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. `,� <br /> • ayuk founty F-Wil <br /> iJAA t. iA i <br /> JOB AbDRESS: 1' PEJ-r SR#._ <br /> fi <br /> V`5 <br /> .5 <br /> I.. . ......... <br /> Ll I M- 1.1 T I <br /> LCD) <br /> Wtjj�o*jer 9(cornrnenc�with Section 7000)of Divia'on : <br /> emby atfirm that I arnficensed uro�K#�e pray <br /> s <br /> 3 of 6e Busk�*and Professions CW. 11� !els in <br /> futfortearA.-jow <br /> xJ;: <br /> .......... <br /> T_ <br /> License <br /> 0 10&dj1j10v I <br /> Pirin"i Ov_ <br /> 0 <br /> TlC3N. <br /> 0_6 <br /> -j Me I <br /> w <br /> erjury.on <br /> I hereby affirm under penalty ofp <br /> ............ <br /> I have and vA tar <br /> rM <br /> for Ick i�issued. <br /> iq e Work Wh <br /> i ;the L;� a "i: 11 <br /> by Section 3700, t C E—th' <br /> W <br /> enc! r+ maintain viorke `jWWed by Section 3700 of the Labor.Code, <br /> mrkemcompensadon insurance <br /> thit <br /> Pe <br /> *vd po"- <br /> C "W� E.AL_ <br /> I <br /> certifperson in y thatftz,#ve perkir;m of awwo. flot efflow, <br /> pm <br /> laws ofcai anyas to,manner: bd60t00:sub*tW_j 9 ,ate°agree that if t <br /> I shalt <br /> 1--�tat Cp-!;1e <br /> p <br /> shou.Wpbecorift:. Ao t!6n' <br /> A- <br /> 1fortl t Mrnpty with thosa, siorWi,:­ <br /> :47 <br /> j E)q)lratlon Date: { D ! O __S,gtture• ) <br /> Pdr1w:Mil <br /> a4­ <br /> M.. <br /> WARNING;FAILURE TO SEC Rti;M,',:C <br /> _10A LAWFUL HALL SUBJECT <br /> AN EM00YER TO CRIMNAL.rk"ALIft C IV I L�F I M S UFF!TW-I bl w 0'!`,-Ht w0$WD TMIAAMLARS <br /> DOL <br /> ($100,001k.)i IN AMMON tO THE CAST '111llt ONNEYS FEES AND DAMAGESAS <br /> NiA.­1:.7EREST,A�ft <br /> PROVIDEt) <br /> M t,� <br /> 0711 <br /> -". TION FOR 1ZA , <br /> • <br /> hereby atAhadrw(print nanri6) <br /> to sign On Joaquin Cotwvty Well Permit Appficaoqn 6 urkdoo#"....#9 auMorbmt1o"L ft <br /> ift' valid W <br /> If I <br /> jw. <br /> ()ne(1)Yll!�Afand.ls limited to the work ptan dated 9 W. of this--as appl: ET <br /> WJ NU <br /> M <br />