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r <br /> See By: Gregg Drilling & Testing, Inc.; 925 313 0302; Nov-18-99 11 :23; Page 1/2 <br /> ,3+ ilks/aa THU 10:32 FAX 310 11a, 6 CHYY BILL X002 <br /> ll-QS-1999 1 1 :A2AM MOM � P.6 <br /> r i <br /> t i <br /> f <br /> aatt i I Coua V dnrkemrrarr4il(with Unit IV kNas FrN AppllaMtlbft ark <br /> JOB ADDMo"- Fi[Pafvf PERMIT SRith <br /> LICENSED CONTRACTORS DECLARATION {� <br /> I haraby anYnr dart 1 am naaraald WNW Mia proApbf a of Chapbr i(oWmain"With Sedan 7000)Of Wallin <br /> S of tha®uehlas arta PrOfaaabns Code and my Hoar"It In AIt Tame and eNxL <br /> Llmu m ( % 4D? _ Date: 10131- 2ao0 <br /> Dae: III lg!i l;plpaCklr <br /> agnswm: l��/t dL _ TWO-le. . u..i <br /> Prkmd name• N LZ AwS <br /> � eA <br /> YYORKERSeommNsATpN DECLARATION <br /> 1 tNraby Blinn under pamlb of ps"One a Or WWAdnO doeWatbns: (OWCt(ALL THAT APPLY) <br /> —I hwe arld WU wmWAWn a cipf"opla or conasiglo soUnsum for workwW—,w-- 11' mpmwkladfwby <br /> Seokn$700 Labor parNnnsnm w"for vAdah I wood, <br /> �l!nava end wiN r1naYlMin WOfkam'mrnparlMMen Nlsraaflaa.ag 1agWmd by tisoMan 3700 of ria Lana Code, <br /> arm.pa/dnMnoe a Mle work tot wt11d1 MNs prrNt a awed, My waken'congw Wm kwuralw <br /> canar and palmy rwmtkm Era: <br /> Carrier:,�A't- ��•+"�� Penny Nrn6e�_.IL 44 (l n Age 4_ <br /> _I gw*plat to tin;PO11ornualoe of 1M work for whkh tha pwm4 k issued,I shall not smpby any person M <br /> any nrrrww so ae to classing WAjed to Mra wodrare'om .Aden win of Caw wrda.and a"W*if 1 <br /> wwlas neoome albjW to Mh wOdWW ownpanswn pmvwft of LOW Gode,l Shan <br /> f re wish amply%vm lhoea 0mvislow1�--- <br /> Datr III I�slrrismm=_ - <br /> PAnbgdmaane:_j�1ThPtAl,JA — <br /> rYAaallo:fA"MToSECUNM1nCFjCB 'Coppg3a M=Covgw"9aUMAVARX.ANDSHOA.LSUDJWr <br /> AM MVL0Y0t To CWMWL pgMALWW AND CIVIL pWo uP ToCoo WAIM eD THottsAM DOLLARS <br /> Pplt IN OF <br /> DOMOM 1n*THR 3701 0"O MOOR TWK'ATEREFr,ATYOMEY'C FMe.AND DAMAOM AS <br /> 9"OVAIM11- <br /> 1. a ft"w"mmmwt ed'!P ler herow <br /> ac.: Pit �`1Ir1C'P.E� b Ct�7.fY14i it <br /> a elan MMg Sen Joaquin CoW10r ME FMnURAPPROMaon ee Ply Grp• 1 rarderagnA tl+is eua�enhellon V wind for <br /> serer rand ro NmNed work en ew e► w <br />