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Gregg Drilling & Testing, Inc. ; 925 313 0302; Dec-13-99 10:58; Page 2 <br /> SENT $Y:9163622316-Sacra. , 102-13-99 9:08M :RADIAN INTERNATI119 825 313 030216 2/ 2 <br /> 12-10-1999 12,95PM FitCM P. 3 <br /> or(q n airnElt icon "' �Ndces,--- I�r IOafWh'9LPPNinan! <br /> JOB A9mRm*. <br /> . r <br /> LICENSED CONTRACTORS DECLARATION ILCD) <br /> I herby SMM blot I am licensed under the pro,WOM of Chapter 9 (epmman ing with Sather 7000)vi DiVIOW <br /> 3 of the Suelnsw and Frotessions Coot and my downs Is In full fora and dicot. /mn <br /> Licanset. FximoonDee�la J 1 !vy <br /> DW. J S Con//kador.��"reTeC aG[tyn <br /> stpnature; u�'r�Zo/ Tkla7�/ah r OC�Lr� <br /> Pdowd names <br /> WORKERS'C UMSATION DECLARATION <br /> I he noW sffim under penally of par" one of the bbmin9 deciamtlons: (CHECK ALL THAT APPLY) <br /> I have and WIN nv lnt*m a carfiks a of consent to seNanwus for worlan'canpardwi ion, as provided for by <br /> Section 3700 of the Labor Code.for Ihs perbrmmoe of the work for with thle permit is Issued. <br /> I hove and win maintain wot' OV cantpsnastlon ineurame,as regL*od by 9ecion 3700 efthe Labor Code, <br /> fpr tale pergrmanw orttr,root br ankh Ihls permit k Mwwd. My vrorkara'Compenaetivn Ireunnoe <br /> a urier End policy numbers we: �j // <br /> Carrier: (f L,}1 _ co'niP Poi"Number. �gq�fi&� <br /> _1 Crab* that in the pwfnrmenaa of"+wrk for which"o panne Is Iswrad. I&,all rat emPloy IM Perron in <br /> any meaner so as to become subject to the woArra,oampenaadw laws of Caalomaa,and apse that N i <br /> should b wirne aub)mp,to the workers'oompensNion prowsiOm of Section 1700 of the Labor coda,I shat <br /> brt w,.ith c/omw with those prlavl lona, <br /> Dade I -./g q Ofpwelre: "I`^ <br /> Printed Nanw: c1'' <br /> WARNING:FAILURE TO SCOUPA WORraRS'cOASalNSATIOR COVERAGE K UNLAWFUL.AND!MALL SUDJECT <br /> AN WAPLOYlR TO CRIMINAL PaNALTize AND CIVIL POW UP TO ONE HUNDRED THOUSAND DOLLARS <br /> pios.ebo.h IN ADDnwk To THE COST OF COa1POUTION,INTUEST,ATTORNEYS FEES,AND DAMAOlS AS <br /> PRwIDED FOR 1N SCCI N]Tei Of LTHE tAaat cool <br /> [, C�,� -�JJ�-:.�L�_ �r�j�F/'�u/�! hear ore«red aullwremd raansenravrb nasty <br /> eD aqn Ohio Sen Joaquin Coaxy Well Peweh Appdm&an on my behiO. I unmmeand this authorhreon is vend far <br /> ane 1 ver and is 1anMaa to tM week tssa dapdan the nem Dopa as baa appaoaewl -- <br />