21971
BIN #
"When filed, this application and all supporting material becomes subject to the California Public Records Act. All public information
related to this application is subject to public inspection and will be posted on the County's website for electronic access.
OWNER INFORMATION
Last Nam v
First Nam/�
t/��,-�`�
Mailing Address
Citya`je
Stat
Zip $lf j�
v
Phone
Fax
E-mail
APPLICANT INFORMATION
CONTRACTOR
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Fax
E-mail
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Fax
E-mail
State License Number
APPLICANT INFORMATION
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
PROJECT LOCATION
AP# - �Sz
Property Address .
City zI&'SGL l
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than licensed contractors, a certificate of
worker's compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Sq FT- Living Garage Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
Zoning
Flood Zone
SRA
I Yes
I No
Occ.
Type Const.
_t //01 - oC)
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #:(530) 538-7541 FAX#: (530) 538-2140
WEBSITE: www.buttecounty.net\dds
PROJECT INFORMATION
Site Address: 79 OAKWOOD LN
Owner:
Permit NO: B07-1598
APN: 025-030-052
KUHN, ANGELA
Issued Date: 07/24/2007 By TMP
Permit type: MISCELLANEOUS
1547 ROYAL OAKS DR
Subtype: Electrical
OROVILLE, CA 95966
Expiration Date: 07/23/2008
Description: ELECTRICAL REPAIRS TO UNDEI
(530) 370-0664
Occupancy: Zoning: U
Contractor
Applicant:
Square Footage:
OUT TO BID
KUHN, ANGELA
Building Garage Remdl/Addn
1547 ROYAL OAKS DR
OROVILLE, CA 95966
Other Porch/Patio Total
(530)370-0664
FEE INFORMATION
DBE Other Electrical Inspectio $115.98
Total Charged: $115.98 Fees Paid: $115.98
Balance Due: $0.00 Receipt No: B3997
LICENSED CONTRACTOR'S DECLARATION
OWNER / BUILDER DECLARATION
Contractor (Name) State Contractors License No. / Class / Expires
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License
OUT TO BID / /
Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that
requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance,
also requires the applicant for such permit to file a signed statement that he or she is licensed
I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license
pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000)
is in full force and effect.
of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
X 07/24/2007
the applicant to a civil penalty of not more than five hundred dollars [$500];
Please check one of the following:
Contractor's Signature Date
❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE
COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR
WORKERS' COMPENSATION DECLARATION
OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of the property, who builds or improves thereon, and who does
I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations:
the work himself or herself or through his or her own employees, provided that such improvements
❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR
are not intended or offered for sale. If, however, the building or improvement is sold within one
WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the
year of completion, the owner -builder will have the burden of proof that he or she did not build or
performance of the work for which this permit is issued.
improve for the purpose of sale.).
❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by
I, / t I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED
d CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code:
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
The Contractor's License Law dows not apply to an owner of the property who builds or improves
My Workers' Compensation insurance carrier and policy number are;
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Carrier. Policy Number: Exp. Date:
(This section need not a competed if the permit is for one hundreddollars ($100) or s—es )
❑ I AM EXEMPT under Section B. 8 P.C. for this reason:
❑I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED, I shall not employ any person in any manner so as to become subject to the Workers'
Compensation laws of California, and agree that if I should become subject to the workers'
07/24/2007
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those
Owners i ature Date
provisions.
X 07/24/2007
I rt
hereby certify that I have read this application and state that the above information is coect. I agree
to comply with all City and County ordinances, rules, regulations, and State laws relating to building
Signature Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless
Butte County, its officers, agents and employees from any and all claims and liability for personal
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
injury, including death, and property damage caused by, arising out of, or in any way connected with
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the
DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND
use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte
ATTORNEY'S FEES.
County to enter the above mentioned property for inspection purposes. I hereby certify that I am the
properk owner or am autho ized to act on the property owner's behalf.
CONSTRUCTION LENDING AGENCY
(,� a 07/24/2007
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for
Name of Poldinittee [SIGN] Print Date
the performance of the work for which this permit is issued. (3097 civ. code)
12 Owner El Contractor OR ElAgent for Owner DAgent for Contractor
FILE COPY
Lender's Address City State Zip
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION.
OFFICE #: (530) 538-7541 FAX #: (530) 538-2140
A FEE WILL BE REO UIRED AT TIME OF APPLICATION
Website: w. ew.buttecounty.net/dds
**PLEASE PRINT CLEARLY**
OWNER INFORMATION
Last Name
First Name
Mailing Address5 I
Address
Ci vt 1 >Z I
Sta Zip
Phone _
Fax
E-mail
APPLICANT INFORMATION
CONTRACTOR
Name
City V '
Address
SRA
City
Fax
State
Zip
Phone
Fax
E-mail
Lic. #
Class
APPLICANT INFORMATION
ARCHITECT/ENGINEER
Name
City V '
Address
SRA
City
Fax
State
Zip
Phone
Fax
Email
State License Number
APPLICANT INFORMATION
Name e
Address
City V '
St
SRA
Phone
Fax
E-mail
PROJECT LOCATION
API0-
Property AddressII"I�
City C 05
PERMIT
NO. c
307'
BIN #
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
DESCRIPTION OR SCOPE OF WORK:
Zoning
Flood Zone
p/37.
SRA
Yes
Sq FT- Living Garage
Open Cov
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
For office use only:
Zoning
Flood Zone
SRA
Yes
1. No
Occ.
Type Const.
Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 95965
(530) 538-7601 Telephone
(530) 538-2140 Fax
www.buttecounty.net/dds
OWNER -BUILDER INFORMATION
An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified.
For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed
by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from
possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by
law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and
protection:
° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire
project and such persons are not licensed as contractors or subcontractors, then you may be an employer.
° If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal
° income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions.
There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance.
° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small business
Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through thier own employees,
without a license contractor or subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is
providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321
-CLSB (2752) or by accessing thier website at www.CSLB.ca.gov.
PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE
AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED.
OWNER BUILDER VERIFICATION
PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING
PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED.
1. I PERSONALLY PLAN TO PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY
IMPROVEMENT. YES R NO)
2. I VE VE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK.
3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION:
ADDRESS CITY
PHONE CONTRACTORS LICENSE NO
4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE
THE MAJOR WORK:
NAME
ADDRESS CITY
PHONE CONTRACTORS LICENSE NO
5. I WILL PROVIDE SOME OF THE WORK BUT I HAVE CONTRACTED (HIRED) THE FOLLOWING PERSONS TO PROVIDE THE WORK INDICATED:
NAME ADDRESS PHONE TYPE OF WORK
Description: ELECTRICAL REPAIRS TO UNDERGROUND(TRENCHING)
Reference Number: B07-1598
Applicant Name: KUHN, ANGELA
Owner's Name: KUHN, A L AP # : 025-030-052 `--/
Signature of Property 0 e • Date: —4 -2�- d T
4f