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r1 - <br />JOB ADDRESS.2 c, t= E NitS+- ar ANS PERMIT SR#: <br />ud taxi ddv s� o abv Cy, eyl uo jlla uald )pom •4Y 0; pat!Wll 91 PUT <br />LICENSED CONTW'" R5 DECL�RAIFI0�1 (LCD) <br />jeaA (4) auo aoj P!I�A al un!;ezuo43ns si4t pusyswapun I {layaq Aw uo ua5n:)ilddd;lwlod IIIM.clur�o� ulnbeo` <br />1 he ` Y�' �l�tdt aommen g it f6 io o viuit�is <br />3 of he Business and Professions Code) a d license -is in u _force and . e <br />�Sgalay (�aplay aaundll'•LS'0) fitly <br />Lice ise #: Expiration Date: <br />Si <br />Prin <br />A'^'3QOA auQuV1 3H1 �O 904; NO1103S NI 1104 a3alAOU <br />� <br />o r�§19.ty' o 1100 30 ZS00 3H1 01 NQl,LIO(Jd NI'('000,0065) <br />SNIY170a C1NVV104103MONnH INC) 01 do S3NIJ 1IA10 CINV S3U-IYN3d-IVNIWILIO 01 M3A01dw3 NV <br />twea sins -ndH5 cmV `-In3MY-jNn 91 a0lflf�AOZ) 01.3d1111Vd :JNINl!4b'M <br />ECLAeRATION"Q ySQ AIeQ <br />-- --�� -suolslnold 9so4t 41!M AIdwoo y11MV01 j <br />1 herbyllg I��it 9�11p�►cA�o•#d►sed�Ik�ad�da�tioa�s�4bl'E��oTu+1P3�yq <br />I t! %941 Aa,6a put 't+u,nigeD So•SMe1 uoltesuadwoo Sja�,om ay► of Ioa(gns awaoaq of se as I$uusw cue <br />_ na��u�b��vr��i�aa�t��,fl�+t�id a!��aar�'�o�r�aror�r� �I�wbd�ti�� Kor �dy <br />ection 3700 of the Labor Code, for the performance of the work for which -this ermit is i sued. <br />6 LZti7/Zg RO :.iagLunN �tollod 5 _ :10!1�a0 <br />have and will maintain workers' compensation insurance, as required by Section 37 of'he Labor Code; <br />fir the performance of the work for which this ermit is issu d. NI wcrkeA"c�-4�` TRH a auLl o <br />c frier ar►�P��lih'Rti�€3? ,s�sK�oM AWd '13oanaS! S, 1!w,a�9141 4�!4M lo; �{3aM aut jo aouew�oyi �3 <br />'apOo 10g91 gt4lO DOLE uolloaS Aq paimbei se lo3ueinsui uo!tesuadwoa S18kJOM 011ulew I11M pu'3 aAgq I <br />Ca rier: <br />n e ' a gsu�dw o s,8 IoM o a�nsul-yl�s o1 tuasuoo}o at3aljlush to ulelulgu.t pIM Put 9A8y 1 <br />1 ert�a�,R�� �er�o�nance o� file v or �o which this permit is issued, I II not employ any person i <br />a iy mannergjg L f -�1�; �i ? p+ t� fit�}1Ei�)®� <br />s ould bec c to he wor ers com' ensation provisions of Section 3700 of the Labor Code, I shat <br />f rthwith comply with those prW64W'V-1DBa NOI-LVSN34WOJ S�1080M <br />Date: MSignatuM.��i :awe pelu�d <br />:e.In;euBlg <br />WARN NG: F _ Ci RrQ Ste( fdA�i� I ERA��P11LA1NFUL,1� �MQ SU� <br />AN EM LOYER TO CRIM11 L PENALT �D CIVIL IVES UP O ONE HUNDREf THOUS R$ <br />(5900, 00.), I .C,?MPE%%1VZW,!MEREST, ATTORNEY'S �' DANr ��� <br />PROVI ED.FOR IN SECTION 370!1 i HE LABOR CODE. <br />t. <br />130,4;;PU2 =011 lIr4 u! s! Mxuso!I ALU Pug WOO auclss;mold pug aseulsnsa ay11a <br />�lgIMO �o DdOL uo!togS yi!M Qulauawwoo) g ja1da4D }c SuoiS!=d ayI Japun paSuaoll wt 11941 wjwg Aqa104 I <br />I, (C-57 lic6nse holder), hereb <br />author zeI,_.1�1 7, �bYr�� ir1g), to sign this Sa <br />Joaquin County Witt P rrnit rpht,23io i, <Cir ►e�(1�:yc " <br />yaur <br />d 5aQQV Cdr <br />and is imited t®tAlv�w1Z Qatof this a <br />90 39md N01N001S 39d <br />bd Wd80:TT OOOE GT 'hpW 2T988299TGT ON Xdd <br />9ITTL9G60Z 5£:TT oglaV6T/90 <br />1.1 rM <br />06, IL -IM: <br />-V <br />