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.� <br /> � ��� � �' ��"��..%���1[�E �,�`.�� <br /> ,�.; �,�, :`s� .�.✓'+C: _�v c:. <br /> �_--�-------- __-,.�-_�. <br /> � -�� -:� ���,-��f��� <br /> .�. . �.�- <br /> Di1CT SEAL -aFFIDAV(T <br /> Job Name �-C'G�f S �0�2� .�� l,icense# CAC0�3948 <br /> Addr�ss `�y � l /G' T l'J ,S f Permit# �J`���� <br /> Z�'/_. � 7� Nr ��� �� <br /> .�3-�"y Z <br /> Phone ��.�- ���- ��� _� <br /> �- �� V% %'�'__�/� �'��'� . aftiani_ herby atiirm that I am the dull� liccl�seci <br /> -- - <br /> contract�ir ��f record fc�r the ahove re�ferenced permit, that all of the forgoing informati��n is tru� <br /> and accurate. and that ihe �1uct sealing at the ah<�ve referenced address has heen c���rn��leted in <br /> acc�rdancc with all applianct c��de� and standard� with: <br /> Mastic I ape Id-tVlastic <br /> ('���ntractoi-�s Nan1e (printcdl ��'� v � '•v � �9/�/�- Date <br /> Signature �� �� <br /> --___._,� <br />