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L <br />JOB ADDRESS:- I CtSvn N1 Clv'` PERMIT- SR#: <br />LICENSED CONTI pZ' C� `t;�° A"�R��Rl1e�� �.��(3olp"Iuj!I1lpue <br />jH;3A (L) nuo JO) pllenA 91 u0pc2IJ0Lf nr S!gt pueis-►apun 1 11ggaq Aw uo u01192l!ddy 1!!J8d 15M Alunoo ulnbvor <br />1 c � Iri �![ta►�ote �s �#�iaytaian <br />3 of he u mess and Pro essio s Code) an m cense �s 1n fuTio ce <br />dge�ay'(�eplog a�uaoil !q-0) C.�.V2rtr't2,(7� �'-+tVy1"� � j�-� <br />Lice se #: Expiration Date <br />3400 2i0Ab�f 3HJ, d0 90CF N011�36 NI bOd 03C AMId <br />Date r§8lartl '1s;21a.,,.—ti'.!-•"'nj 1f sma ;tin? san aN i Cf � NO!1!QC1d NI_�( 000'00 5) <br />Sign t Sd'OO1Oq ONYSPOH.l 03b0NnH 3N0 01, do 33NIJ 11^10 CNV S31JIVN9d IVNIW180 Ol �0AO IdW3 Nb' <br />Jnr-aps jaxWs nNy '-jn4my7jN(l S! JZ)VJ3A00 N0117SN347M ,stiJMOrA 3LlnD3s o.l 32An-uvJ :0N{Nbivm <br />Print d me. :awtN paluu,d <br />WO M02N C.jrA1 ON <br />'Suvis=ld 99041 yllrn �SldwnQ ytiMyJv1 <br />I her byll it j 'apo �c�'qe '7 1���e0r��'�'i�? &ti AHPQtAf4PYiQ45 <br />u9 'eiuJavjeo }d SM91 uvIsSu9dw0�1 S1a7 )OM agl of ,oafgns auuoQaq of sa os lauupul rtus <br />_ I avel�n blI1�yt�i�>s]�� b1Qdp�l�as�rlagtacaoaatdD�41�51�� foY <br />ec�ionoiuttu of the Labor Code, for the performance of the work for which this permit is issued. <br />t L n :aagwnN A�llnd /+fit �al��ea <br />I ave and will rn rf � ai � rker ' compensation insurance, as required by Section 3700 he Labor Code, <br />f r the performance of the work for which this permit is issued. IJP al'c 1� Aff" <br />c rrier an�lop�jl4 unuolllaeu9 to ,saa�I�aM AW 'panssl s! l Wjgd s14t gQworkersi4M sof �JQrn 8 10 aoueW�o� aVt X01 <br />'apoa aoge l �y1.10 OOL£ uol}oaS �q pa�lniaaa ga 'a�uainsui ualte%uadwoo ,SlaVOm uialulew MAX Pua A^s4 17( <br />Ca rier. Polis Number- <br />'pan5si s11iu1ja 8141 y ! 4114 a�ou9u�loypd <br />I er iCty�4 > f�pi >> ri 4 H '�Q?h a ' FR^f8� VrLi l �as plelumStuisais�s ed W shaP(I not employ any person in <br />a y manner so as to becomeub ec tr� tgh���'��j�d��i'i�df9lilr�ld�ur14�!�� <br />s ould becdr4a� '�j��th� � ��P compensation provisions of Sectio" 3700 of the Labor Code, I shall <br />fo Lhv✓ith comply with those proNiS'ip ��fa3Q NOUVSN3dW00 ,SN3MOM <br />Date: <br />:aweu pi;ulaj <br />;qln;vub1S <br />WARN] 'G: F i RAG(BI>A'#AMLAVVFUL, AMDUS <br />AN EM. LOYER TO CRIMIN P 'ALTIES AN r'IL FINE UP TO ONE HUNDRED THOUSAND DOLLARS <br />(S100,0 D:), I J - %Sa-uatc ORNEY'S F ELS !WSSAM„dlt�10?l§ <br />PROVI ED FOR IN SECTION 3 0 0 i LABOR CODE. <br />paKa Pu Et aojo� 11n; ul sl asuaoli Au pull Oapa0 sual99a;o1d put ssaulsng 9(4110 C <br />uolsinla 10 OOOL U01paS 4�! dulouvwulao) 6 Js;de40 ,o sualslAoid 4411&pun p4gsuaog we I;By; uliL4e Rgaae4 I <br />(C-57 license holder), hereb <br />a uthori <br />.f,, <br />Joaqui <br />and is -a <br />County Wel6Rexzrp .� [V'2-�o_p <br />nited t ® I ate <br />C0 39dd <br />Ed WdZO:TT OOOE ST 'FPW <br />NOlN00iS 39d BTTTL9b60L 96:iT 900L/6t/50 <br />ET988299TiST : 'ON Xdd ;PwzeH ;SDM : WOH-d <br />