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JOB ADDRESS: PERMIT #: <br />I Xe_re4y,2YirAk tX,2t I 2xK licexsef uxiter tke Xrtvis4xs if CX.2Xtp-r 9 (c*mAkev#�Ag wift Secti*A THifl,if 1ivisi+A 3 *f tXe RUSiXeSS 29T, <br />Professions Code and my license is in full force and effect. <br />�- - �,, I M <br />A r <br />TUNM= <br />121#1LIA liellftol 1611 go Mm (01W11011 so] 0 <br />1111110, W -Mm 011ronm TIT-WRTMO <br />I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy <br />thereof (Section 3800, Labor Code). <br />M== <br />■Certified copy is hereby furnished <br />YJ rot <br />become subject to the Workers' Compensation Laws of California. <br />0= <br />1610MR11 Ift"Wel <br />Civil Code). <br />.- <br />a * 0 0 1 #10411&201:39 ill 111RUM I r_", *I-" Zia <br />13 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in <br />connection with work authorized by the permit, and that no building structure, scaffolding, falsework, or demolition or dismantling <br />thereof, will be more than thirty-six (36) feet high. (Chapter 3.2, Group 2, Article 2, Section 341, Title 8, California Administrative <br />Code). <br />13 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted <br />above, unless such person has a permit to do such work from the division. <br />county to enter upon the above-mentioned property for inspection purposes. <br />=R7 <br />EHD 43-02-007 LICENSED CONTRACTORS DECLARATION 7-15-08 <br />7-15-08 <br />