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Oct-04-99 02 = 13 P _ 02 <br /> f <br /> ME ADDPESS:�Ao PERMITS � C <br /> LICENSED CONTRACTORS DECLARA n& <br /> 1 hereby afitrm that I *M licensed under the pmvcsions of Chapter 9 (cornmertcng with S t—.iori 7000 of Divi i <br /> 3 of the Business ana Prafessions Code. and MY rcQnsQ iS in 15411 fofae acrd effect S�Ort <br /> License 0—s21 An, <br /> Ezpirat Date n F, 1'.n i n i <br /> Date Oct. 4 1.999 Cors r�Wester-n trata Environmot tal, Inc. <br /> Signature <br /> WD - COMPENSATION DECLARATION <br /> I her"y afnrm under penalty of penury one of me Eptlamng dem6-nilans, <br /> I ❑ 1 have and win nv ntain a Certif6cate of consent to se0-insure for workers'corrlpensatio . as pruviaed far h <br /> Section 3700 of 7ne Lauar y <br /> Code. for me perfarrtlanct of me warX for wnictl Vtis permit s ssue4 i <br /> Q i have and wfl) maintain workers' =rprPe7S4rjQn insurances as required ay sec ion 370, or the Loci coca. <br /> For the WfOrmance of the work for wMch this penrra is issued. My workers'=neem ion insurance Omer <br /> and pore*/ number aft <br /> ' Carrier Golden Eagle Ins. Corp pa Number <br /> ❑ I CWWY that In tra Qcrkwrante of Qv wont Far which t tis D is :sued, i srraN net ern <br /> i so as to U=Me Subject to Ina walkeyg W (�Y �' rttc to <br /> n+oeasada� of califePnia.ane��rnu i< :t+a a n+e sc�jea to <br /> �+e rrortcefs' compensator Provisions of Section 37 dor " or C .I shst1-' (C=M chose provisions. <br /> Date Applicwr , <br /> WARNING: FAtLURG TO SgCURE VIIORt(�ltg' TION COV G IS u WF <br /> AN>ZMIt.OY>�TO CRllAINAJr P NO S1iALL Su9JECT <br /> > rt�a,agL FINES U!�TO ONE uND THo IQ l,ouaRs <br /> (100,000). ,N ADDITION TO THE COST OF CO An ICON. OaMe►GE PROAM&n F RI SECTION 3706 OF <br /> rHfi LABOR COOS IMT'E'REST,AND ATTO S pEM <br /> 71Z'd �17�'�N 91� nF13 3 `,�N3 r10JWr)d L �Sv=ZT 666/-r ' 170 <br />