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STATE OF CALIFORNIA <br /> DEPARTMENT OF INDUSTRIAL RELATIONS <br /> DIVISION OF OCCUPATIONAL SAFETY AND HEALTH <br /> No: 2010-903260 <br /> Permit Issued To ANNUAL PERMIT <br /> (Insert Contractor/Project Administrator's Name, Address <br /> and Telephone No.) No <br /> Date 1/15/2010 <br /> (Wayne Perry Inc - <br /> 8281 Commonwealth Ave Region 3 <br /> Buena Park CA 90621 -2537 District 1 <br /> Tel. (714) 558-4451 <br /> ( (714)626.0352 `I <br /> Type of Permit Ti-ANNUAL TRENCH/EXCAVATION <br /> Pursuant to Labor Code Sections 6500 and 6502,this Permit is issued to the above-named employer for the projects described below. <br /> State Contractor's License Number 300345 Permit Valid throughj <br /> January 15, 2011 <br /> Description of Project Location Address City and County Antici ated Dates <br /> Startin Com letion <br /> Various <br /> Conditions of Issuance: Statewide <br /> Jan 15,2010 Jan 15; 2011 <br /> This Permit is issued upon the following conditions: <br /> If this Is an annual permit the 1. That the work is performed by the same employer. appropriate District Office shall <br /> PP P <br /> be notified, in writing, of dates and location of job site prior to commencement. <br /> 2. The employer will comply with all occupational safety and health standards or orders applicable to the above <br /> projects, and any other lawful orders of the Division. <br /> 3. That if any unforeseen condition causes deviation from the plans or statements contained in the Permit Application <br /> Form the employer will notify the Division immediately. <br /> 4. Any variation from the specification and assertions of the Permit Application Form or violation of safety orders may <br /> be cause to revoke the permit. <br /> 5. This permit shall be posted at or near each place of employment as provided in 8 CCR 341.4 <br /> Received From Received By <br /> Richard Allen Permit Unit Investigated by <br /> SAf ineDate <br /> ❑ Cash Amount Date <br /> ® Check 24645 Approved by 1/15/2010 <br /> $100.00 1/15/10 District Manager/Permft Unit Date <br />