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Jul 07 04 09: 578 916-552-9558 p_. 1 <br /> Sent ay:: Ramage Envi,ronmenta2;i . 914 354 1-186, 1ul-7-t 0.1 OAM; E Page 1 t <br /> So <br /> n OAQiZkd 1Ct�pE1l" t ll"!t"1*e1ft� � "t3t1 31 <br /> 1[JpE[ 1I V4f61lt7[it l4�ldi14tV}'tjlt i. 1 <br /> Pesmit SA#: <br /> Job A4000--. <br /> LICE S-D Ct3 'k' ; , tA:R ►'TI+f�N <br /> I hereby atlirYn that X army iictsed under the pica�visio (coi:xgwitlt'Sttrtitin0 r "pvtsion 3 crf` < <br /> . tht;Business and Profession `ode amid MOM106 <br /> cr 106 its it►full fty a atld ct ext, <br /> * <br /> 4 ,✓tVa�S�TIr. .. ......... n. EXplt'allOtt I M.. .. <br /> 1 <br /> Ct1T►ttacter: <br /> U <br /> ,e s. <br /> J <br /> ; <br /> Title- <br /> "Sir" <br /> atu • �` <br /> r.. <br /> 1iVCiI�! "Cf11+�PENS <br /> i hereby aff4m under penalty ofpeat jtlq one of the 1'011oWW9 dcclaratitxas:(00*iliac) <br /> 'I <br /> l ha�vc and will maintain a certificate a0040CO to a 44116=for wOet erj,compeasa#a on. picvided for by r <br /> Section 3700 of the Labor Code,for the petrfotmatt+arG.oE 6.0 work for which this permit is ixect. <br /> I have and will mgmi twin woxkt&compci Econ -as-r *vtd by Section 3700 ofLab"Code,for <br /> ,and <br /> pcc�nxna�acc of the work for w�ch this permit is issuod. My workers'compensation i carrierpolicy numbers am' <br /> end <br /> . s . <br /> Carrier. IM <br /> clr Nttmbec. 5�6 <br /> o I <br /> Pbt ; , <br /> I'certify that in the performance.of%e work'fc r vvhA lu pert zs Issuucd;I thal#not y aay persota» <br /> airy maturer so as to become$14146a to the workers'compact>sa004 laws a#'Cslitorwia+. cc that ifI should <br /> become subject to the workers'razzrpiaacsa�tica'n prewiSlons of Sec ts�onn x'700 of ikie tabor lsha?il Cotthwith <br /> comply with those provisions. w "„ <br /> Signature.: <br /> print Name <br /> o+axi <br /> "Warning. Fahur+e:to store wroelp".91 Col apensadl m Csva>rRgQ to"A&4v4 and et►si�anbjtati tuts e�t=AP <br /> aCo oane ta>sn�dredi atbostsaand do9at'at 0100,000N titadditioa to tar coot ofcalltltl+1Yp arae provided t'o.tm section 370&opf the LO*r Cbd►.Yt SEE"�"RANi -�5 +G pE —ATI )NIZA 10 . <br /> � c �. � urc of�'-571ir�sed:aruthoriz representat c), <br /> -r to sip�ri this S 7�q,�►tn a�+Du>7ty <br /> :heMby allthofi (tainttstaane) _ t`a fid-. <br /> -- i.�c`li>Ettited to <br /> WcII I'ienmit AppLCat ot7t tyu any behalf, i nndctsta�,tlus a tuthca«rir�tsaa`ISNah', f br v=(l Year... <br /> . s ;of this spPlicatann. a . �� - <br /> work plaza dated ora;alta front page <br /> ravt� SITE <br /> ttit72�A2-0U! <br />