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9-22-1999 11:01Pt`t FROM <br />0797 <br />N I <br />1S I n <br />W ID <br />PERMIT#: X4� 6< <br />W_ <br />JOB ADD 7ESl <br />LICENSED CORACl� LARATION <br />I hereby affir that I am licensed under the pro ' f Ch r 9 (comimencing with Section 7000 of Division <br />3 of the Busi iess and Professions Code,��n my ticens 11 and effect <br />License g <br />E� p� ion <br />Date 3 I3 �r on ctor <br />Signature <br />W04 R COMPENSI� lON q�>✓1�RATlON <br />Cn <br />I hereby affirn under penalty of prj a of the follow, czla�tiof� <br />M. <br />I have anc will maintain a certic�e o consen o; rtsu workers' coip�ns�ji , . �;provided by <br />ection 3 00 of the Labor Codef!'fof a pe ncc tqf the for ®_t ed <br />I have an will maintain worker co pen " cn insur°ahtce. ss r b edfion N00 f t bor Cod <br />for the pe ormance of the war f4 hi is permit is 1 5u _ r4cer5' cbmoens n s a e c ier <br />and polis number are: <br />Carner icy Number <br />0 1 certi5/ th t in the perforrpance worts for which This fpeir.-k is ssued. I oy any�e n rt any mann <br />�so as to b come subject to the o rs' compensation la s i omia, a agree th t 1 shout b orae subject to <br />the workers' compensation pr isi d#�Section 3700 0 e �_sbo Code. I N mply it those arovisions� <br />Date APPlicanf <br />l c <br />WARNING: F ILURE TO SEC ORKERS' COMF(E T N OVERAG'c IS UN FUS. HALL SUBJECT <br />AN EMPLOY':R TO CRIMINA P�N LTIES AND CME FI ES -UP TO ONE HUNDRED O "N OLLARS <br />THE LABOR ODE ADDITION NTERES NDO-t WE)f S frRt?tftf) 1=�7R " CTION 3706 OF <br />�OF-OF <br />,-------- -- <br />FILBERT STREET <br />Shell -branded Service Station © Site Plan/Proposed Boring <br />2494 East Fremont Street Location Map <br />Stockton, California <br />CAMBRIA <br />