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California Home <br />Friday, Janu <br />e e Detail CALLFONIA_ __ <br />R_ ._ <br />@ cation Supplement <br />J#,,%WE &se # 680227 PERM T --gid #—. <br />— DISCLAIMER <br />CSLB license data base. Before <br />A license status check provides information taken from the <br />on this informattiC�EU P �ITOf�IS limitations, <br />.�lD) <br />. CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subl <br />I h reby affmpI*QtdiWf9fl�Lns$s�'rm8 p aint.disclosure will appear below. Click on the lin <br />d��P�'B�r�IRr�i�r 9 (commencing with Section 7000) of Division <br />3 the 8i1dW49 §PL8I�rgffil isf � LB are di <br />. Per B&P 7071.1 _, on y con RAq 6W �da1 fh itsf�rra®vartd f <br />Lic ns&#0,rbitrations are not listed unless the contractor <br />Exfails on Dato iley with the terms of the <br />ar i . <br />Da •Due to workload, there may be relevant information that has no ye <br />--mo d s Eisensg data hasgpntractor: <br />Signature: Extract Date: 01/09/2004 Title: <br />Printed name: * * * Business Information * * * <br />W6Rkggi�W , NL INC <br />PN DECLARATION <br />BREA, CA 92821 <br />1 hereby affirm under penalty of If- =cDi3,6dfWblidwl l:CK ONE) <br />_ 1 have and will maintain a certificate of &�ALniP � 8a rel f�&Mb�rs' comp sation, as provided for <br />by Section 3700 of the Lab6PC�?fdr11A9/�9 ��ice o the work for is permit is issued. <br />_ I have and will maintain workers' comperW9f& his e, as*required by Section 3700 of the Labor Code, <br />for the performance of the work for which this perrgitl is i d �jrr�rppr�W.compensation insurance <br />c�flifikpi�yamle��e. All information a ow <br />Carrier: * * * Classific1qtiIonicy Number: <br />I certify that in the perfo of the work for I shall not employ any person in <br />any manner so as to be e s LIURAtLeBWW&-� f California, and agree that if 1 <br />should become subject t ILIRPQ ATE"isions of Sectio 3700 of the Labor Code, I shall <br />forthwith comply with tho <br />Date: Signature* Certifications * * * <br />Description <br />u��in7_ARDC�IIS SUBSTANCES REMOVAL NLAWFUL, AND SHALL SUBJECT <br />WARNING: FAILURE TO SECUR — "� ry �U <br />AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO OWr; HUNDRED THOUSAND DOLLARS <br />($100,000.), IN ADDITION TO THE COSTX FkC06 i'#11AM11 &JNW&EST, ATTORNEY'S FEES, AND DAMAGES AS <br />PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. <br />BOND: This license files Contractor's. Cash Deposit T1 3331-4 in the an- <br />/ t i � ON FOR OTHEffg4PA, M6'. �NING PERMIT APPLICATION <br />fictive Da e: 0 5 <br />I• n .,.aff tpp{eyofC-57 licensed authorized representative), <br />hereby authorize (print name) '. <br />to sign this�hlDcQgL }L1AJ�i 9N%IJ% 1 : The Responsible Managing Icer ' <br />ONG certified that he//she owns 1D' #4��Q�ay������on is valid for <br />one (1) year and is limited to the wo inn f- a I in in ivldual is not required. <br />p�grpt!�A fAgpl9fi)lhis application. <br />This license has workers compensation insurance <br />STATE COMPENSATION INSURANCE F <br />_�,_ rrr. i .._ rl.a,. •///1A IA /1117 Cvnir <br />