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0 <br />-:3 UN-DERCRaWD -;wK RZ R0?ZT. O! PIP•WC 2LPAIR PE;, -IT <br />-'.fIS 7E.'t/•I:=X>.FLS 90 DAYS FY7 Ti APPROv;L:- y1-_ DO SOT --rt rx suAD-, ;,RzA5. j"D-:CA:E PFRr.IT T`pE LIDS: <br />_ P"'I ."Z_::.Oi I: — PrP.. G IITAIR <br />?R47ECT cOXTACI t TFI.£nrf� [ ' <br />t 209 -461-6337 <br />�+Pt{ONE1 <br />2 <br />� l) M 1 �� ��. C , C ` , . C-1 <br />CROSS STIZZE` 1 . <br />S 1 <br />- L,ti1c-,cc' 11,r�4 i <br />c ` ELITE IV CONTRACTORS, INC. <br />0 ?How-' 209 462-6337 1 <br />: 1 c——R •UORFSS 2535 WIGWAM DRIVE 1 ca LIG 1 660016 <br />T � - ` _ -.1 �"� A, C,.1 0, HAZ t <br />R i INSURER V ` r �� J laRz cone s <br />046-008761 i <br />C OrITER It•F�Ar_OR . <br />O 1 <br />,R ( PHOxE i 1 <br />r••'z arrt�rr r.trr..rr•.... ! YfK.1NE'3 - <br />`=+[f Cll ll l..'{/•/alt t[S/{[{1141 -� ' <br />!� T"avr" 7M F �^ T-\= SIZE (b-FStZC.It_; SIL,R£D GL'R/tFaLIL7/PAEirIOU$LZ DAZE ISS: 22GSTLL,IED ' <br />T ! x5-- <br />itlilill <br />1 s <br />11F+ltiiiF1'1II31llYizTllliillii:Iiia?Ii.tf'-[SI)..IlllllallFli!1Ii111II1i1111:1�il�iiiiii��+`Il,li�tl'iiti�ii3'.�..� <br />aj <br />APPROVED WKTH mDmjr-ONISI az=.AY"RovFD _ g <br />DATE l ^ 0 I <br />s';1111111�111[If IIll lilll1311 1!!IiI fill Ill [it <br />lllll!!!lli1111!lNllllltiiift.t I;:illlaliliiillllll l.E aii111I1[iilIll lllilli' <br />�m,ym>,xP rt[IS ?ERFOR •t AZL vOA:C LX ArCgtnA.v� :.`-B SAx t <br />JOAQtTZN `-YbfP! O".�LJWLLT„ SUZE LAWS. <br />-..Y A!.'.::I.N "uf1!1-S hR.=LIC dFdI.T3 72\/TLS_ C;:\ OR LZmrSFD Rt:�w SIGVAT•JR£ IZF.S Z}iE iQ�- x:!rr�.u, "xv"iFY TISA'7' - <br />TIr.FORe C -Z: OF' THE OORK FO� -JUTC; jIUS _�iT1 a. �: ISSTIT�, I :S�:II. NC.T rZ'IPIA7 AxL P� HE SSC:. arum � 1`. :�O <br /><1Rt <br />x.:13 tICF 'IO II:X: l�Q'S COM z?tSAZTO� LAuS OF GaL.-^.RNI]. co"TVACIOIIK HZTZrG OR SD9 - . <br />ACrZxz SGS.;:LIR C''-: f .� T..F :J2.S-J°� tZ y <br />�`_R'I IFY T'+%•- Lv F' d: PERFORXr,-1E '>F "'.3mE t+G.2_.'" :OS 1+XZClE THZS P`_7'+Xr IS :.SZUZD. Z SHALL ErtPI:07 P!:2SON1 SI.-u..T Ca r"OR/C�I"S S <br />_;u7Pc3i:ATION _AVS OF CAL-cORXZ7._^ - � <br />1 <br />=.�PLICAt•T'S S:GYaTDRc: ',��`�' 7 <br />TLTLE <br />$ iLLING <br />'_ndicare the respons b? e party to lue 2,� 1.le,d for addit ! Onal PRS -E. -ED st3tf t=aee e_xper.(led hey '.'i <br />=�c_mit palment coverage per talzk_ if t►ie party designated below is diz`fcxent than he p"=r.iL <br />anplicaat, e -g_ property owner, t:.e party must ackno,.Ledge this respon_.ib ..jLv Eo: the A' !.i <br />,2-->%rtur <br />sicrxe and date below. <br />neer �y cl . ti 1,1 - L -33 Z— <br />