Laserfiche WebLink
='Cbl *r-= NTIER DRILLINGFAX N0 . 209 559 0211 Jul . 05 1999 09 : 14AM P1 <br /> A <br /> 1F , GXO P N1` 5 S '_ RL GP , 2955274g10 .15t. en az <br /> CrE- ED <br /> J U L U 7 1999 <br /> r nntl,RC ! MENTAL HEALTH <br /> 3 c , t8rt _ r nn PERMIT / SERVICES;' <br /> JOBADDRESS : 745 E . (Onar � e : tiay , St ) cktoniCa PERM(T#; <br /> i <br /> I LICENSED CONTRACTORS DECLARATION <br /> ( I hereby & fire that I am No2ased uroar Ste pr�ision8 of C::",apter 9 (cc m2ncinq with Section 70rG of D0. istot j <br /> 3 ohne Btisiness and Professions Goo? . and my licenses in ruli force and a cut. <br /> License # � cxpirationDat6 4� <br /> oete 04 <br /> i Sinnatura I <br /> ERS' CO PENSATION DECLARATION <br /> I ngteny affirm under penaay of peruR• onv of the fCPG•r:1'iy deClarattdns <br /> i <br /> s kava and w iI meintain a ce lificate of consent to sal`-insure for vnorksrs c❑mpecsvtion, as Prodiesd yr my i <br /> Section 3700 of Ue Lecor Coca, for the permor of tc work K%r ',vNiCh IIS . ermit is issuaa. <br /> I have and will -mairtain worxers' compensation ;nsurance, as req•_ired t>y Section `s7G0 of fne Labor Cpce.for the performance cf the •.vork for which this permit is iMedp,F,r workers compensation insurance carrier <br /> 2roo poiScy number are: <br /> C:an•la; .s. .r�'4- ✓ Pcl cy NLnVXr " 7 T i. <br /> 1 •mortify that in the performance o`: ;he work `cr ,which this perr^Jt is issued, 1 shell not empioy any person in <br /> any man:-rer so as to became SUble'� to 4*.6 Wor<c S A^ . nsa,on laws ct Ca;lfo;nia, and agree that i° 1 <br /> should becom? subject to the wor'rers Compensation provisions of Section 3700 of tra LaLwr Cede. I shh <br /> ail <br /> fotthwith comply with those prr, rision5 <br /> ❑etc ,_ 7 _ ,� _ � C�" signature: --- <br /> WARNING: fPJLUh'E TO SECURE wOFk5R5' COMPENSATION I:OVc GE 18 UN UL AND SHALL SUBJECT <br /> AN EMPLOYER To CRjhjlNALPENALTIES AND CNIL FINES UPTO ONE NUNpRED HFC;R I NO tlOLLARS <br /> (700;000), IN ADDITION TO THE COST OF COMPENSATIOR. PAmAGE3 A9 PROVIDED F4R IN $ECTION 3706 OF <br /> THE LABOR Cofl2, INTEREST, AND ATTORNEYS PEES- <br />