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12:110/99 16:47 FAX /*. Q02 <br /> 289-5795 MU ESTQ RTC PAGE 03 <br /> '' ', i Am FRK7M <br /> � QE P;�l 2: 1 1 <br /> an 38aq trMetmemat ' Gervieft. L*W N WON Pwmwe Appftaaw=w nt T; <br /> JOR ADORE$e: .,1,17 Audrw�p,�_ I� PgRMIT sft 00 22,1 <br /> UCENSED CONTRACTOR DECLARATION 1 &Q} <br /> 111ereby S*m that 18M iioMUW W1dtr VW VWitiam of ill der 0(GoMmengin9 wish 8aatlon 7000)of EW'Slen <br /> ! 3 of tats f)11Meas Wd Prof worwo Cade and my Hann iva loroe and e(hcL <br /> rWle: <br /> f i)IIIAs: I IJA Azg2CQ now <br /> • ' ZfiiMladlTa' Tmw T� <br /> � FirinMd rlarite: a <br /> WORK%RW"MPRH" IOM DECLMAMON <br /> i 1 hereby a1Mn under penalty of penury one of the loftwino daetarelionA: (CKECK ALL TMT&"LY) <br /> I hew and w!N mairmal"a a.smofloaia of ommmet fo 6994"for walkers'eempens Sun, as primkiod tar dy i <br /> 8ecbm 3700 Of*4 Labor Cade,toe qw pt txmnos cf the wait low w"Ch V"perm is i"U" <br /> I haYa aRCI will maintain worlctra'compensatlen lrtlirarwo,so requV"1W SoMn 3700 of the Labor Colts. <br /> Sor"PWWMsnee o4 flit work tar which thls ptrMN Is ISGUM. lAy workers'earnper,sMion insurance <br /> {gib"W 40d Poft n1.911t mare: <br /> t <br /> carrier. &116LAlurebor: -ri_YgS.!l - ._..._...,... <br /> � ,,.�oaFNN fret M Itrs p•elblrnanae eyF the woAc ter wTiialr fhb penrtlt b hewed.f ltinas npt er'Ivpby arty perwr+in <br /> aN manner•o as tQ beams sW WO werltara'WrrWftfaW laws of Calibrnin.and alpmo that If I <br /> lhOtrid baaerns subject to the vra*Wt WM00nration prmlalcns of SwW 37dp*I pts Labor Coria,I shlok <br /> ktmmAth comply W h Ahmm prlCnrisimm <br /> Dow IA *.: 7 " <br /> I f�INap Nllgte <br /> w,wrINM1M4!PWLUM 10"CUM WCMIIVA,,C0hpftMTl lj CCAVlliAW Id%WtAWFUL,AND s14ALL five iter <br /> A"UV LOYEIi T4 N MAL Pmma nap AM CrV 16 t't%flft u*To OM tilN VM0 7m&~100 t QLL AR* <br /> ADFCMO Tfp OF Wale COQl.CK 1f MEST,AWORNEV-d PUB.AMPCAMAGS$AS <br /> I <br /> -97 VGWWW sutherhod repre!lntetk*): heft" <br /> auther}a. <br /> rw sigh ifs ft"J"9149%c4Kw t►tn�il M►swwrt Ap"C"ert on my blAtrF. r VIK%mland No auttttria"an is walW for s <br /> i a"llJZM 8"b linthad In the*umrk w faftd on Wo trot atl!! Uon. - - <br />