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09/19/2001 09:48 7073745677 WOODWARD DRIL_LIh-G CO y F .GE � <br /> 010DES70 ATC <br /> dart ,lttquart iauPt$,l rtvirdnvrlec#ril l rsa[th�o tt,a�e, U9 it T* tr+l�611 Pen"ft~Application Sarpplemont <br /> .10ACiDRll ~ s. .- W6 PERMIT $R#, DOZ? 2 7 <br /> ! <br /> LICENSED CONTP.ACTORS D LARATIONLQ ) <br /> � <br /> I haegby astfirm thmt t arra liceriSed under lire };rdvisionS-odf Chapter g {commencing vWth Section 7()00} of Divig1fon ' <br /> 3 of th-e Business€ and Profeeslons Code and my Iicenve Is in full force and effect. <br /> Lloenst <br /> twe: '"1 *�.... .__ Contractor. � ! .._�..� _... <br /> a <br /> WORKERS' COMPENSATION DE CLARATION <br /> I hvr&,,; .dfain under penalty of perjuryotic or the folfcwIng declarallons: (CHECK ALL THAT APPLY) <br /> 1 h as n and Wilmaintain a oertifir,.ate of eorisimI to seif-iilsUrs for worker s'craWenaafion, as providied,lebr by <br /> Sah- <br /> -Ion V00 CO the Lgbor Code, for fbe pertwmance of the work for which tNs pe'tmet is issued. <br /> I ,lave and will rflaintain workers'exmp�ensalion insurance, as fequired by Sectloj� 3700 of the Labor Cade, <br /> for ship pefttmasnt�e df the wc?rk for which lhfs pe emit is fssuitd. My w,orkem' ot3nipefiination irtmo ance i <br /> rriesr and partcy nurmbe m."ire: <br /> Policy Number: <br /> µ t 4•erY tyr that fn ,net pofurmance of thte work €or;Mhwn this partnit is f ueSJ, i d`Itlt net wrtptoy$fly person in <br /> arty T318ryi1+far 9c+ s 41;b000rna %jbject to Lho wor'kerW c",pengatlon laws of lEfcftrtisxf rid .*tat if! 1 <br /> slould baecon-io to 111t proA,,�na of Sfttfan 3101 of the Labor Code, t sh€llt � <br /> kjett,wi►.t':campiy with those pccvis tons. { <br /> Clete: ,1"1 -^" � ._ St�r�e#ut`e: t <br /> l <br /> Printed Narrit: <br /> r <br /> I trVARl+lINC: ✓j,%JLURF-TO $E-CURE vtdC3RKIERV COMPENSATION CO'+ RAGE iS UNLAV4FUL,AND S 14A,LL SUBJECT t <br /> AN LIMP LOVEOZ TO MMiNAL FE-NALTiES ANC CIVIL t=INEcS UP To o?J1~ Nf1Ns7RED TFttitJ$r xt1 o0LLAR5 r <br /> i ESl0t),�-N0.), slat ADLOLO 3 ON TCD THE COS;Or- t;OMPENSATtON,iNTERr--.ST,A.-ITTORN Y`$ PEAS, AND DAMAGES AS II <br /> PROVIM) F014 IN 39CTI N+t 3708 OF-;�fE oaor%CODE, <br /> .67 ifcivaand a1t1h0t'> d P'ep1��er12tiV6}, hereb <br /> tel Sign thiS Siffn .r48garlr4 (.",oLitt ty W01 A9rrw,it Appllcatkoi gn my baWf- 1 �rtid�r�tanrl.it4« #�kks.rlr�yux+ ;+s vain?far <br /> 1 <br /> coo{t}y"r osis fit Ornitad to tho A,**pli". ftlatl v-n the Iront pzge. of thfe 50p0c&tJG— <br />